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Central Venous Catheter-Related Deep Vein Thrombosis in the Pediatric Cardiac Intensive Care Unit

Emily H Steen1, Javier J Lasa2, Trung C Nguyen2

  • 1Department of Surgery, Baylor College of Medicine, Houston, Texas; Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.

The Journal of Surgical Research
|April 27, 2019
PubMed

Insights

Central venous catheter (CVC) use in critically ill children with congenital heart disease increases deep vein thrombosis (DVT) risk. Identifying CVC-related DVTs and risk factors is crucial for improving outcomes in pediatric cardiac intensive care units.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Vascular Thrombosis

Background:

  • Central venous catheters (CVCs) are frequently used in critically ill children, particularly those with congenital heart disease.
  • Deep vein thrombosis (DVT) is a known complication of CVCs, but data specific to pediatric cardiac intensive care units (CICUs) are limited.
  • CVC-related DVTs carry significant morbidity and mortality in this vulnerable population.

Purpose of the Study:

  • To determine the incidence of CVC-related DVT in critically ill children with congenital heart disease.
  • To identify risk factors associated with DVT development in this patient cohort.
  • To understand the impact of DVT on patient outcomes within the CICU.

Main Methods:

  • Retrospective review of the PC4 database and radiologic imaging database at Texas Children's Hospital.
  • Analysis of patient demographics, CVC placement details, and DVT incidence and complications.
  • Statistical analysis to identify significant risk factors for DVT.

Main Results:

  • DVT was diagnosed in 8% of admissions with a CVC (1215 lines over 851 admissions).
  • Significant risk factors included multiple lines, increased line hours, prolonged intubation, extended CICU stay, low cardiac output syndrome, sepsis, central line-associated bloodstream infection, and cardiac catheterization.
  • Cardiac surgery with cardiopulmonary bypass showed a protective effect against clot formation.
  • DVT was a significant risk factor for mortality.

Conclusions:

  • CVC-related DVTs in pediatric congenital heart disease patients are linked to increased morbidity and mortality.
  • There is a critical need for further research to develop preventative and treatment strategies.
  • Establishing guidelines for monitoring and follow-up of these patients is essential.
Abstract

Keywords:
Central venous catheter(s)Congenital heart diseaseCritical careDeep vein thrombosis (DVT)Venous thrombus

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