Elsevier

The Journal of Pediatrics

Volume 133, Issue 6, December 1998, Pages 770-776
The Journal of Pediatrics

Central venous catheter related thrombosis in children: Analysis of the Canadian Registry of Venous Thromboembolic Complications,☆☆,,★★

https://doi.org/10.1016/S0022-3476(98)70149-0Get rights and content

Abstract

Background: Central venous lines (CVLs) are frequently associated with deep venous thrombosis (DVT) in children; however, little is known about the epidemiologic characteristics or outcome of CVL-related DVT. Methods: The Canadian Childhood Thrombophilia Registry monitored 244 consecutive patients with objectively diagnosed CVL-related DVT for a median duration of 24 months (range 3 months to 7 years). Results: The incidence of CVL-related DVT was 3.5 per 10,000 hospital admissions. CVL-related DVTs were more frequent in the upper venous system. Ultrasonography or echocardiography were the most commonly used diagnostic tests (n = 183 patients). Venograms were performed on 82 (34%) patients. A variety of therapies were used. Thirty-nine children had pulmonary emboli, but most were not investigated for pulmonary emboli. Nine (3.7%) children died as a consequence of their thromboembolic disease. Recurrent DVT occurred in 16 (6.5%) children, and postphlebitic syndrome occurred in 23 (9.5%) children. Conclusion: Currently no uniform guidelines exist for the prevention and management of CVL-related DVT in children. The frequency and clinical consequences of CVL-related DVTs justify controlled trials of primary prophylaxis in children requiring central venous access. (J Pediatr 1998;133:770-6)

Section snippets

Participating Centers

The Canadian Childhood Thrombophilia Registry comprises 16 Canadian tertiary pediatric centers (Appendix). Patients in this report were entered from July 1, 1990 to December 31, 1996 for a total of 78 months.

A designated pediatric hematologist at each center maintained a prospective list of consecutive children with documented DVT referred to their service, prompted by a mailed reminder monthly. In addition, medical records in each institution used specific codes for thrombotic complications

RESULTS

Consecutive children with CVL-related DVT (n = 241) were entered into the registry and constituted 60% of the broader registry of all VTE (n = 405). The geographic distribution of patients reflected both the size of the participating institutions and centralization of resources in Canada. The median duration of follow-up was 24 months (range 3 months to 7 years). The total number of admissions per center during the time of the registry was used to calculate an incidence of CVL-related DVT in

DISCUSSION

The major complications of venous access lines are sepsis and CVL-related DVT.2 We reviewed our experience with a consecutive cohort of 244 children with CVL-related DVT. The mortality and morbidity rates associated with this complication support the need for prophylactic trials to prevent CVL-related DVT.

The incidence of CVL-related DVT in children in our study, 3.5 per 10,000 hospital admissions per year, is likely an underestimate. CVL-related DVTs accounted for 60% of all childhood DVTs

Acknowledgements

The authors acknowledge the directors of the Canadian Childhood Thrombophilia Program for their contribution to this study. The contributors are as follows: Kaiser Ali, Dorothy Barnard, Mark Bernstein, Linda Brisson, Michele David, Sunil Desai, Marie-Francis Scully, Jacqueline Halton, Sara Israels, Lawrence Jardine, Michael Leaker, Patricia McCusker, Marianna Silva, John Wu, Ron Anderson.

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    From the Canadian Childhood Thrombophilia Program, Hamilton Civic Hospital Research Centre, Hamilton, Ontario, Canada, and the Department of Haematology, Hospital for Sick Children, Toronto, Canada.

    ☆☆

    Supported from a grant-in-aid from the Heart and Stroke Foundation of Ontario. Dr. Andrew is a career scientist with the Heart and Stroke Foundation of Canada.

    Reprint requests: Maureen Andrew, MD, Hamilton Civic Hospitals Research Centre, 711 Concession St, Hamilton, Ontario, Canada L8V 1C3.

    ★★

    0022-3476/98/$5.00 + 0  9/21/94589

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