Catheter related thrombosis in pediatric surgical patients
Abstract:
Background: Perioperative central venous catheters are required but may be associated with various complications.
Aims: The purpose of our study was to assess the incidence and perioperative risk factors for catheter-related internal jugular vein thrombosis in pediatric surgical patients.
Methods: This prospective observational study included children under 6 years of age who were scheduled to undergo central venous catheterization of the right internal jugular vein under general anesthesia. A central venous catheter was inserted under real-time ultrasound guidance. An investigator examined for thrombosis using ultrasonography at predetermined time points. The primary aim was the incidence of catheter-related thrombosis from insertion until the 5th day post operatively or the removal of the central venous catheter. The secondary aim was the determination of the risk factors for thrombosis.
Results: Eighty patients completed the study. Internal jugular vein thrombi were found in 31 patients (38.8 %, 95% CI 28.0-49.4). On multiple logistic regression analyses, the number of insertion attempts was the only influencing factor for catheter-related thrombosis (P<0.001). More than two insertion attempts increased the risk of thrombosis (odds ratio 5.6; 95% CI 1.7 - 18.7, P=0.004). Anesthesia time (P=0.017; mean difference 166.4 min; 95% CI 55.7-277.1), intraoperative red blood cell transfusion (P=0.001; median difference 21.1 ml kg-1 ; 95% CI 6.6-34.4), and intensive care unit stay (P=0.001; median difference 100.0 h; 95% CI 48-311) differed between patients with transient thrombosis and those with thrombosis lasting for more than 3 days.
Conclusion: Internal jugular vein thrombosis was frequently detected by ultrasound following central venous catheterization in pediatric surgical patients. Multiple insertion attempts may be associated with the incidence of thrombosis. The clinical relevance of thrombi detected via ultrasound surveillance has not been determined.
Reference:
Kim EH, Lee JH, Kim HS, Jang YE, Ji SH, Kang PY, Song IS, Kim JT. Central venous catheter-related thrombosis in pediatric surgical patients: A prospective observational study. Paediatr Anaesth. 2021 Nov 29. doi: 10.1111/pan.14346. Epub ahead of print. PMID: 34843146.