Central venous thrombosis in children with intestinal failure on long-term parenteral nutrition

González-Hernández, Jessica; Daoud, Yahya; Styers, Jennifer; Journeycake, Janna M.; Channabasappa, Nandini; Piper, Hannah G.

doi:10.1016/j.jpedsurg.2016.02.024

Cited by 48 publications

(36 citation statements)

References 29 publications

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“…One retrospective study reported 53 children with intestinal failure (43). Thirty subjects had venous imaging, and 57% of the imaged children had at least one symptomatic CVC-VTE with a mean of 5.6 ± 3.8 (range 1–12) CVCs per patient.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

2017

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The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

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Section: Resultsmentioning

confidence: 99%

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

2017

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“…In this population, perhaps because of baseline liver dysfunction and a proinflammatory state, the prevalence of having at least 1 thrombosed central venous access site may be as high as 57%, and up to 40% may have at least 2 thrombosed sites. 11 The importance of preserving central venous access is highlighted by the still relatively high morbidity and mortality of resorting to intestinal transplantation. Current 5-year pediatric survival rates after intestinal transplantation are ∼44% to 75%, 12,13 and some of these patients continue to require PN.…”

Section: Discussionmentioning

confidence: 99%

Recanalization of Occluded Central Veins in a Parenteral Nutrition–Dependent Child With No Access

Sullivan¹,

Merritt²,

Pelayo

et al. 2018

Pediatrics

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Central venous thromboses are common and pose challenges in the care of chronically ill pediatric patients. Among patients with intestinal failure (most commonly because of short bowel syndrome) who depend on parenteral nutrition, progressive loss of central venous access sites is a potentially fatal complication. We present the case of a 5-year-old girl with parenteral nutrition-dependent short bowel syndrome and no remaining standard central venous access sites despite medical anticoagulation, in whom angioplasty and stent implantations were used to reconstruct chronically occluded central veins. The patient presented with a bloodstream infection necessitating tunneled central venous line removal from the left internal jugular vein. All other standard access sites had known occlusions. The right iliofemoral vein (RIFV) and infrarenal inferior vena cava were recanalized and dilated with high-pressure balloons. The left internal jugular line was removed and a line was placed in the now-patent RIFV for antimicrobial therapy. After treatment, the RIFV line was removed and the vessels were stented open for future access. The occluded left innominate vein was recanalized and dilated to allow a new tunneled line to be placed. At 10 months, the line was functional and uninfected and the RIFV and inferior vena cava stents were patent without in-stent restenosis. We propose a new paradigm that uses these techniques to prevent access site exhaustion in patients who do not respond to anticoagulation therapy. This approach may reduce morbidity and mortality in patients with chronic access needs and the need for intestinal transplantation in patients with intestinal failure.

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“…Thrombosis risk is significantly increased in patients who have had multiple CVCs, in patients with temporary and midline catheters, and in patients with cardiovascular implanted electronic devices . Inherited or acquired thrombophilia should be considered in any child who develops deep vein thrombosis (DVT) …”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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Central venous thrombosis in children with intestinal failure on long-term parenteral nutrition

Cited by 48 publications

References 29 publications

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

Recanalization of Occluded Central Veins in a Parenteral Nutrition–Dependent Child With No Access

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

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