Catheter Related Septic Central Venous Thrombosis of the Superior Vena Cava and Right Atrium

Česká verze

Authors: Miroslav Bambuch; Jiří Latta
Authors place of work: Interní klinika Krajské nemocnice T. Bati, a. s., Zlín, přednosta prim. MUDr. Jiří Latta
Published in the journal: Vnitř Lék 2014; 60(2): 171-176
Category: Kazuistika

Summary

Catheter related septic central venous thrombosis (CR-SCVT) is an uncommon but serious complication related to central venous catheter use. Prolonged sepsis, late detection of the right diagnosis, difficult, long and costly treatment (and its own complications) threaten patients with further, potentially lethal complications. By the patients with an evidence of catheter sepsis, which persists despite targeted antibiotic therapy, it is important to think of this possible complication. Diagnosis can be determined by a combination of clinical, laboratory, microbiological and imaging techniques, from which is transesophageal echocardiography the most useful diagnostic test. Treatment of CR-SCVT consists of long-term targeted antibiotic therapy, the role of anticoagulation is not clearly solved. The article presents case studies of four patients diagnosed and treated in our clinic for infected thrombus in the superior vena cava and right atrium in relation with a central venous catheter. It also compares our diagnostic and therapeutic strategies with the similar cases described in literature.

Key words:
catheter related sepsis – catheter thrombosis – central venous catheter – septic thrombosis

Zdroje

1. Nightingale CE, Norman A, Cunningham D et al. A prospective analysis of 949 long-term central venous access catheters for ambulatory chemotherapy in patients with gastrointestinal malignancy. Eur J Cancer 1997; 33(3): 398–403.

2. Arnow PM, Quimosing EM, Beach M. Consequences of intravascular catheter sepsis. Clin Infect Dis 1993; 16(6): 778–784.

3. Timsit JF, Farkas JC, Boyer JM et al. Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998; 114(1): 207–213.

4. Abad CL, Safdar N. Catheter-related Bloodstream Infections. Infect Dis Spec Ed 2011; 14(9): 84–98.

5. Rooden CJ, Tesselaar MET, Osanto S et al. Deep vein thrombosis associated with central venous catheters – a review. J Thromb Haemost 2005; 3(11): 2409–2419.

6. Gressianu MT, Dhruva VN, Arora RR et al. Massive septic thrombus formation on a superior vena cava indwelling catheter following Torulopsis (Candida) glabrata fungemia. Intensive Care Med 2002; 28(3): 379–380.

7. Majdák P, Kubík J Jr, Harmátová L. Prípad vlajúceho infikovaného trombu v. jugularis interna, septických pneumónií a heparínom indukovanej trombocytopénie. Vnitř Lék 2011; 57(1): 117–121.

8. Kaufman J, Demas C, Stark K et al. Catheter-related septic central venous thrombosis-current therapeutic options. West J Med 1986; 145(2): 200–203.

9. Bulas J, Murín J, Kiňová S et al. Vlajúci trombus v pravej predsieni ako komplikácia po kanylách centrálnej žily. Cardiol 2002; 11(2): 116–119.

10. Mermel LA, Allon M, Bouza E et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49(1): 1–45.

11. Raad II, Luna M, Khalil SA et al. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994; 271(13): 1014–1016.

12. Volkow P, Cornejo-Juárez P, Arizpe-Bravo AB et al. Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials. Thromb J 2005; 3: 11. Dostupné z DOI: <http://doi: 10.1186/1477–9560–3-11>.

13. van Rooden CJ, Schippers EF, Barge RM et al. Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study. J Clin Oncol 2005; 23(12): 2655–2660.

14. Bouffandeau B, Jabrani K, Trojette F et al. Usefulness of transesophageal echocardiography to detect Staphylococcus aureus infected superior vena cava thrombosis. Intensive Care Med 1999; 25(11): 1331–1332.

15. Kniemeyer HW, Grabitz K, Buhl H et al. Surgical treatment of septic deep venous thrombosis. Surgery 1995; 118(1): 49–53.

16. Frank DA, Meuse J, Hirsch D et al. The treatment and outcome of cancer patients with thromboses on central venous catheters. J Thromb Thrombolysis 2000; 10(3): 271–275.