Lasagni Donatella, Nosadini Margherita, Molinari Angelo Claudio, Saracco Paola, Pelizza Maria Federica, Piersigilli Fiammetta, Putti Maria Caterina, Gaffuri Marcella, Giordano Paola, Lorenzoni Giulia, Francavilla Andrea, Trapani Sandra, Luciani Matteo, Suppiej Agnese, Tufano Antonella, Tormene Daniela, Martinato Matteo, Gregori Dario, Sartori Stefano, Simioni Paolo
Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.
Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Front Pediatr. 2022 Mar 23;10:843643. doi: 10.3389/fped.2022.843643. eCollection 2022.
Central venous catheters (CVCs) represent one of the main risk factors for venous thrombotic events (VTEs) in children.
We studied the Italian Registry of Pediatric Thrombosis (RITI) with regard to systemic radiologically confirmed CVC-related VTEs (CVC-VTEs) occurred during 6.5 years in children aged 29 days to 18 years.
A total of 78 CVC-VTEs were included, which occurred in 76 patients (40/76, 53% males). CVC-VTEs comprised 67 non-cardiac VTEs (86%) and 11 intracardiac thrombotic events (ICTEs) (14%); the median age at onset was 19 and 17 months, respectively. The most frequent reason for CVC insertion was supportive therapy. The catheters were placed percutaneously in 85% of cases (56/66) and surgically in the remaining 15% (10/66). Peripherally inserted central catheters (PICCs) were used in 47% (31/66) cases, partially implanted catheters in 42% (28/66), non-implantable catheters in 7% (5/66), and totally implanted catheters (Port) in 2% (1/66). CVC-VTEs were symptomatic in 77% of cases (60/78), while in the remaining 23%, they were incidentally detected on the imaging performed for the underlying condition. The median time between CVC insertion and the onset of symptoms was 10 days in non-cardiac VTEs and 39 days in ICTEs. Doppler ultrasound was the diagnostic technique most frequently used. The venous compartment most frequently affected was the veins of the lower extremities (52%, 43/73). Anti-thrombotic treatment was administered in 96% of CVC-VTEs (75/78). About 2.6% (2/76) of patients experienced a second thrombotic event. At discharge, post-thrombotic syndrome was reported in 13.5% (5/37) events with available data, CVC replacement in 10.8% (4/47), and ischemic necrosis with toe finger amputation in 2.7% (1/37). Three patients died due to an underlying condition; no CVC-VTE-related deaths were reported.
We have carried out a registry-based study on CVC-VTEs in the children in Italy, providing the data that may help improve the detection and management of this CVC-related complication.
中心静脉导管（CVC）是儿童静脉血栓形成事件（VTE）的主要危险因素之一。
我们研究了意大利儿科血栓形成登记处（RITI），该登记处记录了29天至18岁儿童在6.5年期间发生的经系统放射学证实的与CVC相关的VTE（CVC-VTE）。
共纳入78例CVC-VTE，发生在76例患者中（40/76，男性占53%）。CVC-VTE包括67例非心脏VTE（86%）和11例心脏内血栓形成事件（ICTE）（14%）；发病的中位年龄分别为19个月和17个月。插入CVC最常见的原因是支持治疗。85%的病例（56/66）经皮放置导管，其余15%（10/66）通过手术放置。47%（31/66）的病例使用外周静脉穿刺中心静脉导管（PICC），42%（28/66）使用部分植入式导管，7%（5/66）使用非植入式导管，2%（1/66）使用完全植入式导管（Port）。77%的CVC-VTE病例（60/78）有症状，其余23%在为基础疾病进行的影像学检查中偶然发现。非心脏VTE中，CVC插入与症状出现之间的中位时间为10天，ICTE为39天。多普勒超声是最常用的诊断技术。最常受累的静脉腔是下肢静脉（52%，43/73）。96%的CVC-VTE（75/78）接受了抗血栓治疗。约2.6%（2/76）的患者发生了第二次血栓形成事件。出院时，13.5%（5/37）有可用数据的事件报告了血栓形成后综合征，10.8%（4/47）报告了CVC更换，2.7%（1/37）报告了趾指缺血性坏死并截肢。3例患者因基础疾病死亡；未报告与CVC-VTE相关的死亡。
我们对意大利儿童的CVC-VTE进行了一项基于登记处的研究，提供了可能有助于改善这种与CVC相关并发症的检测和管理的数据。
