title: Evaluation of pediatric oncology patients with previous multiple central catheters for vascular access: is Doppler ultrasound needed?
abstract: OBJECTIVE
  Pediatric oncology patients who have undergone placement of multiple central venous catheters may have thrombosis or stenosis in the upper venous system. The purpose of this study was to identify factors that predict venous thrombosis or stenosis and to evaluate the role of Doppler ultrasonography in assessing the upper venous system of pediatric patients requiring multiple central vascular catheters.
  
  
  METHODS
  The medical records of eligible patients were reviewed with regard to demographics, primary disease, type of catheter, duration of previous central venous access, association with infection, operative notes, and Doppler ultrasonographic findings.
  
  
  RESULTS
  Our evaluation criteria were met in 50 cases (47 patients). In 10 cases, Doppler ultrasonography revealed abnormality in the upper venous system. Patient demographics, primary disease, type of catheter, duration of previous central venous access, or association with infection were not found to significantly predict the abnormality in the upper venous system. Placement of central venous access device was performed without difficulty when the site of placement was chosen on the basis of ultrasonographic findings.
  
  
  CONCLUSIONS
  Doppler ultrasonography is useful in diagnosing thrombosis or stenosis in asymptomatic pediatric patients requiring placement of multiple central venous catheters.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
authors.forename: Himesh
authors.initials: H
authors.lastname: Gupta
authors.forename: Yuko
authors.initials: Y
authors.lastname: Araki
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
authors.forename: Bhaskar N
authors.initials: BN
authors.lastname: Rao
authors.forename: Fredric A
authors.initials: FA
authors.lastname: Hoffer
authors.forename: Catherine
authors.initials: C
authors.lastname: Billups
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Shochat
mesh_terms: D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology