Significant association with location of central venous line placement and risk of venous thrombosis in children

Christoph Male; Jim A. Julian; Patricia Massicotte; Michael Gent; Lesley Mitchell; for the PROTEKT Study Group

doi:10.1160/TH03-02-0091

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 94(03): 516-521
DOI: 10.1160/TH03-02-0091

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Significant association with location of central venous line placement and risk of venous thrombosis in children

Christoph Male

¹Children’s Hospital, Medical University of Vienna, Vienna, Austria

,

Jim A. Julian

²Henderson Research Centre, McMaster University, Hamilton, Canada

,

Patricia Massicotte

³Stollery Children’s Hospital, University of Alberta, Edmonton, Canada

,

Michael Gent

²Henderson Research Centre, McMaster University, Hamilton, Canada

,

Lesley Mitchell

³Stollery Children’s Hospital, University of Alberta, Edmonton, Canada

,

for the PROTEKT Study Group

› Author Affiliations

Abstract

Summary

Venous thromboembolic events (VTE) in children are frequently associated with central venous lines (CVL). Identifying risk factors related to CVL management could potentially minimize CVL-related thrombotic complications. The objectives of the study were to assess whether CVL location, type, size, and duration of placement are associated with the incidence of VTE in children. The study was a prospective, multicentre cohort study in a general pediatric population requiring CVL. Data on CVL characteristics were documented prospectively using standardized case report forms. Outcome assessments were by i) clinical monitoring for symptomatic VTE which were confirmed by appropriate objective test, or ii) screening by venography at study exit. Among 158 children, 21 (13%) hadVTE. The incidence of VTE was increased with femoral CVL (32%) and subclavian CVL (27%) compared to brachial CVL (12%) and jugular CVL (8%;p=0.01). The incidence ofVTE was independent of CVL type (peripherally inserted central catheters, untunneled CVL, tunneled exteriorized CVL, subcutaneous ports; p=0.90), and CVL size (CVL diameter, p=0.42; number of CVL lumen, p=0.58). The incidence of VTE did not increase with duration of CVL placement: 0–5 days (17% VTE), 6–20 days (19%), 21–35 days (10%), and 36–50 days (11%,p=0.68). The incidence of CVL-relatedVTE may be reduced by preferred placement of CVL in brachial or jugular veins. The choice of CVL type and size does not significantly influence the risk of VTE. Short-term CVL are associated with a similar risk of VTE as longer-term CVL.

Keywords

Central venous line - children - location - risk factors - venous thrombosis

Full Text

References

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