Catheter Tip Thrombus: A Rare but Serious Complication

Introduction: The hemodialysis catheter serves as a crucial instrument in renal replacement therapy. While it can be life-saving, its insertion is not without risks. Despite being rarely reported, catheter tip thrombosis lacks a standardized approach due to its infrequency. Case Description: We present a case involving a 62-year-old woman with diabetes and hypertension, along with a history of ischemic stroke and one year of dialysis. Initially, she had a temporary hemodialysis catheter placed in the right internal jugular vein due to a non-maturing arteriovenous fistula (AVF) on her left arm. However, she experienced intermittent palpitations and chest discomfort exacerbated by certain movements, eating, and dialysis sessions. Cardiac arrhythmias (supraventricular tachycardia and rapid atrial fibrillation) were documented, necessitating pharmacological cardioversion. A chest X-ray revealed the catheter tip was erroneously positioned in the right atrium, likely contributing to the arrhythmias. Though repositioning was planned, echocardiography revealed a 1.1 cm x 0.4 cm thrombus attached to the catheter tip in the right atrium, increasing the risk of embolization during manipulation. Hence, a conservative approach was adopted, initiating intravenous anticoagulation and dual antiplatelet therapy (clopidogrel and aspirin). Symptoms gradually improved over six days of treatment, with a subsequent echo scan showing thrombus resolution. Anticoagulation was ceased, and the patient was discharged on antiplatelet therapy, now undergoing dialysis without symptoms. Discussion: Catheter tip thrombosis in hemodialysis patients represents a rare yet grave complication associated with considerable morbidity. Its diagnosis requires a high index of suspicion since it can mimic an acute coronary syndrome, particularly in patients predisposed to cardiac events. In hemodynamically stable individuals, considering anticoagulation and antiplatelet therapy as treatment options may prove beneficial.