title: Major thrombotic complications with lower limb PICCs in surgical neonates.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kisa
authors.affiliation: Division of Neonatatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ting
authors.affiliation: Division of Neonatatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Callejas
authors.affiliation: Division of Neonatatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Neonatology, Children's & Women's Health Centre of BC, Vancouver, BC, Canada.
authors.forename: Horacio
authors.initials: H
authors.lastname: Osiovich
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada. Electronic address: sbutterworth@cw.bc.ca.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Butterworth
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*
keywords: Abdominal surgery; NICU; Neonates; PICCs; Venous thrombo-embolism