Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children

Abstract

Background Upper-extremity venous thrombosis is associated with the use of peripherally inserted central catheters (PICCs). Few pediatric studies have focused on this issue. Objectives To determine the incidence and risk factors for PICC-related superficial vein thrombosis (SVT) and deep vein thrombosis (DVT) in children. Patients/methods An observational follow-up cohort study was conducted at a single hospital between June 2012 and June 2015. All patients receiving a PICC were enrolled and followed up, with weekly Doppler ultrasound examination of the catheterized limb until PICC removal. Patient, procedural and follow-up data were analyzed. Results In the study period, 265 PICCs were inserted (median age of patients 6.5 years, interquartile range [IQR] 2.4-13 years; median weight 20 kg, IQR 11-38 kg; 54% males; 67.9% chronically ill), and patients were followed up for a total of 9743 days. The median indwelling time was 21 days (IQR 12-37 days). During follow-up, 88 (33.2% of insertions) PICC-related thromboses (incidence rate [IR] 9.03 per 1000 catheter-days) were diagnosed, 66 (24.9%) as isolated SVT, seven (2.6%) as isolated DVT, and 15 (5.7%) as SVT with associated DVT (IR 6.78, 0.71 and 1.54 per 1000 catheter-days, respectively). Only 9.9% of patients with SVT and 18.2% of those with DVT were symptomatic. The main risk factors for PICC-related SVT and DVT were a catheter/vein ratio of > 0.33 and thrombosis of the catheterized superficial vein, respectively. Conclusions PICC-related thrombosis is a common and nearly always asymptomatic complication in children, the SVT rate being approximately three times higher than the DVT rate. Optimal vein and catheter selection, yielding the lowest possible catheter/vein ratio, may decrease the rate of PICC-related thrombosis.

Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

“…For the entire study cohort, CVL indwelling time of >28 days was shown to be associated with a significantly higher incidence of aVTE compared to those with <28 days (29%, 95% CI: 17%‐23% versus 13%, 95% CI: 9%‐18.6%; P < .01). Several studies chose a 7‐day time point showing that indwelling time longer than 7 days increased the risk of aVTE . The same 7‐day time point was confirmed in an RCT evaluating continuous infusion of UFH for prevention of CVL‐related VTE in young infants with cardiac disease .…”

“…For patients requiring short‐term CVLs (<30 days), surveillance imaging was mostly performed within 24 to 72 hours after CVL placement and then serially at a 3‐ to 7‐day interval as long as CVL was in place and then at the time of CVL removal until a week after CVL removal . The majority of aVTE were detected within 2 to 7 days of CVL placement .…”

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

“…In the more general pediatric population, the prevalence of lineassociated thrombosis is not well understood, but the authors of 1 study of 265 children who underwent peripherally inserted central catheter placement for various indications found that ∼8% had line-associated thromboses, the majority of which were asymptomatic. 10 The exhaustion of central venous access sites due to recurrent thrombosis is a potentially fatal complication for patients who rely on PN or intravenous medications. Indeed, the American Society of Transplantation lists the impending loss of central venous access as an indication for intestinal transplantation in infants and children receiving PN for IF.…”

Right Device Assessment and Selection in Pediatrics

“…Thrombosis and intraluminal occlusions are the most common cause of PICC failure in pediatric patients (Menendez et al 2016;Morgenthaler and Rodriguez 2016). A recent development in PICC material involves the incorporation of antithrombogenic material (Endexo™) throughout the catheter-the inside, the outside, and the cut surface.…”