Central Venous Catheter-Associated Deep Venous Thrombosis in Critically Ill Children

AbstractThe presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway.

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Incidence and Acute Complications of Asymptomatic Central Venous Catheter–Related Deep Venous Thrombosis in Critically Ill Children

The Journal of Pediatrics ◽

10.1016/j.jpeds.2012.06.059 ◽

2013 ◽

Vol 162 (2) ◽

pp. 387-391 ◽

Cited By ~ 46

Author(s):

Edward Vincent S. Faustino ◽

Philip C. Spinella ◽

Simon Li ◽

Matthew G. Pinto ◽

Petronella Stoltz ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Critically Ill ◽

Venous Catheter ◽

Critically Ill Children ◽

Central Venous ◽

Acute Complications

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The natural history of asymptomatic central venous catheter–related thrombosis in critically ill children

Blood ◽

10.1182/blood-2018-05-849737 ◽

2019 ◽

Vol 133 (8) ◽

pp. 857-866 ◽

Cited By ~ 12

Author(s):

Sophie Jones ◽

Warwick Butt ◽

Paul Monagle ◽

Timothy Cain ◽

Fiona Newall

Keyword(s):

Natural History ◽

Central Venous Catheter ◽

Critically Ill ◽

Venous Catheter ◽

Critically Ill Children ◽

Postthrombotic Syndrome ◽

Central Venous ◽

History Of ◽

Clinically Significant

Abstract Asymptomatic central venous catheter (CVC)–related thrombosis in children varies in incidence from 5% to 69%. The rate of acute and long-term complications, such as postthrombotic syndrome (PTS), from asymptomatic CVC-related thrombosis is unknown. This article reports the outcomes of a prospective study of 189 children in pediatric intensive care that aimed to determine the frequency of asymptomatic CVC-related thrombosis during hospital admission, and the incidence of residual CVC-related thrombosis and clinically significant PTS 2 years later. Risk factors associated with CVC-related thrombosis were also identified. This study is distinct from previous work as children identified to have asymptomatic CVC-related thrombosis were not treated (clinical team kept blinded) and the entire cohort was followed for 2 years to determine the natural history of asymptomatic thrombosis. Ultrasounds of 146 children determined a 21.9% incidence of acute CVC-related thrombosis. Two children were symptomatic. No radiological thrombosis extension or clinical embolization occurred in the 126 children assessed at follow-up. Using 2 recognized PTS scales, clinically significant PTS was reported in 2 children (1 symptomatic, 1 asymptomatic CVC-related thrombosis), however, neither had functional impairment. Cardiac arrest was a risk factor for CVC-related thrombosis during admission and femoral CVC placement was predictive of residual thrombosis 2 years later. This study challenges the notion that critically ill children with asymptomatic CVC-related thrombosis require anticoagulant treatment, as the results demonstrate that the incidence of acute or long-term complications is low. A larger confirmatory study of nontreatment of CVC-related thrombosis in critically ill children is justified.

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Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children

Journal of Pediatric Hematology/Oncology ◽

10.1097/mph.0000000000000370 ◽

2015 ◽

Vol 37 (6) ◽

pp. 462-467 ◽

Cited By ~ 4

Author(s):

Jeanine J. Sol ◽

Hennie Knoester ◽

Marjorie de Neef ◽

Anne M. J. B. Smets ◽

Aukje Betlem ◽

...

Keyword(s):

Central Venous Catheter ◽

Critically Ill ◽

Venous Catheter ◽

Critically Ill Children ◽

Central Venous ◽

Chronic Complications ◽

Catheter Related Thrombosis

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Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

QJM ◽

10.1093/qjmed/hcab113.022 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Marwa W Nasef ◽

Maha M El-gaffary ◽

Mervet G Mansour ◽

Esraa S Abd El Aty

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Meta Analysis ◽

Venous Catheter ◽

Controlled Trials ◽

Central Venous ◽

Thrombotic Occlusion ◽

Thrombotic Complications

Abstract Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.

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