Jugular venous catheter-associated thrombosis and fatal pulmonary embolism: A case report

Autor: Shufen Guo, Huimian Shang, Jinrong Wang, Lili Wang, Chaobo Cui, Yanling Wang, Xiaoya Yang
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
pulmonary embolism
medicine.drug_class
Computed Tomography Angiography
medicine.medical_treatment
Point-of-Care Systems
Low molecular weight heparin
catheters related thrombosis
Inferior vena cava
03 medical and health sciences
0302 clinical medicine
Jugular vein
Internal medicine
Upper Extremity Deep Vein Thrombosis
medicine
Ventricular outflow tract
Humans
030212 general & internal medicine
Clinical Case Report
Ultrasonography
business.industry
Anticoagulants
General Medicine
Venous Thromboembolism
Middle Aged
medicine.disease
Thrombosis
Urokinase-Type Plasminogen Activator
Pulmonary embolism
medicine.anatomical_structure
medicine.vein
Ventricle
bedside emergency ultrasound
030220 oncology & carcinogenesis
cardiovascular system
Cardiology
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Jugular Veins
business
Central venous catheter
Research Article
Zdroj: Medicine
ISSN: 1536-5964
Popis: Supplemental Digital Content is available in the text
Introduction: Central venous catheters related thrombosis (CRT) insertion has been shown to increase the risk of venous thromboembolism, particularly pulmonary embolism (PE). Nevertheless, deaths cased due to PE have been rarely reported. Patient concerns: A central venous catheter was introduced through the right jugular vein during the operation due to severe septic shock from a 57-year-old male patient. Two days after surgery, the hemodynamics was stable. On the 7th day, and low molecular weight heparin calcium (4100 units, once a day) was added for anticoagulation to prevent venous thromboembolism. On the 15th day, during the process of central venous catheter removal, the patient suddenly lost consciousness, suffered cardiac arrest, and received emergency cardiopulmonary resuscitation. Diagnosis: Jugular venous catheter-associated thrombosis and fatal PE. An acute bedside ultrasound showed a thrombus drifting with the blood stream in the right jugular vein. The lower section of the xiphoid process by echocardiography showed decreased systolic amplitude of the right atrium and right ventricle, widened and fixed inferior vena cava, and no variation with respiration. Para-sternal left ventricular long axis section showed that the right ventricular outflow tract was significantly extended, and the contraction amplitude of the anterior and posterior walls of the left ventricle decreased. Left ventricular short axis section indicated a right ventricle enlargement and ventricular septum deviation of left ventricle, showing “D” sign. Apical 4-chamber view showed that the right ventricular ratio increased and the contractile capacity decreased. Interventions: One and a half million units of urokinase were immediately given trough intravenous drip. Outcomes: Twenty minutes after thrombolysis, the patient's autonomic heart rhythm was recovered, but continued to suffer from hypotension and coma, followed by multiple organ failure, and died 50 hours later. Conclusion: Recent clinical practice guidelines recommend against the routine use of any anticoagulant thromboprophylaxis in patients with central venous catheters, but for patients at particularly high risk for CRT, consideration can be given to using higher doses of anticoagulant as prophylaxis, although there are virtually no data to support this approach.
Databáze: OpenAIRE
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