Central line thrombus is a well recognized complication of long-term venous access devices. Oncology nurses are key players in the recognition and treatment of central line thrombus. An understanding of the mechanisms and interrelated variables in the formation of thrombus, as well as knowledge of treatment alternatives is essential for the pediatric oncology nurse. Described here are some of the causes and contributing factors in the development of central line thrombus. In addition, a case study is used to examine an unusual presentation and treatment of a complicated central line thrombus. Issues discussed include (1) the effects of L-asparaginase and its analogs on clotting mechanisms; (2) the effects of suboptimal placement of the catheter tip on thrombus formation; (3) the diagnosis of a intracardiac central line related thrombus by means of routine echocardiogram in an asymptomatic patient; and (4) the necessity of cardiac surgery as an intervention for large right atrial thrombus.
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