Skip to main content

Thrombosis, Central Venous Lines, and Parenteral Nutrition in Pediatric Intensive Care

  • Living reference work entry
  • First Online:
Diet and Nutrition in Critical Care
  • 117 Accesses

Abstract

Central venous catheters are widely used in pediatric clinical practice and moreover in pediatric intensive care units. Besides using them to provide fluids or drugs, they are often used to deliver parenteral nutrition in some specific pediatric patients. Although catheter infection is often more referenced and studied, there are two late mechanical complications, obstruction and thrombosis, that due to its frequency and consequences should be taken into account. Incidence, risk factors, prophylaxis, proper diagnosis, and therapeutic options are widely explained in order to avoid or, at least, reduce its incidence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Abbreviations

CVC:

Central venous catheter

HPN:

Home parenteral nutrition

LMWH:

Low-molecular-weight heparin

NICU:

Neonatal intensive care unit

PICU:

Pediatric intensive care unit

PN:

Parenteral nutrition

References

  • Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D, et al. Venous thromboembolic complications (VTE) in children: first analysis of the Canadian registry of VTE. Blood. 1994;83:1251–7.

    CAS  PubMed  Google Scholar 

  • Andrew M, Marzinotto V, Pencharz P, et al. A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home. J Pediatr. 1995;126:358–63.

    Article  CAS  PubMed  Google Scholar 

  • Ayas NT, Norena M, Wong H, Chittock D, Dodek PM. Pneumothorax after insertion of central venous catheters in the intensive care unit: association with month of year and week of month. Qual Saf Health Care. 2007;16:252–5.

    Article  PubMed Central  PubMed  Google Scholar 

  • Barnes C, Newall F, Monagle P. Post-thrombotic syndrome. Arch Dis Child. 2002;86:212–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Barnes RW, Wu KK, Hoak JC. Fallibility of the clinical diagnosis of venous thrombosis. JAMA. 1975;234:605–7.

    Article  CAS  PubMed  Google Scholar 

  • Beck C, Dubois J, Grignon A, Lacroix J, David M. Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: a prospective study. J Pediatr. 1998;133:237–41.

    Article  CAS  PubMed  Google Scholar 

  • Bern MM, Lokich JJ, Wallach SR, Bothe Jr A, Benotti PN, Arkin CF, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med. 1990;112:423–8.

    Article  CAS  PubMed  Google Scholar 

  • Bruzoni M, Slater BJ, Wall J, St Peter SD, Dutta S. A prospective randomized trial of ultrasound- vs landmark-guided central venous access in the pediatric population. J Am Coll Surg. 2013;216:939–43.

    Article  PubMed  Google Scholar 

  • Burke JF, Wolfe RR, Mullany CJ, Mathews DE, Bier DM. Glucose requirements following burn injury. Parameters of optimal glucose infusion and possible hepatic and respiratory abnormalities following excessive glucose intake. Ann Surg. 1979;190:274–85.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Casado-Flores J, Barja J, Martino R, Serrano A, Valdivielso A. Complications of central venous catheterization in critically ill children. Pediatr Crit Care Med. 2001;2:57–62.

    Article  PubMed  Google Scholar 

  • Chastre J, Cornud F, Bouchama A, et al. Thrombosis as a complication of pulmonary artery catheterization via the internal jugular vein: prospective evaluation by phlebography. N Engl J Med. 1982;306:278–81.

    Article  CAS  PubMed  Google Scholar 

  • Chidi CC, King DR, Boles Jr ET. An ultrastructural study of the intimal injury induced by an indwelling umbilical artery catheter. J Pediatr Surg. 1983;18:109–15.

    Article  CAS  PubMed  Google Scholar 

  • Citak A, Karabocuoglu M, Ucsel R, Uzel N. Central venous catheters in pediatric patients–subclavian venous approach as the first choice. Pediatr Int. 2002;44:83–6.

    Article  PubMed  Google Scholar 

  • Coss-Bu JA, Klish WJ, Walding D, Stein F, Smith EO, Jefferson LS. Energy metabolism, nitrogen balance, and substrate utilization in critically ill children. Am J Clin Nutr. 2001;74:664–9.

    CAS  PubMed  Google Scholar 

  • Cruzeiro PC, Camargos PA, Miranda ME. Central venous catheter placement in children: a prospective study of complications in a Brazilian public hospital. Pediatr Surg Int. 2006;22:536–40.

    Article  PubMed  Google Scholar 

  • De Jonge RC, Polderman KH, Gemke RJ. Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med. 2005;6:329–39.

    Article  PubMed  Google Scholar 

  • Donnelly KM. Venous thromboembolic disease in the pediatric intensive care unit. Curr Opin Pediatr. 1999;11:213–7.

    Article  CAS  PubMed  Google Scholar 

  • Ferrero dela Mano LJ, Medina Villanueva A, Concha Torre A, Menéndez Cuervo S, Testa Fernández A, Rey Galán C. Fibrinolysis with urokinase in thrombosis secondary to femoral vein catheterization in critically-ill children. Med Intensiva. 2001;25:244–7.

    Article  Google Scholar 

  • Gittins NS, Hunter-Blair YL, Matthews JN, Coulthard MG. Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: a randomized controlled trial. Arch Dis Child. 2007;92:499–501.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M. Association of hyperglycemia with increased mortality after severe burn injury. J Trauma. 2001;51:540–4.

    Article  CAS  PubMed  Google Scholar 

  • Goulet O, Ruemmele F, Lacaille F, Colomb V. Irreversible intestinal failure. J Pediatr Gastroenterol Nutr. 2004;38:250–69.

    Article  PubMed  Google Scholar 

  • Guilbert AS, Xavier L, Ammouche C, Desprez P, Astruc D, Diemunsch P, Bientz J. Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICUs: a feasibility study. Pediatr Crit Care Med. 2013;14:351–5.

    Article  PubMed  Google Scholar 

  • Haire WD, Lynch TG, Lieberman RP, Lund GB, Edney JA. Utility of duplex ultrasound in the diagnosis of asymptomatic catheter-induced subclavian vein thrombosis. J Ultrasound Med. 1991;10:493–6.

    CAS  PubMed  Google Scholar 

  • Hanslik A, Thom K, Haumer M, Kitzmüller E, Albinni S, Wolfsberger M, Salzer-Muhar U, Male C. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the upper venous system. Pediatrics. 2008;122:1284–91.

    Article  PubMed  Google Scholar 

  • Heird WC, Driscoll Jr JM, Schullinger JN, et al. Intravenous alimentation in pediatric patients. J Pediatr. 1972;80:351–72.

    Article  CAS  PubMed  Google Scholar 

  • Johnson EM, Saltzman DA, Suh G, Dahms RA, Leonard AS. Complications and risks of central venous catheter placement in children. Surgery. 1998;124:911–6.

    Article  CAS  PubMed  Google Scholar 

  • Kalmanti M, Germanakis J, Stiakaki E, Syfridaki C, Christidou A, Tsetis D, et al. Prophylaxis with urokinase in pediatric oncology patients with central venous catheters. Pediatr Hematol Oncol. 2002;19:173–9.

    Article  CAS  PubMed  Google Scholar 

  • Karapinar B, Cura A. Complications of central venous catheterization in critically ill children. Pediatr Int. 2007;49:593–9.

    Article  PubMed  Google Scholar 

  • Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R, Parenteral Nutrition Guidelines Working Group, European Society for Clinical Nutrition and Metabolism, European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), European Society of Paediatric Research (ESPR). Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41 Suppl 2:S1–87.

    Article  PubMed  Google Scholar 

  • Kuter DJ. Thrombotic complications of central venous catheters in cancer patients. Oncologist. 2004;9:207–16.

    Article  PubMed  Google Scholar 

  • LeDuc K. Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. J Emerg Nurs. 1997;23:306–9.

    Article  CAS  PubMed  Google Scholar 

  • Lensing AW, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989;320:342–5.

    Article  CAS  PubMed  Google Scholar 

  • Letton RW, Chwals WJ, Jamie A, Charles B. Early postoperative alterations in infant energy use increase the risk of overfeeding. J Pediatr Surg. 1995;30:988–92.

    Article  CAS  PubMed  Google Scholar 

  • Lloyd DA. Energy requirements of surgical newborn infants receiving parenteral nutrition. Nutrition. 1998;14:101–4.

    Article  CAS  PubMed  Google Scholar 

  • Male C, Chait P, Ginsberg J, et al. Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body in children: results of the PARKAA study. Thromb Haemost. 2002;87:593–9.

    CAS  PubMed  Google Scholar 

  • Male C, Julian JA, Massicotte P, Gent M, Mitchell L, PROTEKT Study Group. Significant association with location of central venous line placement and risk of venous thrombosis in children. Thromb Haemost. 2005;94:516–21.

    CAS  PubMed  Google Scholar 

  • Male C, Kuhle S, Mitchell L. Diagnosis of venous thromboembolism in children. Semin Thromb Hemost. 2003;29:377–90.

    Article  PubMed  Google Scholar 

  • Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40:2479–85.

    Article  PubMed  Google Scholar 

  • Massicotte MP, Dix D, Monagle P, Adams M, Andrew M. Central venous catheter related thrombosis in children: analysis of the Canadian Registry of Venous Thromboembolic Complications. J Pediatr. 1998;133:770–6.

    Article  CAS  PubMed  Google Scholar 

  • Miliken SJ, Cain TL, Hansbrough J. Rapid volume replacement for hypovolemic shock: a comparison of techniques and equipment. J Trauma. 1984;24:428–31.

    Article  Google Scholar 

  • Mitchell L, Lambers M, Flege S, Kenet G, Li-Thiao-Te V, Holzhauer S, et al. Validation of a predictive model for identifying an increased risk for thromboembolism in children with acute lymphoblastic leukemia: results of a multicenter cohort study. Blood. 2010;115:4999–5004.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, Vesely SK, American College of Chest Physicians. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e737S–801.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Pierro A, Jones MO, Donnell SC. Total parenteral nutrition in surgical infants. Biochem Soc Trans. 1998;26:131–6.

    Article  CAS  PubMed  Google Scholar 

  • Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M, ESPEN. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28:365–77. doi:10.1016/j.clnu.2009.03.015. Epub 2009 May 21.

    Article  PubMed  Google Scholar 

  • Pratt RJ, Pellowe CM, Wilson JA, et al. EPIC2: national evidence-based guidelines for preventing heatlhcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007;65S:S1–64.

    Article  Google Scholar 

  • Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials. Chest. 1998;113:165–71.

    Article  CAS  PubMed  Google Scholar 

  • Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996;24:2053–8.

    Article  CAS  PubMed  Google Scholar 

  • Rey C, Alvarez F, De La Rua V, Medina A, Concha A, Díaz JJ, Menéndez S, Los Arcos M, Mayordomo-Colunga J. Mechanical complications during central venous cannulations in pediatric patients. Intensive Care Med. 2009;35:1438–43.

    Article  PubMed  Google Scholar 

  • Rey C, Alvarez F, De-La-Rua V, Concha A, Medina A, Díaz JJ, Menéndez S, Los-Arcos M, Mayordomo-Colunga J. Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit. Intensive Care Med. 2011;37:678–85.

    Article  PubMed  Google Scholar 

  • Richardson MW, Allen GA, Monahan PE. Thrombosis in children: current perspective and distinct challenges. Thromb Haemost. 2002;88:900–11.

    CAS  PubMed  Google Scholar 

  • Shopbell JM, Hopkins B, Shronts EP. Nutrition screening and assessment. In: Gottschlich MM, editor. The science and practice of nutrition support. Dubuque: Kendall/Hunt; 2001. p. 107–40.

    Google Scholar 

  • Shulman RJ, Phillips S. Parenteral nutrition in infants and children. J Pediatr Gastroenterol Nutr. 2003;36:587–607.

    Article  PubMed  Google Scholar 

  • Starkhammar H, Bengtsson M, Morales O. Fibrin sleeve formation after long term brachial catheterisation with an implantable port device. A prospective venographic study. Eur J Surg. 1992;158:481–4.

    CAS  PubMed  Google Scholar 

  • Tager IE, Ginsberg MB, Ellis SE, et al. An epidemiologic study of the risks associated with peripheral intravenous catheters. Am J Epidemiol. 1983;118:839–51.

    CAS  PubMed  Google Scholar 

  • Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, et al. Central vein catheter related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest. 1998;114:207–13.

    Article  CAS  PubMed  Google Scholar 

  • Tulikoura I, Huikuri K. Morphological fatty changes and function of the liver, serum free fatty acids, and triglycerides during parenteral nutrition. Scand J Gastroenterol. 1982;17:177–85.

    Article  CAS  PubMed  Google Scholar 

  • Turi RA, Petros AJ, Eaton S, Fasoli L, Powis M, Basu R, Spitz L, Pierro A. Energy metabolism of infants and children with systemic inflammatory response syndrome and sepsis. Ann Surg. 2001;233:581–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Van Ommen CH, Tabbers MM. Catheter-related thrombosis in children with intestinal failure and long-term parenteral nutrition: how to treat and to prevent? Thromb Res. 2010;126:465–70.

    Article  PubMed  Google Scholar 

  • Veldman A, Nold MF, Michel-Behnke I. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vasc Health Risk Manag. 2008;4:1337–48.

    PubMed Central  PubMed  Google Scholar 

  • Vivanco Allende A, Rey Galán C, Rodríguez de la Rúa MV, Alvarez García F, Medina Villanueva A, Concha Torre A, Mayordomo Colunga J, Martínez Camblor P. Thrombosis and obstruction associated with central venous lines. Incidence and risk factors. An Pediatr (Barc). 2013;79:136–41.

    Article  CAS  Google Scholar 

  • Wakefield A, Cohen Z, Rosenthal A, Craig M, Jeejeebhoy KN, Gotlieb A, et al. Thrombogenicity of total parenteral nutrition solutions: II. Effect on induction of endothelial cell procoagulant activity. Gastroenterology. 1989;97:1220–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ana Vivanco-Allende .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this entry

Cite this entry

Vivanco-Allende, A., Rey, C., Medina, A., Concha, A. (2014). Thrombosis, Central Venous Lines, and Parenteral Nutrition in Pediatric Intensive Care. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_122-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_122-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-8503-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics