Children's Hospital Los Angeles, Los Angeles, CA.
Children's Hospital of Philadelphia, Philadelphia, PA.
Blood. 2020 Jan 16;135(3):220-226. doi: 10.1182/blood.2019002260.
Venous thromboembolism (VTE) incidence in children has sharply increased with the majority of cases secondary to central venous catheters (CVCs). Among CVCs, the number of peripherally inserted central catheters (PICCs) placed has risen significantly. In this multicenter, prospective, observational cohort study, we enrolled patients aged 6 months to 18 years with newly placed PICCs or tunneled lines (TLs). We evaluated the incidence of VTE, central line-associated bloodstream infections (CLABSIs), and catheter malfunctions in PICCs and TLs, and risk factors of CVC-related VTE. A total of 1967 CVCs were included in the analysis. The incidence of CVC-related VTE was 5.9% ± 0.63%. The majority of the cases, 80%, were in subjects with PICCs, which had a significantly higher risk of catheter-related VTE than subjects with TLs (hazard ratio [HR] = 8.5; 95% confidence interval [CI], 3.1-23; P < .001). PICCs were significantly more likely to have a CLABSI (HR = 1.6; 95% CI, 1.2-2.2; P = .002) and CVC malfunction (HR = 2.0; 95% CI, 1.6-2.4; P < .001). Increased risk of CVC-related VTE was found in patients with a prior history of VTE (HR = 23; 95% CI, 4-127; P < .001), multilumen CVC (HR = 3.9; 95% CI, 1.8-8.9; P = .003), and leukemia (HR = 3.5; 95% CI, 1.3-9.0; P = .031). Children with PICCs had a significantly higher incidence of catheter-related VTE, CLABSI, and CVC malfunction over TLs. The results suggest that pause be taken prior to placing CVCs, especially PICCs, due to the serious complications they have been shown to cause.
静脉血栓栓塞症（VTE）在儿童中的发病率急剧上升，大多数病例继发于中心静脉导管（CVC）。在 CVC 中，外周静脉置入中心静脉导管（PICC）的数量显著增加。在这项多中心、前瞻性、观察性队列研究中，我们纳入了年龄在 6 个月至 18 岁之间、新置入 PICC 或隧道式导管（TL）的患者。我们评估了 PICC 和 TL 中 VTE、导管相关血流感染（CLABSI）和导管故障的发生率，以及 CVC 相关 VTE 的危险因素。共纳入 1967 例 CVC。CVC 相关 VTE 的发生率为 5.9%±0.63%。大多数病例（80%）发生在 PICC 患者中，与 TL 患者相比，PICC 患者的导管相关 VTE 风险明显更高（风险比[HR] = 8.5；95%置信区间[CI]，3.1-23；P<0.001）。PICC 更有可能发生 CLABSI（HR = 1.6；95%CI，1.2-2.2；P=0.002）和 CVC 故障（HR = 2.0；95%CI，1.6-2.4；P<0.001）。有 VTE 病史（HR = 23；95%CI，4-127；P<0.001）、多腔 CVC（HR = 3.9；95%CI，1.8-8.9；P=0.003）和白血病（HR = 3.5；95%CI，1.3-9.0；P=0.031）的患者 CVC 相关 VTE 的风险增加。与 TL 相比，PICC 患儿的导管相关性 VTE、CLABSI 和 CVC 故障发生率明显更高。结果表明，由于 PICC 等 CVC 会导致严重并发症，在置入 CVC 时应慎重考虑。
