Peripherally inserted central catheters (PICCs) can lead to development of venous thrombosis and/or stenosis. The presence of venous thrombosis and/or stenosis may preclude children with chronic medical conditions from receiving lifesaving therapies, from hemodialysis in end-stage renal disease to total parenteral nutrition in short bowel syndrome. Several adult studies have found an association between PICCs and venous thrombosis and/or stenosis, but none has evaluated for this association in children.
To determine the incidence of venous thrombosis and/or stenosis after PICC placement and identify factors that increase the risk of venous thrombosis and/or stenosis after PICC placement in children.
Materials and methods
We conducted a retrospective review of children ages 1–18 years with a PICC placed between January 2010 and July 2013 at our center, and included those who had at least one vascular imaging study of the ipsilateral extremity (Doppler ultrasound, venogram or MR angiogram) after PICC placement. Logistic regression was applied to determine risk factors for development of venous thrombosis and/or stenosis.
One thousand, one hundred and ten upper extremity PICCs were placed, with 703 PICCs in the right and 407 PICCs in the left. Eight hundred fifty-one imaging studies (609 Doppler ultrasounds, 193 contrast venograms and 49 MR angiograms) were performed in 376 patients. The incidence of venous thrombosis and/or stenosis in the imaged cohort was 26.3%. PICC laterality, insertion site, duration, patient height to PICC diameter ratio, and number of PICCs per patient were not associated with development of venous thrombosis and/or stenosis. Additionally, primary diagnosis and symptoms at the time of imaging did not predict findings of venous thrombosis and/or stenosis. However, patients exposed to non-PICC central venous catheters (CVC) were more likely to develop venous thrombosis and/or stenosis (odds ratio 1.95, 1.10–3.45).
More than a quarter of the vascular imaging studies performed in this study cohort showed previously unknown venous thrombosis and/or stenosis, irrespective of PICC laterality, insertion site, duration and size and the number of PICCs. A history of CVC was associated with a nearly two-fold increase in risk of venous thrombosis and/or stenosis after PICC placement. We suggest that PICCs and CVCs should be placed judiciously in all children, but especially in those with lifelong medical conditions who are more likely to incur direct consequences from limited vascular access.
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Bourgeois FC, Lamagna P, Chiang VW (2011) Peripherally inserted central catheters. Pediatr Emerg Care 27:556–561
Dubois J, Rypens F, Garel L et al (2007) Incidence of deep vein thrombosis related to peripherally inserted central catheters in children and adolescents. CMAJ 177:1185–1190
Westergaard B, Classen V, Walther-Larsen S (2013) Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand 57:278–287
Crowley JJ, Pereira JK, Harris LS et al (1997) Peripherally inserted central catheters: experience in 523 children. Radiology 204:617–621
Kanin M, Young G (2013) Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs). Thromb res 132:527–530
Gibson C, Connolly BL, Moineddin R et al (2013) Peripherally inserted central catheters: use at a tertiary care pediatric center. J Vascul Interv Radiol 24:1323–1331
Loughran SC, Borzatta M (1995) Peripherally inserted central catheters: a report of 2506 catheter days. JPEN J Parent Enteral Nutr 19:133–136
Matsuzaki A, Suminoe A, Koga Y et al (2006) Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children. Support Care Cancer 14:153–160
Agarwal AK (2009) Central vein stenosis: current concepts. Adv Chronic Kidney Dis 16:360–370
Barrier A, Williams DJ, Connelly M et al (2012) Frequency of peripherally inserted central catheter complications in children. Pediatr Infect Dis J 31:519–521
Chopra V, Anand S, Hickner A et al (2013) Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 382:311–325
Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11:837–840
Lobo BL, Vaidean G, Broyles J et al (2009) Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters. J Hosp Med 4:417–422
Allen AW, Megargell JL, Brown DB et al (2000) Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 11:1309–1314
Gonsalves CF, Eschelman DJ, Sullivan KL et al (2003) Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 26:123–127
Dubois J, Garel L, Tapiero B et al (1997) Peripherally inserted central catheters in infants and children. Radiology 204:622–626
Chait PG, Ingram J, Phillips-Gordon C et al (1995) Peripherally inserted central catheters in children. Radiology 197:775–778
Raffini L, Huang YS, Witmer C et al (2009) Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics 124:1001–1008
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Shin, H.S., Towbin, A.J., Zhang, B. et al. Venous thrombosis and stenosis after peripherally inserted central catheter placement in children. Pediatr Radiol 47, 1670–1675 (2017). https://doi.org/10.1007/s00247-017-3915-9
- Chronic kidney disease
- Peripherally inserted central catheter
- Vascular access