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. 2014 Oct 1;14(1):18.
doi: 10.1186/2052-1839-14-18. eCollection 2014.

Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience

Verena Wiegering  1 , Sophie Schmid  1 , Oliver Andres  1 , Clemens Wirth  2 , Armin Wiegering  3 , Thomas Meyer  3 , Beate Winkler  1 , Paul G Schlegel  1 , Matthias Eyrich  1
Affiliations

Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience

Verena Wiegering et al. BMC Hematol. .

Abstract

Background: Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins-e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring-can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage.

Methods: Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation.

Results: Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis.

Conclusions: We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.

Keywords: Central venous access; Hickman catheter; Pediatric malignancy; Port; Thrombosis.

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Figures

Figure 1
Figure 1
Flow chart of study populations.
Figure 2
Figure 2
Thrombosis and CVC distributions. (A) The proportion of patients with CVC according to the different tumor entities. (B) The distribution of port and Hickman access systems among the different patient groups with CVC. (C) The distribution of port and Hickman access within the patient subpopulation with thrombosis. (D) The proportion of prophylactic anticoagulation at the time of thrombosis according to the different tumor entities. (E) The distribution of the different malignancies with regard to the whole cohort (column 1), the whole patient group with central venous access (column 2), and the patient group with central venous access and CVC-associated thrombosis (column 3). (F) The proportion of patients with thrombosis according to the different age subgroups.
Figure 3
Figure 3
Days from CVC implantation until appearance of CVC-associated thrombosis. (A) The days on which thrombosis occurred for each patient. (B) The days on which thrombosis occurred in patients with port (red) and Hickman (green) catheters. Analysis of the complete follow-up data revealed no significant differences. Analysis of the time-point at which 50% of thrombosis occurred, revealed that port systems reached a peak of thrombosis events earlier than that with Hickman catheters (P < 0.01).
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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/2052-1839/14/18/prepub

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