Thrombotic complications of saphenous central venous lines

doi:10.1016/0022-3468(94)90805-2

Journal of Pediatric Surgery

Volume 29, Issue 9, September 1994, Pages 1218-1219

https://doi.org/10.1016/0022-3468(94)90805-2 Get rights and content

Abstract

Authors of recent publications advocate central venous access by saphenous vein cutdown in the thigh. Even relatively inert SILASTIC^® catheters are recognized to convey a risk of large vein thrombosis when mainteined for long periods. Thrombosis of the inferior vena cava (IVC) and tributaries place the patient at risk for a spectrum of problems not associated with superior vena cava (SVC) cannulation. The authors describe 46 neonatal intensive care patients with central venous cannulation of more than 2 weeks' duration. Prospective monitoring by ultrasound yielded a thrombosis rate of 16.6% for SVC cannulation and 28.5% for IVC cannulation. Complete occlusion of the IVC was clinically apparent and confirmed radiographically in four patients. In another patient, bilateral renal vein thrombosis developed, which contributed to her death. The authors compare their data for IVC and SVC cannulation and question whether the saphenous vein should be a primary route.

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Cited by (32)

Do asymptomatic clots in children matter?
2020, Thrombosis Research
Citation Excerpt :
Nine studies reported the incidence of A-VTE either in a cohort of neonates or a sub-group of neonates within in larger sample of children [13,33,39–45]. Only two of these studies identified A-VTE through prospective screening [13,40]. An RCT, comparing the rate of VTE between long-term and short-term use of umbilical vein catheters, had a rate of VTE of 5% among 210 infants, with no significant difference in the rate of thrombi between groups.
Asymptomatic venous thrombosis is a common complication among hospitalised paediatric patients. Previous guidelines recommend the treatment of all asymptomatic venous thrombosis, even when the diagnosis is made incidentally or the risk factor is no longer present. Whether clinicians need to treat all asymptomatic thrombosis in children, given the likelihood of long-term sequelae, is unclear and there are significant risks associated with anticoagulation treatment. Asymptomatic thrombosis in children is most frequently associated with central venous catheters (CVCs). The incidence of asymptomatic CVC-related VTE is highest in cohorts of children with cancer, but also reported in neonates, children with congenital heart disease and critically ill children. There is significant variation in reported rates of CVC-related thrombosis among cohorts of children with different underlying diseases and of various ages. As asymptomatic thrombosis is often an incidental finding, rates of asymptomatic VTE in children are most likely underestimated. Evidence about the incidence, characteristics and long-term outcomes associated with asymptomatic thrombosis in children often lacks precision as data is presented collectively with symptomatic thrombosis. This review discusses the current evidence pertaining to the necessity for screening for asymptomatic thrombosis, the risk benefit ratio of treatment and the risk of long-term morbidity. To confidently determine the clinical significance of asymptomatic VTE in children, prospective studies with extended follow up are needed.
Major thrombotic complications with lower limb PICCs in surgical neonates
2015, Journal of Pediatric Surgery
Citation Excerpt :
The PICCs were all placed near at the time of NICU admission and increase in length of the patient was likely substantial during their NICU course. The incidence of VTE in the newborn depends on the zeal with which surveillance is performed, the timing and frequency of monitoring, and the diagnostic method used [7–10,23]. Assessment for VTE is variable and controversial: use of clinical signs alone, plain XR, ultrasound or venography.
PICC lines are now used routinely to provide central access for neonatal intensive care unit (NICU) patients. Neonates are known to be at risk for venous thromboembolism (VTE) related to central catheters. No literature exists about VTE PICC-related morbidity in the NICU abdominal surgery subgroup.
With REB approval, a retrospective review of a NICU database of PICC insertions performed at a tertiary children's hospital was conducted (January 2010–June 2013). Information about PICCs and complications was recorded. For patients with a major thrombotic complication, charts were reviewed. A major thrombotic complication was defined as a thrombosis which required medical and/or surgical intervention.
692 PICCs were inserted (485 in the upper extremity, 142 in the lower extremity, and 65 in the scalp). Seventy-four patients had significant intraabdominal pathology, and 5 had a major thrombotic complication. All patients with a major thrombotic complication had a lower extremity PICC which was at or below L1 (L1-S1) running parenteral nutrition.
In the current study, only neonates with abdominal pathology and a lower extremity insertion site suffered major thrombotic complications from PICC lines. Given all patients' PICC tips were below the recommended location, more rigorous surveillance (with repositioning if required) may avoid these complications for future patients.
Central venous catheter-related thrombosis and thromboprophylaxis in children: A systematic review and meta-analysis
2014, Journal of Thrombosis and Haemostasis
In preparation for a pediatric randomized controlled trial on thromboprophylaxis, we determined the frequency of catheter‐related thrombosis in children. We also systematically reviewed the pediatric trials on thromboprophylaxis to evaluate its efficacy and to identify possible pitfalls in the conduct of these trials.
We searched MEDLINE, EMBASE, Web of Science and the Cochrane Central Register for Controlled Trials for articles published until December 2013. We included cohort studies and trials on patients aged 0–18 years with central venous catheters who underwent active surveillance for thrombosis with radiologic imaging. We estimated the pooled frequency of thrombosis and the pooled risk ratio (RR) with thromboprophylaxis by using a random effects model.
From 2651 articles identified, we analyzed 37 articles with 3128 patients. The pooled frequency of thrombosis was 0.20 (95% confidence interval [CI] 0.16–0.24). In 10 trials, we did not find evidence that heparin‐bonded catheters (RR 0.34; 95%CI 0.01–7.68), unfractionated heparin (RR 0.93; 95% CI 0.57–1.51), low molecular weight heparin (RR 1.13; 95% CI 0.51–2.50), warfarin (RR 0.85; 95%CI 0.34–2.17), antithrombin concentrate (RR 0.76; 95% CI 0.38–1.55) or nitroglycerin (RR 1.53; 95%CI 0.57–4.10) reduced the risk of thrombosis. Most of the trials were either not powered for thrombosis or were powered to detect large, probably unachievable, reductions in thrombosis. Missing data on thrombosis also limited these trials.
Catheter‐related thrombosis is common in children. An adequately powered multicenter trial that can detect a modest, clinically significant reduction in thrombosis is critically needed. Missing outcome data should be minimized in this trial.
Combined endovascular and surgical recanalization after central venous catheter-related obstructions
2008, Journal of Pediatric Surgery
Citation Excerpt :
Superior vena cava syndromes occur after a severe decrease in venous return from the upper part of the body. Obstructions resulting from a decrease in blood flow can be intraluminal (obstructed catheter, thrombosis, stenosis) or extraluminal (compressive mass) [1,2]. The CVC-related obstructions are a challenging but well-known complication in children who are dependent on central venous access [3,4].
Central venous occlusion in children is a challenging problem that can occur after a central venous catheter insertion. Long-term catheter-related complications include sepsis and venous thrombosis with consequent loss of central access. We describe 2 cases of children younger than 1 year who were dependent on a central venous catheter for total parenteral nutrition. They developed a chronic extensive obstruction of the right and left brachiocephalic veins with a superior vena cava syndrome. The patients' survival was dependent on the restoration of central venous access until the planned intestinal transplantation could be performed. Retrograde recanalization of the superior vena cava was successfully achieved using a pathway created under general anesthesia from the femoral vein to, respectively, the right thyroid vein and the right subclavian vein.
Scrotal edema: A rare complication of percutaneous central venous atheters
2006, Anales de Pediatria
El uso de catéteres venosos centrales de acceso periférico percutáneo tipo sylastic, es cada vez más habitual en las unidades de cuidados intensivos neonatales. Numerosos estudios avalan la eficacia y seguridad del uso de estos catéteres para la infusión de nutrición parenteral o fármacos. Se describe un prematuro de 32 semanas que presenta al quinto día de vida tumefacción en genitales externos e inicialmente se orienta el cuadro como infeccioso. Revisando las radiografías, se observa introducción del catéter sylastic hasta los vasos espermáticos. Con la retirada del catéter desaparece la tumefacción en pocas horas. Las complicaciones más frecuentemente descritas asociadas a catéteres venosos centrales percutáneos son las infecciosas. Otras complicaciones son: trombosis, embolismo y perforación del catéter con salida de líquido al espacio extravascular. El caso que presentamos es una rara complicación, no descrita anteriormente, consecuencia de un mal posicionamiento de la punta del catéter. Una demora diagnóstica puede tener complicaciones graves.
The use of percutaneous central venous catheters in neonatal intensive care units is becoming increasingly common. Numerous studies support the safety and effectiveness of the use of these catheters for the infusion of parenteral nutrition or medication. We describe a male patient with a gestational age of 32 weeks who showed swelling of the external genitals during the fifth day of life. The etiology was initially thought to be infectious. A review of X-rays revealed the introduction of the silastic catheter to the spermatic vessels.
When the catheter was withdrawn, the genital swelling disappeared in a few hours. The most frequently described complications associated with percutaneous central venous catheters are infectious. Other complications that have been described are thrombosis, embolism, and perforation of the catheter with leakage of fluid to the extravascular space. The case described herein is an unusual complication that has not been previously described and resulted from poor positioning of the catheter tip. Diagnostic delay can cause serious complications.
Venous Disorders in Childhood
2006, Pediatric Surgery: Sixth Edition

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^☆: Presented at the 25th Annual Meeting of the Canadian Association of Paediatric Surgeons, Victoria, British Columbia, September 13–15, 1993.

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Thrombotic complications of saphenous central venous lines☆

Abstract

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg