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Thrombotic complications of central venous catheters in children
Janna M Journeycake1, George R Buchanan
1Department of Pediatrics, Division of Hematology/Oncology, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA. Janna.Journeycake@utsouthwestern.edu
Insights
Central venous catheters are vital for treating sick children but can cause dangerous blood clots. Research highlights that up to 50% of pediatric patients develop these clots, often without symptoms.
Area of Science:
- Pediatric critical care medicine
- Vascular access device management
- Thrombosis research
Background:
- Central venous catheters (CVCs) are essential for managing chronic childhood conditions and critically ill infants/children.
- CVCs are linked to complications like thrombosis, catheter dysfunction, and major vein occlusion.
- Vein occlusion can lead to serious outcomes such as pulmonary embolism and postthrombotic syndrome.
Purpose of the Study:
- To review current research on risk factors for catheter-related thrombosis (CRT) in pediatric patients.
- To explore diagnostic methods for deep venous thrombosis (DVT) associated with upper extremity CVCs.
- To highlight the limited data on CRT prevention, treatment, and long-term outcomes in children.
Main Methods:
- Literature review focusing on pediatric studies concerning CVCs and thrombosis.
- Analysis of existing evidence on risk factors and diagnostic approaches for CRT.
- Synthesis of data on the incidence, clinical presentation, and sequelae of CRT in children.
Main Results:
- Evidence suggests up to 50% of children with CVCs develop DVT, frequently asymptomatic.
- Research is actively identifying risk factors and diagnostic tools for pediatric CRT.
- Significant gaps exist in clinical trial data for CRT prevention and treatment strategies in this population.
Conclusions:
- While CVCs are indispensable in pediatric supportive care, their safety profile requires ongoing attention.
- Further research is crucial to address the incidence, prevention, and management of CRT in children.
- Understanding and mitigating CRT risks are vital for improving long-term outcomes in pediatric patients requiring CVCs.
Abstract:
Use of central venous catheters has become standard in the treatment of many chronic conditions during childhood and for the acute treatment of critically ill infants and children. However, these catheters can be associated with numerous complications, including thrombosis at the tip or in the lumen causing difficulty with its overall function. Even more concerning is the occlusion of large veins into which the catheter is placed, which could predispose patients to pulmonary embolism or postthrombotic syndrome. Recent research has focused on identifying risk factors for catheter-related thrombosis in children and determining methods for diagnosing deep venous thrombosis associated with a catheter in the upper extremities. Evidence now exists that as many as 50% of children with catheters develop deep venous thrombosis; however, most events are clinically silent. Few clinical trials have studied prevention of catheter-related thrombosis in pediatric patients. Data regarding incidence, treatment, and long-term outcome of catheter-related thrombosis in children are limited. Although central venous catheters are extremely important in the supportive care of sick children, concerns remain about their immediate and long-term safety.