Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

Abstract Objective To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children. Methods A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis. Results In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57–5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99–3.46), hematologic disease (OR = 1.45, 95% CI: 1.06–1.99), and cancer (OR = 1.58, 95% CI: 1.01–2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21–2.39), hemodialysis (OR = 2.17, 95% CI: 1.34–3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31–1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06–14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32–0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15–2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41–5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14–0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01–5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99–6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15–6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07–2.54) were associated with an increased CRT risk. Conclusion The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.

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Development of a paediatric central venous access device database: A retrospective cohort study of practice evolution and risk factors for device failure

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14600 ◽

2019 ◽

Vol 56 (2) ◽

pp. 289-297 ◽

Cited By ~ 8

Author(s):

Tricia M Kleidon ◽

Claire M Rickard ◽

Jessica A Schults ◽

Gabor Mihala ◽

Craig A McBride ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Device Failure ◽

Access Device ◽

Venous Access Device

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396 Central venous access device (CVAD) sampling of serum aminoglycoside levels compared with venous sampling in adults with cystic fibrosis

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(05)80352-2 ◽

2005 ◽

Vol 4 ◽

pp. S106

Keyword(s):

Cystic Fibrosis ◽

Central Venous Access ◽

Venous Access ◽

Venous Sampling ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Venous Access Device

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Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)–non-inferiority (peripheral arterial catheter) trial

The Lancet ◽

10.1016/s0140-6736(21)00351-2 ◽

2021 ◽

Vol 397 (10283) ◽

pp. 1447-1458

Author(s):

Claire M Rickard ◽

Nicole M Marsh ◽

Emily N Larsen ◽

Matthew R McGrail ◽

Nicholas Graves ◽

...

Keyword(s):

Central Venous Access ◽

Bloodstream Infections ◽

Venous Access ◽

Arterial Catheter ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Peripheral Arterial ◽

Randomised Controlled ◽

Venous Access Device

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How I treat central venous access device–related upper extremity deep vein thrombosis

Blood ◽

10.1182/blood-2016-08-693671 ◽

2017 ◽

Vol 129 (20) ◽

pp. 2727-2736 ◽

Cited By ~ 20

Author(s):

Anita Rajasekhar ◽

Michael B. Streiff

Keyword(s):

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Postthrombotic Syndrome ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Persistent Symptoms ◽

Vena Cava Filters ◽

Venous Access Device

AbstractCentral venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.

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