Article
Asymptomatic catheter-related venous thrombosis in a child with cystic fibrosis: When to treat?

https://doi.org/10.1016/j.jvn.2018.09.001Get rights and content

Highlights

  • Central venous catheters are important in the management of cystic fibrosis.

  • Central venous catheters are associated with an increased risk of thrombosis.

  • Conservative management of low-risk catheter-related atrial thrombi is safe.

The use of central venous catheters (CVCs) in patients with cystic fibrosis is associated with an increased incidence of right atrial thrombosis. Practically, the management of CVC-related right atrial thrombosis presents a challenge as there are no clinical trials or systematic reviews in pediatric patients with cystic fibrosis. We describe a case of a 5-year-old child who presented with a CVC-related infection due to Candida parapsilosis. Echocardiogram revealed the presence of an incidental thrombus, measuring 1.4 cm × 0.4 cm, at the tip of the catheter, adherent to the right atrial wall and discrete from the tricuspid valve leaflets. Imaging was performed at monthly intervals and showed spontaneous resolution of the thrombus after six months. Follow-up blood cultures were negative, and the course of the patient was uneventful.

Section snippets

Case Report

A 5-year-old Caucasian girl with CF (delta F508 homozygous) had a CVC (Celsite; Braun) inserted in the right subclavian vein for multiple courses of intravenous antibiotics after colonization by Pseudomonas aeruginosa. The CVC had been used for two years after insertion without complication. She presented to the emergency room with a one-day history of fever. Before this presentation, her CVC was flushed with heparin and saline at her routine checkup. On examination, she was normotensive with a

Discussion

VTE is a rare complication in children with CF, and therefore, outcome data are limited.2 More recently, the significant morbidity and mortality associated with CVC-related thrombosis have been recognized.5 This is associated with an increased risk of short-term complications that include CVC-related infection, CVC occlusion, the need for catheter replacement, and embolization. There are, however, few studies on the incidence of long-term complications. Complications such as no thrombus

Conclusion

The use of CVC in patients with CF is associated with an increased incidence of CVC-related VTE. The findings of this case report support the conservative management of CF patients with RAT who are hemodynamically stable and classified as low risk on echocardiography. We recommend close observation with radiological monitoring and removal of the CVC if possible.

Acknowledgments

The authors wish to acknowledge the staff in the Department of Pediatrics, ward 284, and Dr Motara in the department of Cardiology at Charlotte Maxeke Johannesburg Academic Hospital involved in the management of this patient.

References (10)

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All authors have reviewed and agreed upon the manuscript content.

The authors have no conflicts of interest.

This manuscript has not been submitted elsewhere nor previously published.

Ethics: This study has been approved by the Human Research Ethics Committee of the University of the Witwatersrand (M-1080389).

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