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Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children

Julie Jaffray1, Char Witmer2, Sarah H O'Brien3

  • 1Children's Hospital Los Angeles, Los Angeles, CA.

Blood
|January 8, 2020
PubMed

Insights

Peripherally inserted central catheters (PICCs) in children show higher risks of venous thromboembolism (VTE), bloodstream infections, and malfunctions compared to tunneled lines (TLs). Careful consideration of central venous catheter (CVC) use is advised due to these complications.

Area of Science:

  • Pediatric Thrombosis and Vascular Access Devices
  • Infectious Disease Epidemiology in Children
  • Medical Device Complication Analysis

Background:

  • Increasing incidence of pediatric venous thromboembolism (VTE), largely associated with central venous catheters (CVCs).
  • Significant rise in the utilization of peripherally inserted central catheters (PICCs) among pediatric patients.

Purpose of the Study:

  • To evaluate and compare the incidence of VTE, central line-associated bloodstream infections (CLABSIs), and catheter malfunctions between PICCs and tunneled lines (TLs) in children.
  • To identify risk factors associated with CVC-related VTE in the pediatric population.

Main Methods:

  • Multicenter, prospective, observational cohort study.
  • Enrollment of pediatric patients (6 months to 18 years) with newly placed PICCs or TLs.
  • Analysis of 1967 CVCs to assess VTE, CLABSI, and malfunction rates.

Main Results:

  • Overall CVC-related VTE incidence was 5.9%, with 80% occurring in PICCs.
  • PICCs demonstrated a significantly higher risk of catheter-related VTE (HR=8.5), CLABSI (HR=1.6), and CVC malfunction (HR=2.0) compared to TLs.
  • Prior VTE history (HR=23), multilumen CVCs (HR=3.9), and leukemia (HR=3.5) were identified as risk factors for CVC-related VTE.

Conclusions:

  • Pediatric patients with PICCs experience a significantly higher incidence of VTE, CLABSI, and CVC malfunction than those with TLs.
  • The findings underscore the need for careful consideration before placing CVCs, particularly PICCs, due to associated serious complications.
  • Further research into optimizing CVC selection and management in pediatric populations is warranted.

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