A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home

doi:10.1016/S0022-3476(95)70448-5

The Journal of Pediatrics

Volume 126, Issue 3, March 1995, Pages 358-363

https://doi.org/10.1016/S0022-3476(95)70448-5 Get rights and content

Abstract

We performed a cross-sectional evaluation of deep vein thrombosis (DVT) related to the use of central venous lines (CVLs) in all pediatric patients receiving home total parenteral nutrition at our institution (N = 12). All children (5 months to 17 years of age) were examined with bilateral upper limb venography. All CVLs were flushed daily with heparin (200 units). At the time of evaluation, 49 CVLs had been placed in the 12 children. Of the 39 CVLs removed, 27 (66%) were blocked; venograms had not been previously obtained except of one child. Eight children had clinical evidence of superficial collateral circulation in the upper portion of the chest and the upper extremities; five had intermittent symptoms of superior vena cava obstruction. On venography, 8 of the 12 children had extensive evidence of DVT; two were unilateral and six bilateral. Five children were treated with warfarin (0.12 to 0.28 mg/kg per day) to achieve an international normalized ratio of 1.4 to 1.8. Neither bleeding nor further CVL- related DVT has occurred. We conclude that the risk of CVL-related DVT in children requiring home total parenteral nutrition is high, and that venography should be performed early in the event of CVL blockage. A multicenter, controlled trial assessing optimal warfarin therapy in this patient population is indicated. (J PEDIATR 1995;126:358-63)

Section snippets

Patient population

All children followed by the clinical nutrition program at the Hospital for Sick Children, Toronto, Canada, and receiving home TPN through a CVL were assessed clinically and by venography. Comprehensive demographic information was obtained for each patient.

Central venous line information

All CVLs were inserted in the operating room with the patient under general anaesthesia, by surgeons following well-established techniques. The CVL tip was positioned at the superior vena caval-right atrial junction during

Patient population

At the time of evaluation, six girls and six boys were receiving home TPN (Table I). The age range was 5 months to 17 years, with a median age of 5 years. The primary diagnoses included severe combined immunodeficiency syndrome (1 patient), hollow viscous myopathy (1), gastroschisis (2), aganglionosis (1), short gut (3), villous atrophy (2), intestinal pseudo-obstruction (1), and duodenal atresia (1). The direct consequences of CVL-related DVT in our patients included 55 general-anesthesia

DISCUSSION

The clinical histories of our patients were remarkably similar. First, the CVLs did not give blood return, and pressures increased during infusion. Second, the CVLs required repeated urokinase instillation to remove a blockage, and some required a short infusion of a thrombolytic agent. Third, lineograms were obtained to assess the position of the CVLs and to determine whether thrombi were present. Fourth, when the CVLs remained blocked, they were replaced without visualization of the deep

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Citation Excerpt :
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^☆: From the Divisions of Hematology, Clinical Nutrition, and Surgery, Hospital for Sick Children, Toronto, Ontario, Canada

^☆☆: Supported by a grant-in-aid from the Medical Research Council of Canada. Dr. Andrew holds a Career Investigator Award from the Heart and Stroke Foundation of Canada.

^★: Reprint requests: Maureen Andrew, MD, Hamilton Civic Hospitals Research Centre, Henderson General Division, 711 Concession St., Hamilton, Ontario L8V 1C3, Canada.

^★★: 0022-3476/95/$3.00 + 0 9/20/60784

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A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home☆,☆☆,★,★★

Abstract

Section snippets

Patient population

Central venous line information

Patient population

DISCUSSION

J Pediatr Surg

J PEDIATR

J PEDIATR

J Pediatr Surg

Am J Surg

Am J Surg

Gastroenterology

Gastroenterology

J Pediatr Surg

A silicone rubber atrial catheter for prolonged parenteral alimentation

Surg Gynecol Obstet

A modified right atrial catheter for access to the venous system in marrow transplant recipients

Surg Gynecol Obstet

New devices and methods for long-term vascular access for blood sampling and insulin infusion

Diabetes Care

Very low doses of warfarin can prevent thrombosis in central venous catheters: a randomized prospective trial

Ann Intern Med

Improved methods for venous access: the Port-a-Cath, a totally implanted catheter system

J Clin Oncol

Percutaneous central venous catheterization in a pediatric intensive care unit: a survival analysis of complications

Crit Care Med

Comparison of the pediatric Broviac Silastic catheter with a standard No. 3 French Silastic catheter for central venous alimentation

J Pediatr Gastroenterol Nutr

Radiographic aspects of total parenteral nutrition during infancy

Radiology