Upper body peripherally inserted central catheter in pediatric single ventricle patients

Area of Science:

• Pediatric Cardiology
• Vascular Surgery
• Critical Care Medicine

Background:

• Superior vena cava (SVC) stenosis and thrombosis are risks after central catheter replacement, particularly impacting children with single ventricle physiology.
• These complications can hinder access to life-sustaining palliative surgeries in this vulnerable population.

Purpose of the Study:

• To investigate complications, specifically stenosis and thrombosis, associated with upper extremity percutaneous intravenous central catheters (PICCs) in pediatric patients with single ventricle physiology.
• To assess the incidence and outcomes of venous complications in this patient group prior to superior cavopulmonary anastomosis.

Main Methods:

• Retrospective review of univentricular patients undergoing superior cavopulmonary anastomoses (January 2014-December 2018).
• Analysis of clinical data, including ultrasonography, cardiac catheterization, and echocardiogram reports, to identify upper extremity and cervical vessel thrombus or stenosis.
• Recording of data on the presence, duration, and anticoagulation use for upper extremity PICCs and central venous catheters (CVCs).

Main Results:

• Of 76 patients, 56 (73%) had upper extremity PICCs prior to surgery (median duration 24 days).
• Thrombus was detected in 4% of PICCs and 18% of CVCs; all patients received anticoagulation, with resolution in 3 of 5 cases.
• No clinically significant venous stenosis was observed.

Conclusions:

• Upper extremity PICCs in single ventricle physiology patients before superior cavopulmonary anastomosis are associated with a low incidence of catheter-associated thrombosis.
• The findings suggest that PICCs can be used with a relatively low risk of thrombotic complications in this specific pediatric population.