Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients

Gnannt, Ralph; Waespe, Nicolas; Temple, Michael; Amirabadi, Afsaneh; Liu, Kuan; Brandão, Leonardo R.; Connolly, Bairbre

doi:10.1007/s00247-018-4096-x

Cited by 25 publications

(14 citation statements)

References 26 publications

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“…Another possibility is a change in blood flow at the tip or the difference in the stiffness of the catheter. 53 It is generally believed that there is a positive correlation between CRT formation and CLABSI. 54 We found that CLABSI can increase the risk of CRT.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis

Tian

Wan

et al. 2020

Thromb Haemost

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Objective To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children. Methods A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis. Results In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57–5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99–3.46), hematologic disease (OR = 1.45, 95% CI: 1.06–1.99), and cancer (OR = 1.58, 95% CI: 1.01–2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21–2.39), hemodialysis (OR = 2.17, 95% CI: 1.34–3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31–1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06–14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32–0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15–2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41–5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14–0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01–5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99–6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15–6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07–2.54) were associated with an increased CRT risk. Conclusion The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis

Tian

Wan

et al. 2020

Thromb Haemost

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“…108 Color Doppler is useful technique to detect the vessel and thrombosis. 105,106,109 • Thrombosis (thrombophlebitis): venous thrombosis could be caused from an inserted catheter and patient conditions such as an underlying disease, or inadequate prophylaxis (►Figs. 22 and 23).…”

Section: Timing Of Occurrence and Strategy Of Diagnosismentioning

confidence: 99%

Extracardiac Complications in Intensive Care Units after Surgical Repair for Congenital Heart Disease: Imaging Review with a Focus on Ultrasound and Radiography

Hosokawa

Shibuki

Tanami

et al. 2020

J Pediatr Intensive Care

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Pediatric patients show various extracardiac complications after cardiovascular surgery, and radiography and ultrasound are routinely performed in the intensive care unit to detect and evaluate these complications. This review presents images of these complications, sonographic approach, and timing of occurrence that are categorized based on their extracardiac locations and include complications pertaining to the central nervous system, mediastinum, thorax and lung parenchyma, diaphragm, liver and biliary system, and kidney along with pleural effusion and iatrogenic complications. This pictorial review will make it easier for medical doctors in intensive care units to identify and manage various extracardiac complications in pediatric patients after cardiovascular surgery.

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“…However, arm veins should be avoided in patients with potential future need of hemodialysis (chronic kidney disease higher than grade G2A2 or G3a 85 ) because of the cumulative risk of thrombosis and loss of potential AV fistula sites. 26,86 For chronic intermittent access, an indwelling venous port may be placed in the veins of the chest, extremity, or groin. Ports should be used with caution in patients who are immunocompromised at the time of insertion.…”

Section: Elective Access Conditionsmentioning

confidence: 99%

“…Peripherally inserted central catheters are an acceptable alternative. However, arm veins should be avoided in patients with potential future need of hemodialysis (chronic kidney disease higher than grade G2A2 or G3a) because of the cumulative risk of thrombosis and loss of potential AV fistula sites . For chronic intermittent access, an indwelling venous port may be placed in the veins of the chest, extremity, or groin.…”

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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Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients

Abstract: Repetitive PICC insertions in the same arm are associated with an increased risk of symptomatic thrombosis. Double-lumen PICCs are associated with a higher risk of thrombosis compared to single-lumen lines.

Cited by 25 publications

References 26 publications

Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis

Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis

Extracardiac Complications in Intensive Care Units after Surgical Repair for Congenital Heart Disease: Imaging Review with a Focus on Ultrasound and Radiography

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

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