Rates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children*

Abstract

Objectives: Central venous access devices, including peripherally inserted central catheters and central venous catheters, are often needed in critically ill patients, but also are associated with complications, including central-line associated bloodstream infections and venous thromboembolism. We compared different central venous access device types and these complications in the PICU. Design: Multicenter, cohort study. Setting: One hundred forty-eight participating Virtual PICU Systems, LLC, hospital PICU sites. Patients: Pediatric patients with central venous access placed from January 1, 2010, to December 31, 2015. Interventions: None. Measurements and Main Results: Patient and central venous access device variables postulated to be associated with central-line associated bloodstream infection and venous thromboembolism were included. Data were analyzed using Pearson chi-square test or Fisher exact test for categorical variables, Mann-Whitney U test for continuous variables, and logistic regression and classification trees for multivariable analysis that examined significant predictors of venous thromboembolism or central-line associated bloodstream infection. Analysis included 74,196 first lines including 4,493 peripherally inserted central catheters and 66,194 central venous catheters. An increased rate of venous thromboembolism (peripherally inserted central catheter: 0.93%, central venous catheter: 0.52%; p = 0.001) (peripherally inserted central catheter: 8.65/1,000 line days, central venous catheter: 6.29/1,000 line days) and central-line associated bloodstream infection (peripherally inserted central catheter: 0.73%, central venous catheter: 0.24%; p = 0.001) (peripherally inserted central catheter: 10.82/1,000 line days, central venous catheter: 4.97/1,000 line days) occurred in peripherally inserted central catheters. In multivariable analysis, central venous catheters had decreased association with central-line associated bloodstream infection (odds ratio, 0.505; 95% CI, 0.336–0.759; p = 0.001) and venous thromboembolism (odds ratio, 0.569; 95% CI, 0.330–0.982; p = 0.043) compared with peripherally inserted central catheters. Conclusions: Peripherally inserted central catheters are associated with higher rates of central-line associated bloodstream infection and venous thromboembolism than central venous catheters in children admitted to the PICU.

Venous Thromboembolism among Critically Ill Children: A Narrative Review

“…36,[58][59][60] Among critically ill infants, the presence of CVC is likely the strongest contributor to VTE risk given unavoidably greater catheter-to-vein diameter ratios that are related to both endothelial damage and greater venous stasis. 8,43 The physiologic rise in estrogen and testosterone levels, as well as the use of estrogen-containing oral contraceptive pills among females, may contribute to the observed peak in adolescence, along with the high prevalence of obesity in adolescence and factors such as cigarette smoking. [61][62][63] Physical Impairment and Immobility Ambulation and immobility play a major role in hemostasis and the development of VTE.…”

“…7 When considering CVC-related VTE, Patel et al noted an overall cumulative incidence of 0.21%, an incidence rate of 1.57 VTEs per 1,000 line-days, and significantly longer mean length of stay for those with a CVC-related VTE as compared with those without VTE (15.6 vs. 6.1 days, respectively). 8 For PE, Carpenter and collaborators described an increasing trend in incidence rates from 2 per 10,000 hospitalizations in 2001 to 6 per 10,000 hospitalizations in 2014. 32 These data are consistent with work by Rajpurkar and colleagues noting pediatric PE incidence rates increased from 5.1 to 9.2 per 10,000 admissions from 2004 to 2017.…”

“…39 While the clinical significance of asymptomatic VTE has been debated, 40 it is important to highlight that asymptomatic CVC-related DVTs may contribute to morbidity in the form of acquired bloodstream infections, paradoxical strokes, and, if the clinical team elects to remove the catheter, the temporary loss of central access. 8,41 VTE in Critically Ill Children Sochet et al 633…”

“…For critically ill children admitted to the pediatric intensive care unit (PICU), VTE rates vary by presence of thrombophilia (both genetic and acquired), immobility, severity of illness, and clinical factors such as extended length of stay, mechanical ventilation, central venous catheters (CVC), patient age, concurrent infection, hematologic malignancy, or traumatic injury. [6][7][8][9][10][11][12][13][14][15] The development of VTE in this population carries a significant risk for adverse clinical outcomes, including index mortality and reduced ventilator-free days. 12 For adults, routine thromboprophylaxis during hospitalization is recommended by the American College of Physicians 16 and recent assessments reveal these guidelines are generally adhered to.…”

Gefäßzugänge bei Kindern: Technik, Komplikationen und Fallstricke beim zentralen Venenkatheter

“…Allerdings ist der Zugang über die V. femoralis aus verschiedenen Gründen nur bedingt zu empfehlen. Daten aus großen Kollektiven zeigen eine deutlich erhöhte Thromboserate bei Femoralis-ZVK-Anlagen [21,22]. Zudem ist die genannte Region potenziell feucht und kontaminiert, wenn die Kinder noch Windeln tragen.…”