title: Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children.
abstract: Prescription of thromboprophylaxis is not a common practice in pediatric intensive care units. Most thrombi are catheter-related and asymptomatic, without causing acute complications. However, chronic complications of these (a)symptomatic catheter-related thrombi, that is, postthrombotic syndrome (PTS) and residual thrombosis have not been studied. To investigate these complications, critically ill children of 1 tertiary center with percutaneous inserted femoral central venous catheters (FCVCs) were prospectively followed. Symptomatic FCVC-thrombosis occurred in 10 of the 134 children (7.5%; 95% confidence interval [CI], 2.4-9.5). Only FCVC-infection appeared to be independently associated (P=0.001) with FCVC-thrombosis. At follow-up 2 of the 5 survivors diagnosed with symptomatic thrombosis developed mild PTS; one of them had an occluded vein on ultrasonography. A survivor without PTS had a partial occluded vein at follow-up. Asymptomatic FCVC-thrombosis occurred in 3 of the 42 children (7.1%; 95% CI, 0.0-16.7) screened by ultrasonography within 72 hours after catheter removal. At follow-up, mild PTS was present in 6 of the 33 (18.2%; 95% CI, 6.1-30.3) screened children. Partial and total vein occlusion was present in 1 (3%) and 4 (12%) children, respectively. In conclusion, children on pediatric intensive care units are at risk for (a)symptomatic FCVC-thrombosis, especially children with FCVC-infection. Chronic complications of FCVC-thrombosis are common. Therefore, thromboprophylaxis guidelines are warranted in pediatric intensive care units to minimize morbidity as a result of FCVC-thrombosis.
authors.affiliation: *Department of Pediatrics, Groene Hart Hospital, Gouda †Pediatric Intensive Care Unit Departments of ‡Pediatric Radiology ∥Pediatric Hematology, Emma Children's Hospital/AMC, Amsterdam §Intensive Care Unit, Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: Jeanine J
authors.initials: JJ
authors.lastname: Sol
authors.forename: Hennie
authors.initials: H
authors.lastname: Knoester
authors.forename: Marjorie
authors.initials: M
authors.lastname: de Neef
authors.forename: Anne M J B
authors.initials: AM
authors.lastname: Smets
authors.forename: Aukje
authors.initials: A
authors.lastname: Betlem
authors.forename: C Heleen
authors.initials: CH
authors.lastname: van Ommen
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D054070:Postthrombotic Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D013927:Thrombosis / Q000150:complications*