Central venous catheter‐related thrombosis in pediatric surgical patients: A prospective observational study

Abstract

Background: Perioperative central venous catheters are required but may be associated with various complications. Aims:The purpose of our study was to assess the incidence and perioperative risk factors for catheter-related internal jugular vein thrombosis in pediatric surgical patients. Methods: This prospective observational study included children under 6 years of age who were scheduled to undergo central venous catheterization of the right internal jugular vein under general anesthesia. A central venous catheter was inserted under real-time ultrasound guidance. An investigator examined for thrombosis using ultrasonography at predetermined time points. The primary aim was the incidence of catheter-related thrombosis from insertion until the 5th day postoperatively or the removal of the central venous catheter. The secondary aim was the determination of the risk factors for thrombosis.Results: Eighty patients completed the study. Internal jugular vein thrombi were found in 31 patients (38.8%, 95% CI 28.0-49.4). On multiple logistic regression analyses, the number of insertion attempts was the only influencing factor for catheter-related thrombosis (p < .001). More than two insertion attempts increased the risk of thrombosis (odds ratio 5.6; 95% CI 1.7 -18.7, p = .004). Anesthesia time (p = .017; mean difference 166.4 min; 95% CI 55.7-277.1), intraoperative red blood cell transfusion (p = .001; median difference 21.1 ml kg −1 ; 95% CI 6.6-34.4), and intensive care unit stay (p = .001; median difference 100.0 h; 95% CI 48-311) differed between patients with transient thrombosis and those with thrombosis lasting for more than 3 days. Conclusion:Internal jugular vein thrombosis was frequently detected by ultrasound following central venous catheterization in pediatric surgical patients. Multiple insertion attempts may be associated with the incidence of thrombosis. The clinical relevance of thrombi detected via ultrasound surveillance has not been determined.

Ultrasound‐guided supraclavicular cannulation of left brachiocephalic versus right internal jugular vein: Comparative analysis of central venous catheter‐associated complications

“…Several puncture or insertion attempts during CVC placement may also promote thrombosis. 10 Unfortunately, our standard documentation does not provide the number of puncture attempts necessary for the insertion of the CVC. Therefore, based on the available data, no connection can be drawn between repeated punctures and the development of CADVT.…”

“…7 Several studies have reported that CADVT occurs in approximately 15%-39% of pediatric patients with a CVC and the risk is particularly high in preterm infants and neonates. 9,10 It must be noted, that the inflammatory and immunosuppressive effects of cardiopulmonary bypass and major surgery may have a different impact on the occurrence of complications in such patients when compared with other conditions. 5,6 Furthermore, the question of the influence of the puncture site of a CVC on the development of CADVT for pediatric cardiac surgery patients has not been conclusively answered in studies.…”

“…A feared complication following CVC placement is catheter‐associated deep vein thrombosis (CADVT) which is associated with increased morbidity and mortality in pediatric patients 7 . Several studies have reported that CADVT occurs in approximately 15%–39% of pediatric patients with a CVC and the risk is particularly high in preterm infants and neonates 9,10 . It must be noted, that the inflammatory and immunosuppressive effects of cardiopulmonary bypass and major surgery may have a different impact on the occurrence of complications in such patients when compared with other conditions 5,6 .…”

Central venous catheter-associated deep vein thrombosis in critically ill pediatric patients: risk factors, prevention, and treatment

“…Central venous catheter (CVC) placement and ICU admission are the two most important risk factors for VTE in children [2]. Critically ill children are reported to develop CVC-associated DVT (CADVT) at rates of 2–39%, depending on the presence of symptoms and screening techniques [3,4,5 ▪ ,6,7 ▪ ]. CADVT can lead to pulmonary embolism, potentially prolonging duration of mechanical ventilation [8].…”

Risk factors for central venous catheter-related thrombosis in hospitalized children: a single-center a retrospective cohort study

“…Most studies have focused on peripheral central catheter-related thrombus, not central catheter-related thrombus (20)(21)(22). At present, the risk factors for CVC-CRT in hospitalized children are still not well identified (16,23), and there is no consensus on the risk factors for CRT in children.…”