Central venous catheter (CVC) use is common in the management of critically ill children, especially those with congenital or acquired heart disease (CHD). Prior studies suggest that the presence of a CVC augments the risk of deep vein thrombosis (DVT) in adults and children. In recent years, the reported incidence of VTE in children has increased dramatically. How CVC-associated DVTs contribute to morbidity and mortality in this high risk patient population is unknown

1. Emily H. Steen MD1, Javier J. Lasa MD2, Trung C. Nguyen MD2, Sundeep G. Keswani MD1,3, Paul A. Checchia MD2, Marc M. Anders MD2
1. Department of Surgery, Baylor College of Medicine, Houston, TX, USA 2. Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA 3. Division of Pediatric Surgery, Department of Surgery, Texas Children’s
Hospital and Baylor College of Medicine, Houston, TX, USA
.
Contributors, complications, and causative factors for central venous catheter-related deep vein
thrombosis in critically ill children with congenital heart disease
RESULTS RESULTS
REFERENCES
METHODS
QUESTIONS AND SUGGESTIONS
Please contact Emily Steen at Emily.Steen@bcm.edu
OBJECTIVES
• To report the outcomes after DVT in the pediatric cardiovascular intensive
care unit (CICU) at a large, high-volume single center institution.
• To identify the factors associated with DVT and DVT-related
complications in the critically ill population with CHD, a group often excluded
from study.
• Pediatric Cardiac Critical Care
Consortium (PC4) database and a
radiologic database were
retrospectively reviewed for CICU
admissions involving CVC
placement from Jan– Dec 2017.
• Demographics, outcomes, DVT
incidence, and DVT-related
complications were gathered.
• Central venous catheter (CVC) use is common in the management of
critically ill children, especially those with congenital or acquired heart
disease (CHD).
• Prior studies suggest that the presence of a CVC augments the risk of
deep vein thrombosis (DVT) in adults and children.
• In recent years, the reported incidence of VTE in children has increased
dramatically.
• How CVC-associated DVTs contribute to morbidity and mortality in this
high risk patient population is unknown.
Demographics and Outcomes
• Having more than one line (p < 0.0001),
higher total line hours (p < 0.0001), longer
intubation times (p < 0.0001), and longer
CVICU admission duration (p < 0.0001)
were associated with higher risk of DVT.
• Of the above, only higher total line hours
significantly increased the risk of DVT on
multivariable analysis (p< 0.0001; ROC
curve at right, AUC=0.89).
CONCLUSIONS AND FUTURE GOALS
• There is a strong correlation of CVC-associated DVT not only with morbidity, but
also to mortality in the pediatric CICU population.
• There are well-defined risk factors for CVC-associated DVT, as well as specific
factors associated with clot propagation into the IVC.
• Future goal: To provide data that will enable the development of specific risk models to
guide screening and anticoagulation in critically ill children with CHD.
1. Raffini L, et al. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to
2007. Pediatrics 2009.
2. Giglia TM et al. Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientific statement
from the American Heart Association. Circulation 2013.
3. Monagle P et al. Antithrombotic therapy in neonates and children 9th ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines. Chest 2012.
• LCOS (p < 0.0002), sepsis (p < 0.0025), CLABSI (p < 0.0174), and cardiac
catheterization (p < 0.001) were significantly associated with DVT on both
univariate and multivariable analysis.
• LCOS (p = 0.0307) and CLABSI (p < 0.0001) were significantly associated
with thrombus extension into the IVC.
• Cardiac surgery with cardiopulmonary bypass was significantly
associated with a decreased risk of DVT (p < 0.0011).
BACKGROUND
• The majority of patients were male and
Caucasian, with a median age of 1.5
years.
• 83% of admissions were post-
cardiac surgery or other procedure,
including cardiac catheterization.
• 71% of patients only had one CVC
placed.
• The median total line hour duration
(the sum of all central lines multiplied
by the hours each central line was in
place), was 70 hours and reflected
the number of lines per patient.
• The median CVICU admission
duration was 92 hours.
• 66% of patients required
mechanical ventilation, with a
median duration of ventilator support
of 43 hours.
• 12 admissions (1.4%) were
complicated by CLABSI and 22 (2.6%)
were complicated by sepsis.
• 139 admissions (16.4%) had a
reported episode of low cardiac
output syndrome (LCOS).
Outcomes and Risk of Mortality
• 57 patients (7%) and 66 admissions (8%) had ultrasound-positive DVTs.
• Almost 30% of those admissions noted DVTs that extended into the
inferior vena cava (IVC).
Outcomes and Risk of DVT
LIMITATIONS AND STRENGTHS
• Retrospective, single institution studies are subject to bias.
• Large sample size and use of a comprehensive, validated database widens the
generalizability of our findings and controls for possible confounders (e.g. consistent
approach to surgical repairs).
• Overall mortality was 4.95% (37
deaths), equivalent to the average
CVICU mortality rate (4.82%).
• A DVT diagnosis in this patient
population was highly significant
for mortality (p < 0.0001), as was
LCOS, sepsis, CLABSI, cardiac
catheterization, and clot in the IVC.
• Cardiac surgery was associated
with a decreased risk of death.
• Univariate linear regression and multivariable regression analysis was
performed; p < 0.05 considered significant.