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Thrombus associated with central venous catheters in infants and children
P Ross1, R Ehrenkranz, C S Kleinman
1Department of Surgery, Yale University School of Medicine, New Haven, CT 06510.
Insights
Catheter tip thrombus occurred in 16 pediatric patients, particularly premature infants receiving total parenteral nutrition (TPN). Incidence is higher than suspected but low in asymptomatic patients, necessitating individualized treatment.
Area of Science:
- Pediatric Cardiology
- Vascular Access Devices
- Echocardiography
Background:
- Silicone central catheters are used for long-term venous access in infants and children.
- Catheter-related thrombus is a potential complication.
Purpose of the Study:
- To investigate the incidence and characteristics of catheter tip thrombus in pediatric patients.
- To evaluate treatment outcomes for catheter tip thrombus.
Main Methods:
- Retrospective review of 350 pediatric patients with central catheters from 1978 to 1987.
- Real-time echocardiography to detect catheter tip thrombus.
- Analysis of patient demographics, catheter use, indications for echocardiography, and treatment strategies.
Main Results:
- Catheter tip thrombus was identified in 16 patients (4.6%), predominantly premature infants (12/16) receiving total parenteral nutrition (TPN).
- Indications for echocardiography included sepsis, respiratory insufficiency, and evaluation of heart disease.
- Treatment varied, including thrombolysis, catheter removal, and observation; conservative management showed positive outcomes.
- Asymptomatic patients (47) showed no identifiable thrombus, suggesting a low incidence in this group.
Conclusions:
- Catheter tip thrombus incidence is higher than previously suspected, linked to prematurity, TPN, and continuous catheter use.
- Treatment should be individualized, with a trend towards more conservative approaches.
- Asymptomatic patients have a low incidence of thrombus, indicating the value of screening in select cases.
Abstract:
From 1978 to 1987, 350 infants and children had silicone central catheters placed for long-term venous access. Real time echocardiography showed a catheter tip thrombus in 16 patients, including 12 premature infants and four children. Catheters had been in place for eight to 560 days. Thirteen patients were receiving total parenteral nutrition (TPN) at the time thrombus was identified, and one patient had received TPN 2 weeks previously. Indications for echocardiography included sepsis (7), respiratory insufficiency (6), evaluation of heart disease (3), and catheter malfunction (1); several patients had multiple indications. Treatment was individualized and included atriotomy (2), systemic heparin and thrombolytic agents with or without catheter removal (8), catheter removal only (3), and observation (3). Four of eight patients treated with thrombolysis had complete clot lysis and four had partial dissolution. Two patients managed expectantly had resolution of the thrombus. None of the patients suffered further complications or died as a result of the thrombus, but ten of the 16 died 1 to 12 weeks later from their underlying disease. Forty-seven asymptomatic patients were studied by echocardiography to assess the incidence of unsuspected right atrial thrombus. Their catheters had been in place for a mean of 200 days and only 11 had been used for TPN. None of these patients had identifiable thrombus at the catheter tip. The incidence of catheter tip thrombus, which is higher than previously suspected, is related to prematurity, TPN, and continuous catheter use, but not duration of catheterization. The incidence is low in asymptomatic patients. Treatment regimen must be individualized and this series reflects a trend toward more conservative management.