Thromboembolic complications related to indwelling central venous catheters in children with oncological/haematological diseases: a retrospective study of 362 catheters

Abstract

Indwelling central venous catheters (CVC) are essential devices in the management of children with oncological/haematological diseases being treated with chemotherapy or undergoing bone marrow transplantation. Our study was aimed at detecting the incidence of important thrombotic events caused by CVC in children, and the coexistence of coagulation disorders in children affected with thromboembolic disease related to CVC. Therefore, we describe some antithrombotic strategies which have been successfully applied to solve functioning problems of correctly inserted CVC. We retrospectively evaluated the clinical records of 308 children (age range 2 months to 14 years) with oncological/haematological diseases undergoing insertion of 362 indwelling CVC from January 1994 to December 1998 at the Gaslini Children's Hospital. We collected data on seven serious asymptomatic thrombotic episodes diagnosed between 1994 and 1998 following catheter malfunctioning and one case of suspected lung embolism with symptoms. Coagulation tests allowed us to identify one case of probable heterozygosis of Protein C deficiency and one case of G20210A prothrombotic prothrombin mutation. This finding suggests the need for further evaluation for thrombophilia in all patients presenting with thrombotic complications of CVC. We therefore emphasise the importance of prophylaxis with low-dose heparin in children with malignancies receiving CVC. A prospective study, which has already been started, should identify the exact role of thromboembolic complications in children with indwelling CVC for oncological/ haematological malignancies.

Long-Term Treatment of Thrombosis with Enoxaparin in Pediatric and Adolescent Patients

“…In many centers, the total number of cases clearly increased over the last 10 years. This urgently necessitates a reevaluation of the actual incidence [5, 7, 8, 16]. …”

“…Ninety percent involve the lower half of the body [54]. Symptomatic catheter-associated thrombosis, mainly connected to an increasing number of interventions in the fields of cardiology, oncology and intensive care, are equally spread throughout all the age groups [5, 7, 8, 16]. …”

Urokinase for restoring patency of malfunctioning or blocked central venous catheters in children with hemato-oncological diseases

“…If CVC was correctly positioned, a Doppler ultrasound (US) and/or 2D echocardiography were performed to look for deep vein thrombosis (DVT) or thrombi at or near the device tip [7]. Subjects with documented DVT or right atrial thrombus were excluded from this study and treated with other institutional protocols.…”

Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP)

“…The causes of obstruction may be mechanical, chemical (drugs or nutrients, precipitating in the lumen), or thrombotic [4,5,[11][12][13][14][15][16][17]. One of the most frequent causes of CVC dysfunction and occlusion is the formation of a fibrin sheath inside the lumen or at the apex of the catheter, especially in that case without apparent signs of compression or of dislocation, and without a history of infusions of drugs at risk of giving precipitates (i.e., TPN, etoposide, etc.).…”

“…Indeed, two retrospective studies have reported a significant association of CVC dysfunction and TE [9,12]. Figure 1 summarizes the various thrombotic complications of CVC and the mode of presentation.…”