title: Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience.
abstract: BACKGROUND
  Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins-e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring-can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage.
  
  
  METHODS
  Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation.
  
  
  RESULTS
  Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis.
  
  
  CONCLUSIONS
  We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.
authors.affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Wiegering
authors.affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
authors.forename: Sophie
authors.initials: S
authors.lastname: Schmid
authors.affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Andres
authors.affiliation: Division of Pediatric Radiology, University Department of Radiology, Würzburg, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Wirth
authors.affiliation: Division of Pediatric Surgery, University Medical Center ZOM, Würzburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Wiegering
authors.affiliation: Division of Pediatric Surgery, University Medical Center ZOM, Würzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
authors.affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Winkler
authors.affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Schlegel
authors.affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eyrich
keywords: Central venous access; Hickman catheter; Pediatric malignancy; Port; Thrombosis