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LETTER TO EDITOR
Year : 2013  |  Volume : 23  |  Issue : 5  |  Page : 390
 

Catheter related septic inferior vena cava thrombosis


1 Department of Dialysis, Namikikai Namiki Clinic, Japan
2 Department of Emergency Medicine, Nagoya Ekisaikai Hospital, Japan

Date of Web Publication8-Aug-2013

Correspondence Address:
A Tanaka
Dialysis Center, Namikikai Namiki Clinic, Uchidabashi 2-10-22, Minami Ku, Nagoya City, 457-0862
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.116328

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How to cite this article:
Tanaka A, Ito Y. Catheter related septic inferior vena cava thrombosis. Indian J Nephrol 2013;23:390

How to cite this URL:
Tanaka A, Ito Y. Catheter related septic inferior vena cava thrombosis. Indian J Nephrol [serial online] 2013 [cited 2022 Dec 5];23:390. Available from: https://www.indianjnephrol.org/text.asp?2013/23/5/390/116328


Sir,

Placement of central venous catheter (CVC) is an essential technique in the management of critically ill patients. Central venous access is needed to give drugs that cannot be given by mouth or via a peripheral venous access. We experienced a rare complication with CVC and report its images.

An 80-year-old man was hospitalized with cardiopulmonary arrest in July 2007. Despite our intensive care, his consciousness did not recover. Because ventilator could not be removed, tracheostomy was performed in August. But, he presented high fever. Methicillin-resistant Staphylococcus aureus was detected from tracheal tube and blood culture. Thus, vancomycin (VCM) was administered; the course was complicated by VCM-induced acute kidney injury (AKI). CVC was placed in the inferior vena cava (IVC) via the left femoral vein. In September, abdominal computed tomography (CT) done for investigation of fever source revealed air and thrombosis in IVC [Figure 1]. We diagnosed septic IVC thrombosis and CVC was removed. His general condition and renal function gradually recovered. Finally, gastrostomy was performed and he was transferred to another hospital in May 2008.
Figure 1: Abdominal computed tomography (CT) in September. (a) Abdominal CT slice at the level of catheter tip. (b) Enlarged view of Figure 1a square. Arrow shows air in inferior vena cava. Arrowheads show not enhanced area by contrast that is indicating thrombosis

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CVC, thrombosis, and sepsis are related to each other. [1] CT is useful for the diagnosis. [2] Nephrologists often care for AKI patients with CVC in the intensive care unit. AKI patients are immunocompromised and their prognosis is very poor. [3] Although rare, it is important to consider the possibility of catheter-related septic IVC thrombosis.

 
  References Top

1.Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, et al. Central vein catheter-related thrombosis in intensive care patients: Incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998;114:207-13.  Back to cited text no. 1
[PUBMED]    
2.Mori H, Fukuda T, Isomoto I, Maeda H, Hayashi K. CT diagnosis of catheter-induced septic thrombus of vena cava. J Comput Assist Tomogr 1990;14:236-8.  Back to cited text no. 2
    
3.Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 1998;66:S16-24.  Back to cited text no. 3
    


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1 Vancomycin
Reactions Weekly. 2013; 1472(1): 38
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