Ribeiro A F, Neto I S, Maia I, Dias C
Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Department of Anesthesiology, Centro Hospitalar de São João, Porto, Portugal.
Rev Esp Anestesiol Reanim (Engl Ed). 2018 Aug-Sep;65(7):398-402. doi: 10.1016/j.redar.2018.01.009. Epub 2018 Apr 19.
Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role. We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized.
中心静脉导管在重症患者中广泛使用；然而，它们也与发病率和死亡率的增加有关。文献可能低估了导管诱导的无症状但可能危及生命的右心房血栓的发生率。其形成的公认危险因素包括与导管相关的感染、某些药物和输注液引起的机械和化学损伤继发的内皮损伤。患者和导管的特征，如尺寸、材料、类型、位置和插入的难易程度，以及放置时间也起到了额外的作用。我们报告了一例38岁男性的病例，该患者在置入中心静脉导管35天后，出现了无症状的导管诱导右心房血栓，需要进行心脏直视手术。本病例突出了在进行正确快速诊断方面存在的局限性，对于有多种血栓形成危险因素的患者应予以预见。鉴于可用的建议有限，我们认为最合适的策略应该是个体化的。
