Right atrial thrombi in children with cancer and indwelling catheters

Korones, David N.; Buzzard, Carol J.; Asselin, Barbara L.; Harris, J. Peter

doi:10.1016/s0022-3476(96)70338-4

Cited by 96 publications

(63 citation statements)

References 26 publications

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“…Notably, none of the 3 patients who had persistent thrombi received hyperalimentation. Other studies suggest that risk factors for thrombotic complications include the diagnosis of acute lymphocytic leukemia, 8 (which represented only 8% of our sample), treatment with asparaginase, 16 malposition of the catheter, 17 or large catheter diameter. 18 Prospective studies of large numbers of patients are necessary to determine the true incidence of both acute and, particularly, late complications of CVLrelated thrombosis, predisposing conditions, and the potential role of prevention with anticoagulation or other therapies.…”

Section: Discussionmentioning

confidence: 88%

“…Korones and associates described a residual small right atrial thrombus in a child treated for acute lymphocytic leukemia, whose catheter had been removed 2 years previously. 8 Petäjä and co-workers found that 2 of 10 children with central venous thrombosis after cardiac surgery had residual thrombi when studied at 5 to 108 months after surgery. 9 We used unilateral CT-based angiography, as reported previously by Tello et al 10 and Baldt et al, 11 to http://www.pediatrics.org/cgi/content/full/101/2/e7detect thrombosis and related anomalies.…”

Section: Discussionmentioning

confidence: 99%

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Late Vascular Occlusion of Central Lines in Pediatric Malignancies

Wilimas¹,

Hudson²,

Rao³

et al. 1998

Pediatrics

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ABSTRACT. Objective.To determine whether thrombi or vascular occlusion represent a late complication persisting several years after removal of central venous lines (CVLs) in children and adolescents treated for childhood cancer.Methods. Children whose treatment for malignancy included placement of a CVL that had been removed at least 2 months previously were studied during scheduled follow-up that included contrast-enhanced computed tomography. Spiral volume acquisition was used to obtain 3-mm images from the chest apices through the right hilum, and three-dimensional reconstruction of angiograms was performed. Thrombosis/occlusion was defined as narrowing, obstruction, or filling defect of the deep venous system, with or without the formation of collateral veins. Charts were reviewed to document patient characteristics, previous CVL complications, administration of hyperalimentation, use of urokinase, and family history of venous thrombosis.Results. Twenty-three patients treated for solid tumors and 2 treated for B-cell acute lymphocytic leukemia or lymphoma were studied. Lines had been in place from 0.2 to 36 months (median, 7.4) and were removed at 2.3 to 121.8 months (median, 32.5) before study. Nine patients received hyperalimentation for periods ranging from 2 to 38 weeks (median, 12). Four patients had required urokinase instillations, and one developed superior vena cava syndrome; 4 had a CVL-related infection (two superficial and two Candida line infections). Occlusion was seen on computed tomography angiograms in 3 of the 25 patients (12%; 95% confidence interval: 4.5-31%). One of the patients with occlusion had superior vena cava syndrome; none had a family history of thrombosis, use of a double lumen CVL, or multiple instillations of urokinase.Conclusions. Persistent asymptomatic vascular occlusion does occur as a late complication of CVL placement for treatment of childhood malignancies, although the frequency appears low among patients treated primarily for solid tumors. Prospective studies of large numbers of patients with a broader spectrum of diagnoses are necessary to define the incidence of and risk factors for this complication and to assess the need for prevention with anticoagulation or other therapy. Pediatricians caring for patients with a history of cancer and CVLs should be aware that these patients may have persistent vascular occlusion that could predispose them to recurrent thrombosis or postphlebitic syndrome. Pediatrics 1998; 101(2). URL: http://www.pediatrics.org/cgi/content/ full/101/2/e7; thrombosis, central venous lines, late effects, malignancies.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Late Vascular Occlusion of Central Lines in Pediatric Malignancies

Wilimas¹,

Hudson²,

Rao³

et al. 1998

Pediatrics

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“…Recent studies suggest that central line-associated atrial thrombi 9 and pulmonary embolism 8 in children are not as unusual as previously suspected. Parenteral nutrition is known to increase the risk of such complications.…”

Section: Discussionmentioning

confidence: 90%

Anticardiolipin antibodies and thromboembolism after BMT

Qasim

Gerritsen

Veys

1998

Bone Marrow Transplant

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Summary:We describe a 4-month-old child who developed unusual thrombotic complications following allogeneic BMT for Omenn syndrome, a form of SCID. Eight weeks after the procedure the child suffered a major cerebrovascular accident and developed acute pulmonary hypertension in association with persistently elevated anticardiolipin antibody titres. It is postulated that central line-derived microemboli caused these serious thrombotic complications in the context of an evolving hypercoaguable state. Keywords: anticardiolipin antibodies; bone marrow transplantation; Omenn syndrome; central venous catheter Omenn syndrome was first described in 1965 as familial reticuloendotheliosis with hypereosinophilia in a child with a widespread exfoliative skin eruption, hepatosplenomegaly and failure to thrive.1 It is probably a form of 'leaky' SCID with expansion of autoreactive peripheral T cells which infiltrate skin and other organs.2 BMT is the only curative treatment available. 3 Here, we describe a child with Omenn syndrome who underwent successful BMT from a matched sibling at the age of 4 months. However, the post-transplant period was complicated by a left middle cerebral artery stroke and severe pulmonary hypertension in association with raised anticardiolipin antibody titres. We hypothesise that on a background of an evolving hypercoaguable state, central line-related microemboli caused pulmonary hypertension leading to right to left cardiac shunting across a patent foramen ovale and subsequent thromboembolic phenomenon in the left middle cerebral artery. Case reportA male infant, weighing 3.3 kg was born to healthy nonconsanguineous Caucasian parents at full term and without complication. At 5 weeks of age he required hospital admission for high fever and was treated with intravenous antibiotics. A septic screen was negative and he was noted to have a widespread eczematous rash and generalised lymphadenopathy. At 8 weeks first immunisations against diptheria, tetanus, pertussis, Haemophilus influenzae type b and polio were given as scheduled. At 11 weeks he developed respiratory distress and was successfully treated for interstitial pneumonia, presumably caused by Pneumocystis carinii, with high-dose cotrimoxazole (120 mg/ kg/day). Immunological investigations revealed hypogammaglobulinaemia and profoundly low B cell numbers in association with grossly elevated IgE levels and hypereosinophilia (Table 1). T cell responses to the mitogen phytohaemagglutinin were universally low and a substantial proportion of CD3 cells were negative for CD4 and CD8 (double negative T cells) suggesting a 'leaky' form of SCID. Fluorescent in situ hybridisation studies (FISH) detected 100% XY mononuclear and polymorphonuclear cells and thereby excluded maternal engraftment. The diagnosis of Omenn syndrome was made.The dermatitis and lymphadenopathy responded to treatment with 1 mg/kg/day prednisolone. Tissue typing revealed that his healthy 2-year-old sister was genotypically HLA matched. A right subclavian double lumen Hickmann line w...

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“…In fact, if catheter tip is in a higher position (i.e., middle third or upper third of the SVC, or in the brachiocephalic, or in the IJV, or in the SV), there is an increased risk of malfunction [64] and an increased risk of venous thrombosis if compared to a lower position into the superior cava vein or close to the CAJ [65] . If the tip is positioned "too low" (right atrium, right ventricle or inferior vena cava), there is a risk of arrhythmias, tricuspid valve dysfunction or lesions, and thrombosis [19,66,67] . Malpositions are classified as "primary" when malposition occurs during the insertion (e.g., catheter tip into the ipsilateral IJV, as well as into the opposite brachiocephalic vein/SV/IJV) while as "secondary" when the catheter tip migrates spontaneously in the weeks or months following the insertion.…”

Section: Cotogni P Et Al Piccs In Critically Ill Patientsmentioning

confidence: 99%

Focus on peripherally inserted central catheters in critically ill patients

Cotogni

Pittiruti

2014

WJCCM

105

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Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e. , low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. 80November 4, 2014|Volume 3|Issue 4| WJCCM|www.wjgnet.com access devices (CVADs) are key elements of management for either adult or pediatric critically ill patients. Healthcare pro...

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Right atrial thrombi in children with cancer and indwelling catheters

Cited by 96 publications

References 26 publications

Late Vascular Occlusion of Central Lines in Pediatric Malignancies

Late Vascular Occlusion of Central Lines in Pediatric Malignancies

Anticardiolipin antibodies and thromboembolism after BMT

Focus on peripherally inserted central catheters in critically ill patients

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