Characterization of central venous catheter-associated deep venous thrombosis in infants

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• 作者：Brian W. Gray^a ; Raquel Gonzalez^b ; Kavita S. Warrier^c ; Lauren A. Stephens^a ; Robert A. Drongowski^a ; Steven W. Pipe^c ; George B. Mychaliska^a ; ^{mychalis@umich.edu}
• 关键词：DVT ; Deep venous thrombosis ; Central venous catheter ; Infant
• 刊名：Journal of Pediatric Surgery
• 出版年：2012
• 期刊代码：190_00223468
• 类别：med
• 出版时间：June, 2012
• 卷：47
• 期：6
• 页码：1159-1166
• 文件大小：185 K

摘要

Purpose

Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and risk-reduction strategies of CVC-associated DVT in infants.

Methods

Infants younger than 1 year who had a CVC placed at our center from 2005 to 2009 were reviewed. Patients with ultrasonically diagnosed DVT were compared to those without radiographic evidence.

Results

Of 333 patients, 47%(155/333) had femoral, 33%(111/333) had jugular, and 19%(64/333) had subclavian CVCs. Deep venous thromboses occurred in 18%(60/333) of patients. Sixty percent (36/60) of DVTs were in femoral veins. Femoral CVCs were associated with greater DVT rates (27%; 42/155) than jugular (11%; 12/111) or subclavian CVCs (9%; 6/64; P < .01). There was a 16%DVT rate in those with saphenofemoral Broviac CVCs vs 83%(20/24) in those with percutaneous femoral lines (P < .01). Multilumen CVCs had higher DVT rates than did single-lumen CVCs (54%vs 6%, P < .01), and mean catheter days before DVT diagnosis was shorter for percutaneous lines than Broviacs (13 卤 17 days vs 30 卤 37 days, P = .02). Patients with +DVT had longer length of stay (86 卤 88 days vs 48 卤 48 days, P < .01) and higher percentage of intensive care unit admission (82%vs 70%, P = .02).

Conclusions

Deep venous thrombosis reduction strategies in infants with CVCs include avoiding percutaneous femoral and multilumen CVCs, screening percutaneous lines, and early catheter removal.