Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children

Abstract

The incidence of venous thromboembolism (VTE) in children has seen a sharp increase in recent years with the majority of cases secondary to central venous catheters (CVCs). Among CVCs, the number of peripherally inserted central catheters (PICCs) placed in children has risen significantly. In this multi-center, prospective, observational cohort study, we enrolled patients aged 6 months to 18 years with newly placed PICCs or tunneled lines (TLs) and compared the incidence of VTE between them. We also evaluated the incidence and risk factors of CVC-related VTE, central line associated bloodstream infections (CLABSIs) and catheter malfunctions in PICCs and TLs. A total of 1967 CVCs placed in 1742 unique subjects were included in the analysis. The incidence of catheter-related VTE was 5.9{plus minus}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 (HR=8.5, 95%CI, 3.1-23, p<0.001). PICCs were also significantly more likely to have a CLABSI (HR=1.6, 95%CI: 1.2-2.2, p=0.002) and CVC malfunction (HR=2.0, 95%CI: 1.6-2.4, p<0.001) compared to TLs. Increased risk of CVC-related VTE was found in patients with a prior history of VTE (HR=23, 95%CI: 4-127, p<0.001), multi-lumen CVC (HR=3.9, 95%CI: 1.8-8.9, p=0.003) and leukemia (HR=3.5, 95%CI: 1.3-9.0, p=0.031). 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 a CVC, especially PICCs, due to the serious complications they have been shown to cause.