Femoral Vein Catheter is an Important Risk Factor for Catheter-related Thrombosis in (Near-)term Neonates

Abstract

Central venous catheters (CVCs) in neonates are associated with an increased risk of thrombosis. Most reports focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs), whereas data available on femoral venous catheters (FVCs) are limited. We performed a retrospective cohort study in all neonates (gestational age ≥34 wk) with CVCs. The primary outcome was the occurrence of thrombosis in CVCs. The secondary outcomes were possible risk factors for thrombosis, the thrombotic incidence in FVCs, UVCs, and PICCs, and clinical aspects of thrombosis in these groups. A total of 552 neonates received a total of 656 catheters, including 407 (62%) UVCs, 185 (28%) PICCs, and 64 (10%) FVCs. Thrombosis was detected in 14 cases, yielding an overall incidence of 2.1% or 3.6 events per 1000 catheter days. FVC was significantly associated with the occurrence of thrombosis when compared with UVC (P=0.02; odds ratio, 3.8; 95% confidence interval, 1.2-12.0) and PICC (P=0.01; odds ratio, 8.2; 95% confidence interval, 1.6-41.7). The incidence of thrombosis was higher in FVCs than in UVCs and PICCS, that is, 7.8% (5/64), 1.7% (7/407), and 1.1% (2/185), respectively (P<0.01). The number of thrombotic events per 1000 catheter days was 12.3 in FVCs, 3.2 in UVCs, and 1.5 in PICCs (P<0.05). We concluded that thrombosis occurs more frequently in FVCs than in other CVCs.

Catheter-related deep vein thrombosis in newborn infants

“…[8][9][10] Thrombosis incidence rates ranging from 0.8 to 14.9 % and incidence density rates from 0.4 to 13.2 ‰ catheter-days have been reported. [11][12][13] The incidence rates observed in this study when considering only the onset of clinical signs for thrombosis diagnosis were consistent with the lowest values reported in the bibliography; however, this values increased at least 5 times when using a systematic screening protocol based on imaging tests.…”

“…18,19 Catheters may favor the formation of thrombi in newborn infants through damage to the vessel wall, disruption of blood flow in small-diameter vessels, type of catheter used, and infusion of hyperosmolar substances, among other mechanisms. 3 Dubbink-Verheij et al, 12 reported a lower incidence of thrombosis when using umbilical and peripherally inserted catheters compared to femoral catheters in newborn infants with a gestational age ≥ 34 weeks. In a systematic review and metaanalysis on CVC-related venous thrombosis in children, Vidal et al, 20 also observed a lower frequency of thrombosis associated with the use of umbilical and peripherally inserted catheters.…”

Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound

“…However, CVCs are frequently needed in sick infants and other types of central catheters than UVCs are associated with thrombosis as well. Replacement of the UVC by another type of catheter may not necessarily lead to less complications 6 13 22 26 27…”

Trombosis venosa profunda asociada al uso de catéteres en recién nacidos

“…[8][9][10] Se han reportado tasas de incidencia de trombosis que varían del 0,8 % al 14,9 % y de densidad de incidencia entre el 0,4 y el 13,2 ‰ días/catéter. [11][12][13] Las incidencias halladas en nuestro trabajo utilizando solo la aparición de signos clínicos para el diagnóstico de trombosis se encontraron junto con los valores más bajos reportados por la bibliografía; sin embargo, estos valores aumentaron, al menos, 5 veces utilizando un protocolo de búsqueda sistemática con imágenes.…”