Source:

Jaffray
J
,
Witmer
C
,
O’Brien
SH
, et al
.
Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children
.
Blood
.
2020
;
135
(
3
):
220
226
; doi:
https://doi.org/10.1182/blood.2019002260

Investigators from multiple institutions conducted a prospective cohort study to assess the incidence of and risk factors for venous thromboembolism (VTE) and central line–associated bloodstream infections (CLABSI) in children with central venous catheters (CVCs). Children 6 months to <18 years old who were receiving care at 1 of 4 US children’s hospitals from 2013–2018 and had a newly placed CVC were eligible. At enrollment, participant demographics, medical history, and CVC characteristics (eg, catheter type, size, and number of lumens) were collected from the medical records of study patients.

The primary exposure variable was CVC type, categorized as peripherally inserted central catheter (PICC) or tunneled line (TL, such as Port-a-Cath, Hickman, and Broviac). The primary outcome variable was radiologically confirmed symptomatic VTE before or within 30 days of CVC removal, with symptomatic defined as participants with pain, swelling, numbness, erythema, unexplained fever, transaminitis, or thrombocytopenia, as well as discoloration or change in temperature in their limb. The secondary outcome variable was CLABSI, defined as an organism cultured from the blood from a CVC that was in place for >2 days without having an infection at another site. Participants were monitored for these outcomes using the medical chart. Investigators determined the overall incidence of these outcomes by CVC type and used multivariable analyses to determine the association of these outcomes with participant demographics and CVC characteristics.

There were 1,967 CVC placements included in analyses from 1,742 unique participants. PICCs comprised 64% of CVCs placed. Among all participants, the incidence rate of VTE was 5.9% and of CLABSI was 17%. PICCs (vs TLs) were significantly more likely to have a VTE (hazard ratio [HR], 8.5; 95% CI, 3.1–23) and a CLABSI (HR, 1.6; 95% CI, 1.2–2.2). Other factors that were significantly associated with CVC-related VTEs were a prior history of VTE, a multi-lumen CVC, and a diagnosis of leukemia.

Investigators conclude that CVC-related VTE and CLABSI rates are high, with PICCs being associated with higher rates than TLs.

Dr Hogan has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Externalized, non-umbilical CVCs include PICCs and TLs. PICCs are threaded through a narrow basilic, cephalic, or brachial vein at the bedside with little or no sedation. TLs, however, are placed under general anesthesia through the larger internal jugular or subclavian veins. Typically, these CVCs have their tips ending in the proximal third of the superior vena cava or right atrium. Externalized CVCs require daily heparinization and weekly exit site dressing changes performed in a sterile manner.

Rates of CLABSI range from 0.2 to 11 episodes per 1,000 catheter days in children and adolescents. CVCs account for 50%–80% of VTE cases in hospitalized...

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