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Superior and inferior vena caval occlusion in infants receiving total parenteral nutrition
1Department of Surgery, UCLA School of Medicine, CA 90024, USA.
Insights
Superior vena cava (SVC) occlusion is a serious complication of Broviac catheters in infants receiving total parenteral nutrition (TPN). Infusion via the inferior vena cava (IVC) presents fewer risks.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Neonatal Nutrition
Background:
- Broviac central venous catheters are crucial for long-term nutritional support in infants.
- Infants often require these catheters for conditions like malabsorption, short bowel syndrome, and intractable diarrhea.
- Vascular complications associated with central venous catheters can be severe in this population.
Purpose of the Study:
- To evaluate the incidence and outcomes of vena caval thrombosis in infants with Broviac catheters.
- To compare the complications of catheter insertion at different venous sites.
- To assess the risks associated with superior vena cava (SVC) versus inferior vena cava (IVC) thrombosis.
Main Methods:
- Retrospective analysis of 510 infants under 12 months receiving 756 Broviac catheter insertions over 23.5 years.
- Data collection on patient demographics, indications for catheterization, insertion sites, and catheter dwell times.
- Documentation and analysis of vena caval thrombosis events, including location (SVC, IVC, or both) and clinical outcomes.
Main Results:
- The majority of insertions (85%) were via the saphenous vein.
- Vena caval thrombosis occurred in 35 infants.
- Isolated IVC thrombosis had minimal symptoms, while SVC occlusion (isolated or combined) led to significant morbidity and mortality, including death in all cases of combined SVC and IVC thrombosis.
Conclusions:
- Superior vena cava (SVC) occlusion is a critical complication in infants receiving total parenteral nutrition (TPN) via Broviac catheters.
- Catheterization via the inferior vena cava (IVC) is associated with fewer and less severe complications compared to SVC access.
- Careful consideration of venous access site is essential to minimize risks in pediatric central venous catheterization.
Abstract:
During the past 23 1/2 years, 510 infants under 12 months of age had 756 Broviac central venous catheters inserted. At first catheter insertion 51 per cent of patients were less than 1 month old. Catheter function ranged from 3 to 1080 days (mean = 90 days). Sites of insertion were saphenous 85 per cent, external jugular 7 per cent, internal jugular 5 per cent, subclavian 2 per cent, cephalic 0.7 per cent, and transthoracic azygos 0.5 per cent. Eighty-nine patients had malabsorption syndromes, 86 had short bowel syndrome, 74 had intractable diarrhea, and 261 required nutritional support for other reasons. Vena caval thrombosis developed in 35 infants; 23 had inferior vena cava (IVC) occlusion (4.5% at risk); six had isolated superior vena cava (SVC) occlusion (11% at risk), and six had both SVC and IVC thrombosis. No major symptoms or complications resulted from isolated IVC thrombosis, whereas all infants with SVC occlusion developed head and neck swelling, 50 per cent developed pleural effusions, and two died. Each of six infants with combined IVC and SVC occlusion died within 6 months. We conclude that SVC occlusion is a very serious complication in infants receiving total parenteral nutrition (TPN) solutions and that infusion via the IVC has fewer and less serious complications.