Case With Right Atrial Thrombus Related To Central Catheter

Twenty-eight years old woman admitted with duodenal ulcer perforation and undergone a laparotomy where primary suture and omentoplasty was performed. A central venous catheter was inserted from the right jugular vein for TPN. During follow up, intraabdominal abscesses were drained under CT guidance. Extended spectrum antibiotics were prescribed but severe sepsis could not be prevented. She was transferred to the ICU on the fifty-first day post-op. The CVP catheter was removed on the forty-eighth day of insertion. Culture of the catheter tip was positive for E. coli and Acinetobacter spp. No improvement of the clinical status was observed and thorax CT revealed a trombus lying from the right jugular vein into the right atrium. Thoracotomy was performed for thrombectomy, and activated protein C (APC) was added to the treatment. After forty-eight hours the patient recovered from septic shock and was transferred to the ward. Although routine change of CVP catheters is not recommended by guidelines unless a catheter related infection or a systemic infection without any obvious source is present, this case report demonstrates that catheter related infections can be stealthy, and an identified source of infection (abdominal in this report) should not rule out the possibility of catheter infection.