Symptomatic pulmonary embolus after catheter removal in children with catheter related thrombosis: A report from the CHAT Consortium

Abstract

Background: Appropriate timing of central venous catheter (CVC) removal, in relation to start of anticoagulation, in children after the diagnosis of a CVC-related thrombosis (CRT) is not well established. Objectives: This retrospective cohort study evaluated the incidence of symptomatic pulmonary embolism (PE) after CVC removal using data from the multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) Consortium Registry. Patients/Methods: The CHAT Registry consists of data from children aged 0-21 years with a hospital-acquired venous thromboembolism. Eligible subjects were those with CRT diagnosed <3 days after CVC removal. Subjects were excluded if the CRT was due to a failed CVC insertion. Subjects were divided into three groups: those with CVC removal without anticoagulation, those with CVC removal <48 h after starting anticoagulation, and those with CVC removal ≥48 h after starting anticoagulation.

Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal?

“…3 Though, some concerns exist about the possibility that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism (PE). 4 As a matter of fact, despite several effective preventive strategies described in the recent literature 5,6 PICCs-as much as CICCs and FICCs-are inevitably associated with the potential development of catheter-related thrombosis (CRT). [7][8][9][10] This complication is a relatively earlyonset event (usually within 2 weeks), and it may be symptomatic or-more often-asymptomatic.…”

“…3 Though, some concerns exist about the possibility that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism (PE). 4…”

The value of the old and the new

“… 24 In addition, further nonrandomized data in children have also recently been published which contributes to our body of evidence, as have significant changes to adult practice which may influence currently extrapolated data. 25 , 26 , 27 , 28 , 29 …”