Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters

Abstract

Background: Venous thrombosis (VT) in children is often associated with a central venous catheter (CVC). We aimed to determine the incidence of VT associated with percutaneous non-tunnelled CVCs in a general paediatric population, and to identify risk factors for VT in this cohort. Methods: Observational, prospective study enrolling consecutive patients at a tertiary multidisciplinary paediatric hospital. A total of 211 percutaneous, non-tunnelled CVCs were analysed. Data regarding potential risk factors for CVCrelated VT were collected. Compression ultrasonography with colour Doppler was used to diagnose VT. Results: Overall, 30.3% of children developed CVC-related VT, with an incidence rate of 29.6 (confidence interval, 22.5e36.9) cases/1000 CVC days. Upper body CVC location, multiple lumen CVCs, and male gender were independent risk factors for VT in multivariate analysis. All upper body VTs were in the internal jugular vein (IJV). The occurrence of CVCrelated VT did not affect length of paediatric ICU or hospital stay. In patients with VT, femoral CVCs, young age, paediatric ICU admission, and a ratio of CVC/vein diameter >0.33 were associated with VT being symptomatic, occlusive, or both. IJV VT was often asymptomatic and non-occlusive. Conclusions: Paediatric non-tunnelled CVCs are frequently complicated by VT. Avoiding IJV CVCs and multiple lumen catheters could potentially reduce the overall risk of VT. However, IJV VT was more likely to be smaller and asymptomatic compared with femoral vein VT. More data are needed on the risk of complications from smaller, asymptomatic VT compared with the group of VT with symptoms or vein occlusion. Femoral vein CVCs and CVC/vein diameter >0.33 could be modifiable risk factors for VT with larger thrombotic mass. Clinical trial registration: ACTRN12615000442505.

Venous Thromboembolism among Critically Ill Children: A Narrative Review

“…44 Risk factors for CVC-related DVT include the duration of catheterization, catheter type (peripherally inserted central catheters [PICC] may have greater risk than CVC), number of lumens, insertion site, and catheter-to-vein diameter ratios. 8,[44][45][46][47][48][49] In a multicenter, prospective observational cohort study, Jaffray et al reported a cumulative incidence of CVC-related DVT of 5.9 AE 0.63%; among these, 80% were noted in PICC lines. 49 While a smaller-caliber PICC line may limit obstruction of venous blood flow when compared with a larger-bore CVC in any particular vein, newly placed PICC lines in children presenting with critical illness at times remain in situ for extensive durations compared with larger-bore CVCs in an effort to facilitate hospital or PICU discharge.…”

Role of miR-92a-3p, oxidative stress, and p38MAPK/NF-κB pathway in rats with central venous catheter related thrombosis

“…Hence, CRT is an urgent concern because it may promote chronic venous occlusion resulting in loss of vascular access. This condition may increases morbidity, mortality, length of hospital stay, and cost of healthcare [1,7,8].…”

Complications of Central Venous Catheter Insertion in Patients Undergoing Hemodialysis in Iran: A Systematic Review and Meta-analysis

“…According to the findings, the prevalence of thrombosis was 18.3% (95%CI: 11.2%-28.6%), and the prevalence of catheter malfunction was 16.1% (95%CI: 9.2%-26.7%). Östlund et al showed that the incidence rate for CVC-related Venous Thrombosis (VT) was 29.6 per 1000 [38]. Also, in the study of Hughes et al on hemodialysis patients in Nigeria, the dislodging rate was 6 (5.5%), and the low flow rate was 9 (8.3%) [39].…”