title: Clinical risk factors for central line-associated venous thrombosis in children.
abstract: BACKGROUND
  Identifying risk factors related to central venous line (CVL) placement could potentially minimize central line-associated venous thrombosis (CLAVT). We sought to identify the clinical factors associated with CLAVT in children.
  
  
  METHODS
  Over a 3-year period, 3733 CVLs were placed at a tertiary-care children's hospital. Data were extracted from the electronic medical records of patients with clinical signs and symptoms of venous thromboembolism, diagnosed using Doppler ultrasonography and/or echocardiography. Statistical analyses examined differences in CLAVT occurrence between groups based on patient and CVL characteristics (type, brand, placement site, and hospital unit).
  
  
  RESULTS
  Femoral CVL placement was associated with greater risk for developing CLAVT (OR 11.1, 95% CI 3.9-31.6, p < 0.0001). CVLs placed in the NICU were also associated with increased CLAVT occurrence (OR 5.3, 95% CI 2.1-13.2, p = 0.0003). CVL brand was also significantly associated with risk of CLAVT events.
  
  
  CONCLUSIONS
  Retrospective analyses identified femoral CVL placement and catheter type as independent risk factors for CLAVT, suggesting increased risks due to mechanical reasons. Placement of CVLs in the NICU also led to an increased risk of CLAVT, suggesting that small infants are at increased risk of thrombotic events. Alternative strategies for CVL placement, thromboprophylaxis, and earlier diagnosis may be important for reducing CLAVT events.
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Memphis , Memphis, TN , USA.
authors.forename: Samir H
authors.initials: SH
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Memphis , Memphis, TN , USA ; Children's Foundation Research Institute, Le Bonheur Children's Hospital , Memphis, TN , USA.
authors.forename: Alina Nico
authors.initials: AN
authors.lastname: West
authors.affiliation: Department of Performance Improvement and Patient Safety, Children's Hospital of The King's Daughters , Norfolk, VA , USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sepanski
authors.affiliation: Department of Quality Improvement, Le Bonheur Children's Hospital , Memphis, TN , USA.
authors.forename: Debbie
authors.initials: D
authors.lastname: Hannah
authors.affiliation: Le Bonheur Children's Hospital , Memphis, TN , USA.
authors.forename: William N
authors.initials: WN
authors.lastname: May
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Memphis , Memphis, TN , USA.
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
keywords: central venous line thrombosis; clinical outcomes of pediatric thrombosis; pediatric critical illness; pediatric thrombosis morbidity; pediatric thrombosis risk factors