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Occlusion of the vena cava in infants receiving central venous hyperalimentation
Insights
Central venous catheters for total parenteral nutrition in infants can lead to vena cava thrombosis. However, this complication is rarely fatal and typically presents with minimal symptoms.
Area of Science:
- Pediatric Surgery
- Neonatology
- Vascular Surgery
Background:
- Central venous catheters are crucial for long-term nutritional support in infants.
- Total parenteral nutrition (TPN) is indicated for various gastrointestinal and post-operative conditions in neonates.
- Broviac catheters are commonly used for central venous access in this population.
Purpose of the Study:
- To evaluate the incidence and outcomes of vena cava thrombosis in infants receiving central venous hyperalimentation.
- To assess the complications associated with long-term central venous catheter use in neonates.
Main Methods:
- A retrospective review of 118 central venous catheters (Silastic, Broviac) inserted in 94 infants under one year of age over a five-year period.
- Analysis of catheter indications, insertion sites (saphenous, jugular veins), duration of use, and development of vena cava thrombosis.
- Documentation of clinical presentation, complications, and patient outcomes.
Main Results:
- Vena cava thrombosis occurred in 6 out of 94 infants (6.4%), with 5 involving the inferior vena cava and 1 the superior vena cava.
- Catheter duration ranged from 6 to 925 days (mean 104 days).
- Thrombosis presented insidiously with minimal extremity swelling; no pulmonary emboli were observed. Two patients died, but not due to vena cava thrombosis.
Conclusions:
- Vena cava thrombosis is a frequent, though rarely fatal, complication of long-term central venous hyperalimentation in infants.
- The complication is associated with remarkably few serious sequelae despite its common occurrence.
- Close monitoring for thrombosis is essential in infants with long-term central venous catheters.
Abstract:
During a five year period at UCLA Hospital, 118 Silastic, Broviac, central venous hyperalimentation catheters were inserted into 94 infants who were less than one year of age. The indications for total parenteral nutrition were malabsorption syndrome in 26, short bowel syndrome in 24, diarrhea in 15, nutritional support following operation in 11 and miscellaneous in 18. One hundren and two catheters were placed into the vena cava by way of the saphenous vein at the groin, and 16 were inserted through the external or internal jugular veins. The duration of catheter use varied from six to 925 days, a mean of 104 days. In six infants, obstruction of the vena cava developed, five in the inferior vena cava and one in the superior vena cava. Swelling of the extremity was minimal, and the thrombosis was insidious in each patient. None of the patients had pulmonary emboli. Although two of the six patients eventually died, in neither was thrombosis of the cava believed to be related. Thrombosis of the vena cava is a frequent sequela of long term central venous hyperalimentation in infants, but it is rarely fatal and produces remarkably few serious complications.