Kaipa Santosh, Mastropietro Christopher W, Bhai Hamza, Lutfi Riad, Friedman Matthew L, Yabrodi Mouhammad
Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States.
World J Cardiol. 2020 Oct 26;12(10):484-491. doi: 10.4330/wjc.v12.i10.484.
There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement. This complication is more serious among patients with single ventricle physiology, as it might preclude them from undergoing further life-sustaining palliative surgery.
To describe complications associated with the use of upper extremity percutaneous intravenous central catheters (PICCs) in children with single ventricle physiology.
A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure. Clinical data including ultrasonography, cardiac catheterization, echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels. Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter (CVC), and use of anticoagulation were recorded.
Seventy-six patients underwent superior cavopulmonary anastomoses, of which 56 (73%) had an upper extremity PICC at some point prior to this procedure. Median duration of PICC usage was 24 d (25%, 75%: 12, 39). Seventeen patients (30%) with PICCs also had internal jugular or subclavian central venous catheters (CVCs) in place at some point prior to their superior cavopulmonary anastomoses, median duration 10 d (25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs (4%) and 3 of the 17 CVCs (18%). All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients. No patients developed clinically significant venous stenosis.
Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheter-associated thrombosis.
上肢中心静脉导管更换后存在上腔静脉狭窄和血栓形成的风险。这种并发症在单心室生理的患者中更为严重，因为这可能使他们无法接受进一步的维持生命的姑息性手术。
描述单心室生理儿童使用上肢经皮静脉中心静脉导管（PICC）相关的并发症。
对2014年1月至2018年12月期间接受上腔静脉肺动脉吻合术作为二期姑息治疗手术且在此手术前任何时间放置过上半身PICC的单心室患者进行单机构回顾性研究。使用包括超声检查、心导管检查、超声心动图报告和患者记录在内的临床数据来确定上肢和颈部血管是否存在血栓或狭窄。记录有关上肢PICC和上肢中心静脉导管（CVC）的存在和持续时间以及抗凝剂使用的数据。
76例患者接受了上腔静脉肺动脉吻合术，其中56例（73%）在此手术前的某个时间点放置了上肢PICC。PICC使用的中位持续时间为24天（第25百分位数，第75百分位数：12，39）。17例（30%）使用PICC的患者在进行上腔静脉肺动脉吻合术之前的某个时间点也放置了颈内或锁骨下中心静脉导管（CVC），中位持续时间为10天（第25百分位数，第75百分位数：8，14）。在56根PICC中的2根（4%）和17根CVC中的3根（18%）检测到血栓。所有5例患者在检测到血栓时均接受了治疗剂量的低分子量肝素治疗，随后的心导管检查显示5例患者中有3例血栓溶解。没有患者出现具有临床意义的静脉狭窄。
在进行上腔静脉肺动脉吻合术之前，单心室生理患者使用上肢PICC与导管相关血栓形成的发生率较低相关。
