Routine Surveillance Ultrasound for the Management of Central Venous Catheters in Neonates

Haddad, Habib; Lee, Kyong-Soon; Higgins, Ann; McMillan, Douglas; Price, Victoria; El-Naggar, Walid

doi:10.1016/j.jpeds.2013.08.048

Cited by 20 publications

(20 citation statements)

References 22 publications

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“…Management of UVC-related thrombi is based on expert opinion guidelines and the impact of these thrombi on outcome is not clear 20–22 26 28. As shown in our study, spontaneous resolution of UVC-related thrombi detected by screening is likely to occur.…”

Section: Discussionmentioning

confidence: 73%

Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound

Dubbink-Verheij

Visser

Roest

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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BackgroundUmbilical venous catheters (UVCs) are associated with thrombus formation. Most studies on thrombosis in infants with UVCs focus on only one part of the route, and none assessed a control group of infants without UVCs.ObjectiveTo determine the incidence and location of thrombi in infants after umbilical catheterisation and compare this with a control group of infants without umbilical catheters.DesignProspective observational study with serial ultrasonography of the UVC route from the umbilico-portal confluence to the heart. Ultrasonography was performed until day 14 after catheterisation in cases and day 14 after birth in controls.ResultsThrombi in the UVC route were detected in 75% (30/40) of infants with UVCs in the study group, whereas no thrombi were detected in the control group of infants without UVCs (0/20) (p<0.001). Six thrombi (20%) were located in the right atrium. Most of these were also partly present in the ductus venosus. Six thrombi (20%) were located in the ductus venosus only, and in 12 infants (40%), the thrombus was at least partly located in the umbilico-portal confluence. Thrombi persisted after UVC removal in 25/30 cases. Two infants with thrombotic events were treated with low-molecular-weight heparin and resolution was found. In the other 23 infants managed expectantly, 2 died due to necrotising enterocolitis, 1 was lost to follow-up and in 20 spontaneous regression was seen.ConclusionsThrombotic events occur frequently in infants after umbilical catheterisation. Most thrombi were asymptomatic and regressed spontaneously with expectant management. Routine screening for thrombi in UVCs is therefore not advised.

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Section: Discussionmentioning

confidence: 73%

Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound

Dubbink-Verheij

Visser

Roest

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…Some showed that younger age was associated with increased risk of CVL‐related aVTE, while another study showed that older children (>13 years) were more likely to have aVTE compared to infants (<1 year) Other study‐specific risk factors: In newborns, prematurity and low birth weight (<1.5 kg) were associated with an increased the risk of CVL‐related aVTE while in older children, diagnosis of cancer increased the risk of aVTE . Thrombophilia testing was reported in 13 studies with limited information on the timing of the testing and the assays performed.…”

Section: Resultsmentioning

confidence: 99%

“…Resolution was less likely to occur in occlusive aVTE, when aVTE was diagnosed >1 month from CVL placement and if aVTE in jugular vein was >5 mm in diameter . Five longitudinal follow‐up studies of children with short‐term CVLs, of whom only one third were treated with low molecular weight heparin (LMWH), showed no aVTE extension, recurrence or embolization in a repeat imaging 6 months to 10 years after CVL removal …”

Section: Resultsmentioning

confidence: 99%

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

Sharathkumar¹,

Biss²,

Kulkarni³

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as "asymptomatic," "incidental," or "clinically silent/occult" VTE. Objective: To understand the epidemiology, management, and outcomes of uVTE in children. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years). Results: Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I 2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval [CI]: 13%-24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non-CVL settings included post-spinal surgery, post-splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long-term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor-associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management. Conclusion: Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and | 1101 SHARATHKUMAR eT Al.

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“…The incidence of thrombus formation on catheters left in place for greater than 2 weeks is 10% to 15%. 4,5 In no case was the thrombus itself a cause of complications, and none had pulmonary emboli clinically. Thus, screening with echocardiography or ultrasound would not appear to be cost-effective.…”

mentioning

confidence: 99%

Commentary: What's the point?

Huddleston

2019

The Journal of Thoracic and Cardiovascular Surgery

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Routine Surveillance Ultrasound for the Management of Central Venous Catheters in Neonates

Cited by 20 publications

References 22 publications

Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound

Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound

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

Commentary: What's the point?

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