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Catheter-related thrombosis in pediatrics
1Department of Laboratory Medicine, Hematology Section, Warren Grant Magnussen Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Insights
Venous access devices (VADs) are crucial for pediatric care, but clinicians must manage complications like infection and thrombosis. This review details thrombolytic treatments for common VAD-related thromboses, including fibrin sheath obstruction and central vein occlusions.
Area of Science:
- Pediatric Medicine
- Vascular Access
- Hematology
Background:
- Venous access devices (VADs) are increasingly utilized in pediatric patients for various therapies.
- Catheter-related complications, primarily infection and thrombosis, necessitate careful management.
- Understanding hemostasis and fibrinolysis is key to addressing VAD-related thrombosis.
Purpose of the Study:
- To review common catheter-related thromboses in children.
- To outline signs, symptoms, and current treatment options for VAD-related thrombosis.
- To discuss the role of thrombolytic agents and investigational therapies.
Main Methods:
- Overview of hemostasis and fibrinolysis pathways.
- Presentation of clinical manifestations and therapeutic strategies for specific thromboses.
- Review of thrombolytic agents and emerging treatments.
Main Results:
- Fibrin sheath obstruction, subclavian vein thrombosis, and superior vena cava thrombosis are common VAD-related thromboses.
- Thrombolytic therapy is an increasingly utilized treatment modality.
- Investigational agents are being explored for improved outcomes.
Conclusions:
- Clinicians require comprehensive knowledge of VAD complications and thrombolytic treatments.
- Effective management of VAD-related thrombosis is essential for optimal patient care.
- VADs significantly improve treatment delivery and patient convenience in pediatrics.
Abstract:
Venous access devices (VADs) are being used in the pediatric setting with increasing frequency. To care for these devices, clinicians need to be cognizant of the complications that occur. The two most often encountered catheter-related complications are infection and thrombosis. This article begins with an overview of hemostasis as well as the pathway for fibrinolysis. Signs, symptoms, and treatment options available using thrombolytic agents in the three most common catheter-related thromboses are presented including: (a) fibrin sheath obstruction, (b) subclavian vein thrombosis, and (c) superior vena cava thrombosis. Since treatment options using thrombolytic therapy are becoming more widely used, clinicians are expected to be knowledgeable of these agents. A brief overview of the more common investigational agents used for the treatment of catheter-related thrombosis is also provided. VADs in children have played a significant role since being introduced more than 20 years ago. VADs often provide the only means available for the delivery of chemotherapeutic agents, blood products, nutritional support, fluids, antibiotics, and other medications as well as easier access to blood sampling. The convenience of these devices has not only decreased the pain and anxiety of frequent peripheral access for intravenous (i.v.) therapy and blood sampling, but has decreased frequent trips to the clinics or hospitals that are otherwise often required. In recent years family members are using VADs more frequently at home for the delivery of medications.