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Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and
Lingyun Tian1,2, Wan Li1, Yanan Su1
1Xiangya Nursing School, Central South University, Changsha, China.
Insights
Hospitalized children with a history of thrombosis, gastrointestinal/liver disease, or cancer face higher central venous access device-related thrombosis (CVAD-RT) risks. Certain treatments and CVAD types significantly influence this risk, necessitating better risk assessment tools.
Area of Science:
- Pediatric Thrombosis
- Vascular Access Devices
- Healthcare-Associated Infections
Background:
- Central venous access devices (CVADs) are crucial for managing critically ill children but are associated with significant complications.
- Central venous access device-related thrombosis (CVAD-RT) is a serious complication that can lead to morbidity and mortality in pediatric patients.
- Identifying risk factors for CVAD-RT is essential for developing targeted prevention strategies.
Purpose of the Study:
- To systematically identify patient-, treatment-, and CVAD-related factors associated with the risk of central venous access device-related thrombosis (CVAD-RT) in hospitalized children.
- To provide evidence for the development of risk stratification tools for CVAD-RT in pediatric populations.
Main Methods:
- A comprehensive systematic literature search was performed across multiple databases, including PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP.
- Data analysis was conducted using RevMan 5.3 and Stata 12.0 statistical software to assess the associations between various factors and CVAD-RT risk.
- Meta-analysis techniques were employed to pool data and calculate odds ratios (OR) and confidence intervals (CI) for identified risk factors.
Main Results:
- Patient factors like a history of thrombosis (OR=3.88), gastrointestinal/liver disease (OR=1.85), hematologic disease (OR=1.45), and cancer (OR=1.58) increased CRT risk.
- Treatment factors such as parenteral nutrition (OR=1.70), hemodialysis (OR=2.17), ECMO (OR=1.51), and cardiac catheterization (OR=3.92) were associated with higher risk, while antibiotics showed a protective effect (OR=0.46).
- CVAD-related factors including peripherally inserted central catheters (OR=1.81), totally implantable ports (OR=2.81), multiple lumens (OR=3.71), central line-associated bloodstream infection (OR=2.66), and catheter malfunction (OR=1.65) elevated CRT risk, whereas subclavian vein catheterization was associated with lower risk (OR=0.36).
Conclusions:
- Specific patient characteristics, treatments, and CVAD configurations significantly impact the risk of thrombosis in hospitalized children.
- Understanding these risk factors is crucial for developing effective risk assessment tools and implementing targeted preventive measures.
- Further research focusing on these identified factors can lead to improved management and reduced incidence of CVAD-RT in pediatric care.
Objective:
To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children.
Methods:
A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis.
Results:
In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57-5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99-3.46), hematologic disease (OR = 1.45, 95% CI: 1.06-1.99), and cancer (OR = 1.58, 95% CI: 1.01-2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21-2.39), hemodialysis (OR = 2.17, 95% CI: 1.34-3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31-1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06-14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32-0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15-2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41-5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14-0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01-5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99-6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15-6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07-2.54) were associated with an increased CRT risk.
Conclusion:
The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.
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