RIGHT ATRIAL THROMBI ARE RELATED TO INDWELLING CENTRAL VENOUS CATHETER POSITION - INSIGHTS INTO TIME-COURSE AND POSSIBLE MECHANISM OF FORMATION

We studied the effect of central line catheters on thrombus formation in the right atrium (RA), including the incidence and echocardiographi c characteristics of the catheter-associated thrombus as well as possi ble clinical implications in patients. We prospectively studied 55 pat ients by transesophageal echocardiography within 1 week after Hickman catheter implantation and on a follow-up study at 6 to 8 weeks, We suc ceeded in imaging the catheter tip in 48 of the 55 patients (87%). In the baseline study 13 had the tip placed in the RA, eight at the super ior vena cava-atrium junction, and 27 in the superior vena cava. An ab normal mass, consistent with a thrombus, was found in 12.5% of the pat ients, all of which were seen within the 13-patient (46%) group with t he Hickman catheter tip placed in the RA. Hickman catheter insertion i s associated with high incidence (12.5%) of early formation of RA thro mbus, The formation of these thrombi is asymptomatic and highly associ ated (p < 0.001) with the catheter tip position in the RA, in contrast to their positioning in the superior vena cava or in its junction wit h the right atrium. On the basis of these findings, we recommend that special attention and effort be given to placing of the catheter tip i n the superior vena cava and avoiding the RA during the implantation p rocedure.