Central venous line–related thrombosis in children: association with central venous line location and insertion technique

Abstract

Venous thromboembolic events (VTEs) in children are associated with central venous lines (CVLs). The study objective was to assess whether CVL location and insertion technique are associated with the incidence of VTE in children. We hypothesized that VTE would be more frequent with (1) CVL location on the left body side, (2) CVL location in the subclavian vein rather than the jugular vein, and (3) CVL insertion by percutaneous technique rather than venous cut-down. This was a prospective, multicenter cohort study in children with acute lymphoblastic leukemia who had a CVL placed in the upper venous system during induction chemotherapy. Characteristics of CVL were documented prospectively. All children had outcome assessment for VTE by objective radiographic tests, including bilateral venography, ultrasound, echocardiography, and cranial magnetic resonance imaging. Among 85 children, 29 (34%) had VTE; 28 VTEs appeared in the upper venous system, and 1 was sinovenous thrombosis. Left-sided CVL (odds ratio [OR], 2.5; 95% confidence interval, 1.0-6.4; P ‫؍‬ .048), subclavian CVL (OR, 3.1; 95% CI, 1.2-8.5; P ‫؍‬ .025), and percutaneous CVL insertion (OR, 3.5; 95% CI, 1.3-9.2; P ‫؍‬ .011) were associated with an increased incidence of VTE. Interaction occurred between CVL vein location and insertion technique. Subclavian vein CVL inserted percutaneously had an increased incidence (54%) of VTE compared with any other combination (P ‫؍‬ .07). For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk for CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cutdown appears preferable over percutaneous insertion.

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

“…12 However, since CVC are frequently placed temporarily in hospitalized children for blood sampling, fluid resuscitation, and medication or blood product administration, and yet the incidence of VTE in children is rather low, it was not surprising that the presence of a short-term CVC was only shown in unadjusted analyses to be a significant risk factor for pediatric in-hospital VTE, and not as an independent risk factor in analyses adjusted for other demonstrated risk factors. While our analysis did not support long-term CVC as an independent risk factor for in-hospital VTE, it is possible that there may still be an independent association for outpatient VTE in children.…”

Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients

“…[1][2] The benefit derived from these devices can be offset by thrombosis, which may be complicated by pulmonary embolism and CVC dysfunction. [3][4][5] Routine venography of asymptomatic patients undergoing autologous or allogeneic bone marrow transplantation reveals a thrombosis rate that varies from 4 to 42%. [6][7][8][9][10] A large number of studies have been published addressing the association of inherited prothrombotic abnormalities with deep vein thrombosis of the leg and pulmonary embolism.…”

Venous Thromboembolism in Children

“…The risk of VTE is significantly increased with a CVC in the femoral and subclavian veins, suggesting that placement in the brachial or jugular veins may be preferable. 6 External catheters and large-bore lines appear to be associated with a higher risk of VTE, particularly in oncology patients. 7 ALL is the most common cancer associated with thrombosis in children.…”