S. F. Rosati1, J. Brown1, L. Wolfe1, A. Shah1, N. Lee1, A. Maloney1, J. Haynes2, M. F. Amendola1,3 1Virginia Commonwealth University,Department Of General Surgery,Richmond, VA, USA 2Virginia Commonwealth University,Division Of Pediatric Surgery,Richmond, VA, USA 3Virginia Commonwealth University,Division Of Vascular Surgery,Richmond, VA, USA
Introduction:
Invasive lines central lines (CL) are sometimes a necessity in young children and neonates. These lines are known to come with the potential for serious complications, including deep venous thrombosis (DVT) as well as stenosis. Unlike in adults, consensus in the literature is lacking regarding the optimal management of these complications.
Methods:
We retrospectively reviewed all vascular lab studies performed in children younger than 5 years of age from September 2007 to December 2014. We queried our vascular laboratory database for venous studies obtained in the setting of central line placement. We reviewed medical records for subsequent management.
Results:
One hundred and ninety-five studies in 128 children were obtained over the study period. The average age was 1.62 ± 2.01 years for children greater than one year old, if less than one-year-old gestational age was 34.4 ± 6.91 weeks. 55.8% were male. 89.5% of patients reviewed (n=110) had a central venous access line present. Of the forty patients found to have DVT with (n=30) or without (n=10) CL there were several different services following finding with a variety of treatment modalities. The majority of children were evaluated by a Hematology-Oncology consulting service (50%; 20/40) and were being treated with subcutaneous low molecular weight heparin injections (52.5%; 21/40). Multiple linear regression models with step-wise selection of all variables identified presence of CL had an Odd’s Ratio of 2.812 (CI = 1.287 – 6.147; p=0.0095) as a significant predictor of DVT.
Conclusion:
Complications of indwelling central venous access lines are occasional in nature. Loss of pulse and extremity edema was predictive of DVT finding on exam. When present treatment options vary widely in our institution, as does the managing service. It has yet to be defined what the best course of treatment is for these complications and warrants further broader investigation.
