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Venous thrombosis and stenosis after peripherally inserted central catheter placement in children
H Stella Shin1, Alexander J Towbin2, Bin Zhang3
1Division of Pediatric Nephrology, Emory University, 2015 Uppergate Dr. NE, Atlanta, GA, 30322, USA. stella.shin@emory.edu.
Insights
Peripherally inserted central catheters (PICCs) in children can lead to venous thrombosis and/or stenosis. A history of central venous catheters (CVCs) nearly doubles the risk of developing these complications after PICC placement.
Area of Science:
- Pediatric Medicine
- Vascular Access
- Medical Device Complications
Background:
- Peripherally inserted central catheters (PICCs) are crucial for long-term therapies in children with chronic conditions.
- Venous thrombosis and/or stenosis are known complications of PICCs, potentially limiting essential treatments.
- Limited research exists on PICC-associated venous complications in pediatric populations.
Purpose of the Study:
- To determine the incidence of venous thrombosis and/or stenosis following PICC placement in children.
- To identify risk factors associated with the development of these vascular complications.
Main Methods:
- Retrospective review of pediatric patients (ages 1-18) who received PICCs between 2010 and 2013.
- Inclusion criteria required at least one vascular imaging study of the ipsilateral extremity post-PICC placement.
- Logistic regression analysis was used to identify risk factors.
Main Results:
- The incidence of venous thrombosis and/or stenosis was 26.3% in the imaged cohort.
- PICC characteristics (laterality, site, duration, size ratio, number) and patient diagnosis did not predict complications.
- Prior exposure to non-PICC central venous catheters (CVCs) was associated with a nearly two-fold increased risk (OR 1.95).
Conclusions:
- Over a quarter of pediatric patients studied developed previously unrecognized venous thrombosis and/or stenosis after PICC placement.
- A history of CVC use is a significant risk factor for developing venous complications post-PICC.
- Judicious use of PICCs and CVCs is recommended, particularly for children with chronic conditions requiring lifelong vascular access.
Background:
Peripherally inserted central catheters (PICCs) can lead to development of venous thrombosis and/or stenosis. The presence of venous thrombosis and/or stenosis may preclude children with chronic medical conditions from receiving lifesaving therapies, from hemodialysis in end-stage renal disease to total parenteral nutrition in short bowel syndrome. Several adult studies have found an association between PICCs and venous thrombosis and/or stenosis, but none has evaluated for this association in children.
Objective:
To determine the incidence of venous thrombosis and/or stenosis after PICC placement and identify factors that increase the risk of venous thrombosis and/or stenosis after PICC placement in children.
Materials And Methods:
We conducted a retrospective review of children ages 1-18 years with a PICC placed between January 2010 and July 2013 at our center, and included those who had at least one vascular imaging study of the ipsilateral extremity (Doppler ultrasound, venogram or MR angiogram) after PICC placement. Logistic regression was applied to determine risk factors for development of venous thrombosis and/or stenosis.
Results:
One thousand, one hundred and ten upper extremity PICCs were placed, with 703 PICCs in the right and 407 PICCs in the left. Eight hundred fifty-one imaging studies (609 Doppler ultrasounds, 193 contrast venograms and 49 MR angiograms) were performed in 376 patients. The incidence of venous thrombosis and/or stenosis in the imaged cohort was 26.3%. PICC laterality, insertion site, duration, patient height to PICC diameter ratio, and number of PICCs per patient were not associated with development of venous thrombosis and/or stenosis. Additionally, primary diagnosis and symptoms at the time of imaging did not predict findings of venous thrombosis and/or stenosis. However, patients exposed to non-PICC central venous catheters (CVC) were more likely to develop venous thrombosis and/or stenosis (odds ratio 1.95, 1.10-3.45).
Conclusion:
More than a quarter of the vascular imaging studies performed in this study cohort showed previously unknown venous thrombosis and/or stenosis, irrespective of PICC laterality, insertion site, duration and size and the number of PICCs. A history of CVC was associated with a nearly two-fold increase in risk of venous thrombosis and/or stenosis after PICC placement. We suggest that PICCs and CVCs should be placed judiciously in all children, but especially in those with lifelong medical conditions who are more likely to incur direct consequences from limited vascular access.
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