Related Experiment Video
Updated: Jan 19, 2026
Author Spotlight: Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model
Published on: March 31, 2023
Symptomatic catheter-associated thrombosis in pediatric trauma patients: Choose your access wisely
Cory M McLaughlin1, Erica N Barin1, Michael Fenlon2
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Femoral venous catheters in critically injured children are linked to higher rates of symptomatic thrombosis. Avoid femoral sites for central venous access in pediatric trauma patients when possible.
Area of Science:
- Pediatric critical care medicine
- Vascular access and thrombosis
- Trauma surgery
Background:
- Traumatic injury and central venous catheters are key risk factors for pediatric venous thromboembolism.
- Previous studies highlight the need to understand catheter-associated thrombosis in critically injured children.
Purpose of the Study:
- To determine the incidence of symptomatic, catheter-associated thrombosis in critically injured children.
- To compare the rate of thrombotic complications between femoral and non-femoral central venous catheters.
Main Methods:
- Retrospective cohort study of 209 pediatric trauma patients (2006-2016) with central venous access.
- Analysis of radiographic evidence for symptomatic catheter-associated thrombosis.
- Poisson regression to compare incidence per 1,000 catheter days between femoral and non-femoral catheters.
Main Results:
- Femoral catheters (65% of cases) were larger and removed earlier than non-femoral catheters.
- Catheter-associated thrombosis occurred more frequently with femoral catheters (18.4 per 1,000 catheter days) compared to non-femoral (3.5 per 1,000 catheter days).
- The difference in thrombosis incidence was statistically significant (P = .01).
Conclusions:
- Femoral venous catheters are associated with a significantly higher incidence of symptomatic thrombosis in pediatric trauma patients.
- The femoral site should be avoided for central venous access in injured children.
- Consider smaller diameter catheters if femoral venous access is necessary.
Background:
Traumatic injury and the presence of a central venous catheter are 2 of the strongest risk factors for venous thromboembolism in children. The purpose of this study was to determine the incidence of symptomatic, catheter-associated thrombosis in critically injured children. We hypothesized that femoral venous catheters are associated with a greater rate of thrombotic complications when compared with all other central venous access points.
Methods:
We reviewed a retrospective cohort (2006-2016) of injured children (≤18 years) admitted to a pediatric intensive care unit with central access placed ≤7 days from admission. Symptomatic, catheter-associated thrombosis was determined by radiographic evidence. Poisson regression was used to compare the incidence of catheter-associated thrombosis per 1,000 catheter days between femoral and nonfemoral catheters. All comparisons were 2-tailed with α = 0.05.
Results:
We examined 209 pediatric trauma patients with central access (65% femoral, 19% subclavian, 11% arm vein, and 5% internal jugular). Femoral catheters were removed earlier (median [interquartile range] 4 [2-7] vs 8 [3-12] days, P < .001) and were larger in diameter (5 Fr [4-7] vs 4 Fr [4-4], P < .001) when compared with all other catheters. Catheter-associated thrombosis was more frequent in femoral versus nonfemoral catheters (18.4 vs 3.5 per 1,000 catheter days, P = .01).
Conclusion:
Femoral venous catheters are associated with a greater incidence of symptomatic, catheter-associated thrombosis in pediatric trauma patients. When central venous access is indicated for injured children, the femoral site should be avoided. If a femoral venous catheter is necessary, use of a smaller catheter should be considered.
Related Concept Videos
08:51Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model
05:31Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
10:02Whole-body PET/MRI of Pediatric Patients: The Details That Matter
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
08:14Central Venous Catheter Insertion: Subclavian Vein
Central venous access is necessary in a multitude of clinical situations for hemodynamic monitoring, medication delivery, and blood sampling. There are three veins in the body that are accessed for central venous cannulation: the internal jugular, the subclavian, and the femoral vein.
Central venous access via the subclavian vein has several advantages over other possible locations. The subclavian...
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution