Intracatheter nitroglycerin infusion fails to prevent catheter-related venous thrombosis: a randomized, controlled trial.
OBJECTIVE
Catheter-related thrombosis is a common problem in the pediatric intensive care unit. Strategies that reduce the incidence of thrombosis may have significant clinical advantage. Nitroglycerin (NTG) infusions release nitric oxide (NO). NO is responsible for much of the vasodilating and antithrombotic properties of the vasculature. We hypothesized that an intracatheter NTG infusion would reduce the incidence of catheter-related thrombosis.


METHODS
Prospective, randomized, controlled trial.


METHODS
Pediatric intensive care unit.


METHODS
Children of 6 years or less with femoral venous catheters who were not on antithrombotic therapy.


METHODS
Subjects were randomly assigned to NTG or control groups. NTG group patients received NTG at 0.1 mcg x kg x min in 5 % dextrose; control group patients received only 5 % dextrose. Infusions were delivered continuously through the catheter until the catheter was removed. Demographic data, physical and laboratory findings, catheter insertion attempts and infusate composition were recorded. Clinical evidence of vascular thrombosis or catheter malfunction was noted. Ultrasound examinations were performed within 2 days of catheter insertion and within 2 days after removal.


RESULTS
Forty-four patients (age 12.0 +/- 2.6 months) completed the study, 21 in the NTG group and 23 in the control group. Duration of catheter placement was 7.5 +/- 0.7 days. Twelve of 44 patients (27 %) had thrombi: 7/21 in the NTG group; 5/23 in the control group (p = NS). There were no significant differences between children with and without thrombi in age, gender, number of insertion attempts, duration of catheter placement, clinical signs of thrombosis or infections.


CONCLUSIONS
Catheter-related thrombosis is common after placement of femoral venous catheters in children. Low dose intracatheter NTG infusion does not protect against catheter-related venous thrombosis in children.
Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. jacobs@chmcc.org
B R
BR
Jacobs
L L
LL
Barr
R J
RJ
Brilli
K A
KA
Lyons
H R
HR
Wong
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D008297:Male; D005996:Nitroglycerin / Q000627:therapeutic use*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D018615:Ultrasonography, Doppler, Color; D014665:Vasodilator Agents / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D014665:Vasodilator Agents; D005996:Nitroglycerin