Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience

Abstract

BackgroundReliable central venous access (CVC) is essential for hematology–oncology patients since frequent puncture of peripheral veins—e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring—can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage.MethodsHere we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation.ResultsOf the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis.ConclusionsWe conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.

Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection

“…Subclavian lines have a lower success rate for insertion (87% versus 94% femoral CVC), with 26–40% of children experiencing an AE . Furthermore, bleeding complications arising during cannulation and insertion of subclavian and internal jugular lines can be difficult to manage, leading to hemothorax, cardiac tamponade and even death . Other complications of thoracic CVC are pneumothorax, cutaneous emphysema, air embolism, brachial plexus injury, and cardiac arrhythmias (Table ) .…”

“…Details regarding the CVC size and manufacturer were available in 67 (89%) patients ( Table 1). The median CVC size for all patients was 10 French (range, [7][8][9][10][11][12][13][14]. In young children (<5 years), the median catheter size was 10 French (range, 7-12) including 50% of children under 3 years of age ( Figure 1A).…”

“…In addition, A‐HPCC using some tunneled silicone‐type catheters still requires a peripheral intravenous catheter (PIV) for return to avoid recirculation due to the close proximity of the draw and return lumens . Finally, long‐term catheters have in increasing risk of infection, catheter dysfunction, and thrombosis in 10–74% of patients …”

“…4 Finally, long-term catheters have in increasing risk of infection, catheter dysfunction, and thrombosis in 10-74% of patients. [5][6][7][8] Our institution has routinely used short-term femoral CVC in young pediatric patients undergoing A-HPCC. Patients undergo femoral line placement the morning of their first scheduled A-HPCC, followed by line removal 6-24 h after their last procedure.…”

Venous Thrombosis Associated with Peripherally Inserted Central Catheters in Oncology Patients: A Single Institutional Experience

“…Very few studies compared the incidence of central venous catheter-related thrombosis among different type of malignancies. One study by Wiegering et al attributed DVT occurrence to multifactorial etiologies related to the catheter characteristics and to the patient features [22]. On the other hand, intensive chemotherapy, whether in hematological or solid tumors, was associated with earlier DVT occurrence compared to low intensity regimens [20].…”