Department of Pediatric Intensive Care Medicine, La Paz University Hospital, Madrid, Spain.
Department of Preventive Medicine and Public Health-Biostatistics, Universidad Autónoma de Madrid, Madrid, Spain.
J Thromb Haemost. 2016 Nov;14(11):2158-2168. doi: 10.1111/jth.13478. Epub 2016 Oct 12.
Essentials Pediatric studies on peripherally inserted central catheter (PICC)-related thrombosis are scarce. This study analyzes incidence and risk factors for PICC-related venous thrombosis in children. PICC-related thrombosis is a common, and nearly always, asymptomatic complication. Echo-guided insertion and a catheter to vein ratio < 0.33 may notably decrease this complication.
Background Upper-extremity venous thrombosis is associated with the use of peripherally inserted central catheters (PICCs). Few pediatric studies have focused on this issue. Objectives To determine the incidence and risk factors for PICC-related superficial vein thrombosis (SVT) and deep vein thrombosis (DVT) in children. Patients/methods An observational follow-up cohort study was conducted at a single hospital between June 2012 and June 2015. All patients receiving a PICC were enrolled and followed up, with weekly Doppler ultrasound examination of the catheterized limb until PICC removal. Patient, procedural and follow-up data were analyzed. Results In the study period, 265 PICCs were inserted (median age of patients 6.5 years, interquartile range [IQR] 2.4-13 years; median weight 20 kg, IQR 11-38 kg; 54% males; 67.9% chronically ill), and patients were followed up for a total of 9743 days. The median indwelling time was 21 days (IQR 12-37 days). During follow-up, 88 (33.2% of insertions) PICC-related thromboses (incidence rate [IR] 9.03 per 1000 catheter-days) were diagnosed, 66 (24.9%) as isolated SVT, seven (2.6%) as isolated DVT, and 15 (5.7%) as SVT with associated DVT (IR 6.78, 0.71 and 1.54 per 1000 catheter-days, respectively). Only 9.9% of patients with SVT and 18.2% of those with DVT were symptomatic. The main risk factors for PICC-related SVT and DVT were a catheter/vein ratio of > 0.33 and thrombosis of the catheterized superficial vein, respectively. Conclusions PICC-related thrombosis is a common and nearly always asymptomatic complication in children, the SVT rate being approximately three times higher than the DVT rate. Optimal vein and catheter selection, yielding the lowest possible catheter/vein ratio, may decrease the rate of PICC-related thrombosis.
确定儿童经外周静脉穿刺中心静脉置管（PICC）相关浅静脉血栓形成（SVT）和深静脉血栓形成（DVT）的发生率和危险因素。
患者/方法：这是一项在 2012 年 6 月至 2015 年 6 月期间在一家单中心进行的观察性随访队列研究。所有接受 PICC 的患者均入组并接受随访，每周对置管肢体进行多普勒超声检查，直至 PICC 拔出。分析患者、操作和随访数据。
在研究期间，共置入 265 根 PICC（患者的中位年龄为 6.5 岁，四分位间距[IQR]为 2.4-13 岁；中位体重为 20kg，IQR 为 11-38kg；54%为男性；67.9%为慢性疾病患者），患者总共随访了 9743 天。中位留置时间为 21 天（IQR 为 12-37 天）。在随访期间，诊断出 88 例（占置管总数的 33.2%）PICC 相关血栓（发生率[IR]为 9.03/1000 导管日），其中 66 例（24.9%）为孤立性 SVT，7 例（2.6%）为孤立性 DVT，15 例（5.7%）为 SVT 合并 DVT（IR 分别为 6.78、0.71 和 1.54/1000 导管日）。仅有 9.9%的 SVT 患者和 18.2%的 DVT 患者出现症状。PICC 相关 SVT 和 DVT 的主要危险因素分别为导管/静脉比>0.33 和导管化的浅静脉血栓形成。
PICC 相关血栓形成在儿童中是一种常见且几乎总是无症状的并发症，SVT 发生率约为 DVT 发生率的 3 倍。最佳的静脉和导管选择，使导管/静脉比尽可能低，可能会降低 PICC 相关血栓形成的发生率。
