Risk factors for central venous catheter-related thrombosis in children

Abstract

Central venous catheter (CVC) placement is associated with increased risk of thrombosis in the paediatric population, particularly in relation to the type of catheter and the manner of its insertion. Here, we investigate risk factors associated with CVC-related thrombosis in children, with particular emphasis on positioning of the catheter tip. Patients aged 0-18 who underwent at least one CVC placement from 2008 to 2013 at a single centre with a subsequent follow-up echocardiogram were included for a total of 104 patients and 147 lines. Data on clinical and catheter-related risk factors were collected from patient charts. Statistical analysis using Pearson's χ tests, independent samples t-test, and odds ratios were used to assess potential risk factors for thrombosis. Neither insertion site (subclavian vein or otherwise), left- vs. right-sided insertion, nor catheter type were significant risk factors for thrombosis. There were no thrombotic events reported at the superior vena cava (SVC)-right atrium junction and no significant differences in thrombotic risk with initial tip placement in the SVC-right atrium junction vs. the SVC, right atrium, or inferior vena cava. Acute lymphoblastic leukaemia was a major clinical risk factor for thrombosis. Tip movement was common and may have been an important factor in the development of CVC-related thrombi. Prospective studies can yield insight into the role of follow-up imaging in the prevention of catheter-related thrombosis in children.

Early central line‐associated blood stream infections in children with cancer pose a risk for premature catheter removal

“…These occur through bacterial colonisation, either during the migration of skin bacteria to the bloodstream via an extraluminal route or bacteria entering the lumen of the catheter directly via an intraluminal route. In addition, central line‐associated blood stream infections (CLABSI) may lead to treatment being postponed and they are also associated with an increased risk of CVC‐related thrombosis .…”

Candida thrombophlebitis in children: a systematic review of the literature

“…Certainly, the presence of a CVC is the most important risk factor for the development of deep venous thromboembolism in children. The reported incidence in pediatric patients ranges from 5 to 44% depending on age, the primary condition, and therapies received via the CVC, as well as the type and site of CVC placement [28]. Several possible mechanisms by which CVC causes thrombosis include damage to vessel wall, disrupted blood flow, infusion of substances that damage endothelial cells (in example in case of TPN), and thrombogenic catheter materials [29].…”

Stent‐retriever thrombectomy in the treatment of infants with acute thrombosis of the superior vena cava and innominate vein

“…In the majority of cases, acute vena cava syndrome due to thrombosis of the SVC in neonates and infants has been reported following major surgical procedures. 1,[3][4][5][6] In a large series of 753 infants, who underwent arterial switch operation for surgical correction of transposition ity and mortality. 1 In addition, this treatment was associated with only partial relief of the thrombosis in the survivors.…”

“…It frequently occurs in association with central venous lines in the internal jugular veins required for intensive care treatment of these children. [1][2][3][4][5][6] The resulting sequelae including venous congestion, pleural effusions and chylothorax are associated with significant morbidity and mortality. 1,7,8 Therapeutic options include local and systemic thrombolytic therapy, 9 catheter aspiration thrombectomy, 10,11 and surgery.…”

“…Symptomatic thrombosis of the superior vena cava (SVC) and brachiocephalic veins is a rare but serious complication in critically ill neonates and young infants. It frequently occurs in association with central venous lines in the internal jugular veins required for intensive care treatment of these children . The resulting sequelae including venous congestion, pleural effusions and chylothorax are associated with significant morbidity and mortality .…”