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Comparative Study
. 2019 Dec;166(6):1117-1121.
doi: 10.1016/j.surg.2019.05.018. Epub 2019 Sep 13.

Symptomatic catheter-associated thrombosis in pediatric trauma patients: Choose your access wisely

Cory M McLaughlin  1 , Erica N Barin  1 , Michael Fenlon  2 , Colleen Azen  3 , Timothy W Deakers  4 , James E Stein  2 , David W Bliss  2 , Jeffrey S Upperman  2 , Aaron R Jensen  5
Affiliations
Comparative Study

Symptomatic catheter-associated thrombosis in pediatric trauma patients: Choose your access wisely

Cory M McLaughlin et al. Surgery. 2019 Dec.

Abstract

Background: Traumatic injury and the presence of a central venous catheter are 2 of the strongest risk factors for venous thromboembolism in children. The purpose of this study was to determine the incidence of symptomatic, catheter-associated thrombosis in critically injured children. We hypothesized that femoral venous catheters are associated with a greater rate of thrombotic complications when compared with all other central venous access points.

Methods: We reviewed a retrospective cohort (2006-2016) of injured children (≤18 years) admitted to a pediatric intensive care unit with central access placed ≤7 days from admission. Symptomatic, catheter-associated thrombosis was determined by radiographic evidence. Poisson regression was used to compare the incidence of catheter-associated thrombosis per 1,000 catheter days between femoral and nonfemoral catheters. All comparisons were 2-tailed with α = 0.05.

Results: We examined 209 pediatric trauma patients with central access (65% femoral, 19% subclavian, 11% arm vein, and 5% internal jugular). Femoral catheters were removed earlier (median [interquartile range] 4 [2-7] vs 8 [3-12] days, P < .001) and were larger in diameter (5 Fr [4-7] vs 4 Fr [4-4], P < .001) when compared with all other catheters. Catheter-associated thrombosis was more frequent in femoral versus nonfemoral catheters (18.4 vs 3.5 per 1,000 catheter days, P = .01).

Conclusion: Femoral venous catheters are associated with a greater incidence of symptomatic, catheter-associated thrombosis in pediatric trauma patients. When central venous access is indicated for injured children, the femoral site should be avoided. If a femoral venous catheter is necessary, use of a smaller catheter should be considered.

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Conflict of interest statement

None of the authors have any conflicts of interest to disclose.

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