Venous catheter thrombus formation and pulmonary embolism in children

Abstract

Central venous catheter (CVC)-related thrombus formation has been increasingly recognized as a complication in adults and somewhat less frequently in children and neonates. However, the association of CVC thrombus and pulmonary embolism (PE) has rarely been reported in infants or children, and the few existing reports primarily involve chronic, indwelling CVCs such as Broviac or Hickman catheters. During an 18-month-period of autopsy review, we found that 5 of our pediatric intensive care unit patients had autopsy-proven CVC thrombus and pulmonary embolism. All of them had prolonged mechanical ventilation for respiratory failure and required insertion of one or more short-term, temporary CVCs during the course of routine critical care management. In retrospect, signs related to CVC thrombus were present in 4 patients (3 had positive blood cultures and 1 had persistent hypertension). PE was not diagnosed until autopsy in every case. The diagnosis may have been missed because the symptoms of PE are the same as those of severe lung disease. We, therefore, advocate a heightened suspicion of CVC thrombus formation and PE in critically ill children with respiratory failure and temporary CVCs and recommend early diagnostic ultrasound to confirm the diagnosis. Once a CVC thrombus is found, subsequent pulmonary deterioration may necessitate evaluation for acute PE.

Antithrombotic Therapy in Neonates and Children

“…First, CVAD-related VTEs are associated with CVADrelated sepsis. 447 Second, CVAD-related thrombosis is a common source for PE in children, 17,449,450 which may be fatal. 446 Third, recurrent CVAD-related clot may result in loss of venous access that may be necessary for life-saving intervention such as organ transplantation.…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…222,227 The clinical challenge is that many patients with PE are asymptomatic, including children with CHD and young adults after the Fontan procedure (17% prevalence). …”

“…Prophylactic heparin was shown to decrease CVLassociated thrombosis in adults, bacterial colonization, and probably CVL-related bacteremia. 221 • In children, CVL-associated thrombosis is the most common source of PE 222,223 resulting in mortality. 157 In addition, CVL-associated thrombosis may result in loss of vascular access important for lifesaving therapy in certain illnesses, including heart transplantation.…”

Trombosis en el recién nacido

“…En caso de compromiso de los miembros superiores, también puede presentarse como síndrome de vena cava superior. 18,19,26,37,38 E l s í n d r o m e p o s t r o m b ó t i c o e s u n a complicación a largo plazo que puede aparecer como consecuencia de trombosis neonatal, a partir del mes del episodio y hasta diez años después. Se caracteriza por edema crónico en las extremidades con decoloración de la piel, dificultad para la cicatrización de las heridas, úlceras en la piel y, frecuentemente, impotencia funcional.…”