Incidence of Catheter-Associated Right Atrial Thrombus Detected by
Transthoracic Echocardiogram
Abstract
Introduction: The development of right atrial (RA) thrombus (RAT) is a
known complication of central venous catheter insertion (CVC). Deeper
insertion of CVC within the RA may increase the risk for RAT development
versus those placed at the superior vena cava (SVC)-RA junction. We
sought to evaluate the incidence of catheter-associated RAT as detected
by transthoracic echocardiograms (TTEs), characterize thrombi though
multimodal imaging, and evaluate thrombi management with follow-up
imaging. Methods: A retrospective analysis was conducted of consecutive
TTEs from our institution between October 1, 2018, and January 1, 2020
in which a venous catheter was visualized in the RA. Studies were
reviewed in detail to determine presence of suspected RAT. Demographic
data, comorbidities, laboratory values, characteristics of the catheter
and the thrombus, subsequent imaging and management, and outcomes were
collected. Results: A total of 364 TTEs were performed in 290 patients
with a venous catheter visualized in the RA. Of these 290 patients, 15
had an imaging suspicion for RAT yielding an incidence of 5.2%.
Management strategies included anticoagulation in 13 (86.7%) patients
and catheter removal in 11 (73.3%) patients. At eight months follow-up,
11 (73.3%) patients had resolution of RAT based on subsequent imaging.
Conclusion: In patients with deeply placed CVC catheters, the incidental
detection of RAT by TTE was not trivial. Anticoagulation and catheter
removal and replacement, if deemed safe, were effective methods of
thrombus management. RAT as a complication of CVCs must be accounted for
when addressing factors that influence depth of CVC insertion.