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Thrombosis and embolism in long-term central venous access for parenteral nutrition
C M Dollery1, I D Sullivan, O Bauraind
1Cardiothoracic Unit, Hospital for Sick Children, London, UK.
Insights
Long-term central venous catheters in children receiving parenteral nutrition can lead to serious blood clots and pulmonary embolism. Anticoagulation therapy is advised to prevent these potentially fatal complications.
Area of Science:
- Pediatric Medicine
- Cardiovascular Medicine
- Critical Care
Background:
- Silicone catheters are widely used for long-term central venous access.
- Complications like pulmonary thromboembolism are not well understood in this context.
Purpose of the Study:
- To investigate the incidence of major thrombosis and pulmonary embolism in children with gut failure undergoing long-term parenteral nutrition.
Main Methods:
- Studied 34 children and adolescents with gut failure on parenteral nutrition.
- Evaluated clinical events, lung perfusion scans, and echocardiographic findings.
- Follow-up ranged from 2 months to 9 years.
Main Results:
- Major thrombosis and/or embolism occurred in 12 patients (35%).
- Four patients died due to these complications.
- Actuarial survival free from thrombosis was 53% at 5 years; survival free from fatal pulmonary embolism was 74% at 5 years.
- Three patients required surgical intervention for thrombus removal.
Conclusions:
- Major right atrial thrombosis and pulmonary embolism are frequent and life-threatening complications.
- Long-term central venous access for parenteral nutrition in children necessitates consideration of anticoagulation.
Abstract:
Although the use of silicone catheters for long-term central venous access is widespread, little is known about the incidence of pulmonary thromboembolic complications. We studied clinical events, lung perfusion scans, and echocardiographic screens in 34 children and adolescents with gut failure who had received cyclical parenteral nutrition for 2 months to 9 years. Major thrombosis and/or embolism was identified in 12 patients and 4 died as a consequence. Actuarial survival free from thrombosis was 53% at 5 years (95% Cl, 30-77%). Survival free from fatal pulmonary thromboembolic events was 74% at 5 years (48-99%). 3 patients required surgery to remove right atrial thrombus or pulmonary emboli. Major right atrial thrombosis and pulmonary embolism are common and potentially fatal complications of parenteral nutrition by long-term venous access in childhood. Anticoagulation is recommended.