Importance of central venous catheter tip location
Extract:
“A 31-year-old female patient was diagnosed with triple negative breast cancer, for which carboplatin and paclitaxel were administered through a port. At the time of port placement, neither fluoroscopic guidance, nor postoperative radiography had been possible because of pregnancy. Several months later, routine echocardiography revealed a right ventricular (RV) mass that was further characterized by transesophageal echocardiography. This confirmed the presence of a thrombus (11 × 12 mm) adjacent to the RV free wall, just below the posterior leaflet of the tricuspid valve and showed proximity to the indwelling catheter into the RV (Panels A and B and see Supplementary data online, Video S1). There was no concomitant right-to-left shunt. The diagnosis of catheter-related right ventricular thrombus was made, systemic anticoagulation was initiated and the port was removed. Additional CT pulmonary angiography excluded pulmonary embolism.
Although catheter-related right atrial thrombus (CRAT) is a known complication of central venous catheter misplacement, this is the first report of RV thrombus. The most likely driver of thrombus formation is ventricular wall injury due to mechanical (catheter tip movement) and chemical (chemotherapy infusion) endothelial damage. We based our therapeutic approach on the available CRAT-literature, in which therapeutic anticoagulation and timely catheter removal are cornerstones. The need for surgical intervention is based on individual risk assessment, though previous studies failed to show mortality benefit compared with systemic anticoagulation.”
Reference:
Zwaenepoel B, Casteur L, Dujardin K. Image focus: central venous catheter tip location does matter. Eur Heart J Cardiovasc Imaging. 2022 Dec 5:jeac225. doi: 10.1093/ehjci/jeac225. Epub ahead of print. PMID: 36464838.