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Central Venous Catheter-associated Venous Thromboembolism in Children: A Prospective Observational Study
Aditya S Narayan1, Jaikumar Govindaswamy Ramamoorthy1, Narayanan Parameswaran1
1Department of Pediatrics.
Insights
Catheter-related thrombosis (CRT) affects over 40% of pediatric patients with central venous catheters (CVCs). Prolonged CVC duration is a significant risk factor for developing CRT in children.
Area of Science:
- Pediatric critical care medicine
- Vascular access and thrombosis
- Medical device-related complications
Background:
- Central venous catheters (CVCs) are essential in pediatric care but associated with complications.
- Catheter-related thrombosis (CRT) is a significant concern in children requiring CVCs.
- Understanding CRT risk factors in pediatric populations is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of CRT in pediatric patients undergoing CVC insertion.
- To identify risk factors associated with the development of CRT in this cohort.
- To compare CRT risk between different types of venous access devices.
Main Methods:
- Prospective study enrolling 104 pediatric patients (29 days to 18 years) with percutaneous non-tunneled CVCs.
- Diagnosis of CRT using ultrasonography with venous Doppler scan within 48 hours of CVC removal.
- Analysis of patient demographics, CVC duration, insertion indications, and outcomes.
Main Results:
- Catheter-related thrombosis (CRT) was observed in 43.3% of pediatric patients.
- The incidence rate of CRT was 35.69 per 1000 CVC days.
- Increased CVC duration was independently associated with a higher risk of CRT (OR, 1.06; 95% CI 1.0-1.1; P =0.02).
- A higher risk of symptomatic CRT was noted with central venous catheters compared to hemodialysis sheaths.
Conclusions:
- Catheter-related thrombosis is highly prevalent in pediatric patients with CVCs, with a majority being asymptomatic.
- The duration of CVC placement is a critical, independent risk factor for CRT development.
- Clinical vigilance and potentially shorter CVC dwell times are important for mitigating CRT risk in pediatric patients.
Abstract:
Our objective was to study the proportion of children developing Catheter-related thrombosis (CRT) following central venous Catheter (CVC) insertion and the risk factors of CRT in pediatric patients with CVC. One hundred four children aged 29 days to 18 years who had a percutaneous non-tunneled CVC inserted were enrolled. Ultrasonogram (USG) with venous Doppler scan was performed within 48 hours of CVC removal to diagnose CRT. The major indications for CVC insertion were surgical care 34 (32.6%) and ICU care 28(26.9%). The median age of the patients was 3 years, and 75% were males. The median number of CVC days was 10 (IQR 5.15). CRT was seen in 45(43.3%), of which 33 (73.3%) were asymptomatic. The rate of CRT was 35.69 cases per 1000 CVC days (95% CI 26.03-47.75). The number of days a catheter was in place and USG-guided catheter insertion was a significant risk factor. The multivariate logistic regression model showed that the duration of CVC in situ was independently associated with the development of CRT (OR, 1.06; 95% CI 1.0-1.1; P =0.02). CVC duration was a major risk factor for the development of CRT. There was a higher risk of developing a symptomatic CRT with central venous catheters than hemodialysis sheaths.
