Skip to main content

Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients

Pediatric Radiology volume 48, pages 1013–1020 (2018)Cite this article

Abstract

Background

Peripherally inserted central catheters (PICCs) are associated with superficial and deep venous thrombosis of the arm.

Objective

The purpose of this study was to analyze the sequelae of repeated upper limb PICC insertions in children, in terms of the frequency of upper limb thrombosis in this patient group.

Materials and methods

The study population included all children who underwent their first successful arm PICC insertion between January 2010 and December 2015. We included subsequent ipsilateral arm PICCs in the analysis. Patients were followed until March 2016 or until any alternative central venous line insertion. For each PICC insertion, we collected demographic variables and line characteristics. We correlated all symptomatic deep and superficial thromboses of the arm with the PICC database.

Results

Applying inclusion and exclusion criteria, 2,180 PICCs remained for analysis. We identified first, second, third and fourth PICC insertions in the same arm in 1,955, 181, 38 and 6 patients, respectively. In total there were 57 upper body deep symptomatic thrombotic events. An increasing odds ratio was seen with higher numbers of PICC insertions, which was significant when comparing the first with the third and fourth PICC insertions in the same arm (odds ratio [OR] 6.00, 95% confidence interval [CI] 2.25–16.04, P=0.0004). Double-lumen PICCs were associated with a significantly higher risk of thrombosis than single lumen (OR 2.77, 95% CI 1.72-4.47, P=0.0003).

Conclusion

Repetitive PICC insertions in the same arm are associated with an increased risk of symptomatic thrombosis. Double-lumen PICCs are associated with a higher risk of thrombosis compared to single-lumen lines.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Chait PG, Ingram J, Phillips-Gordon C et al (1995) Peripherally inserted central catheters in children. Radiology 197:775–778

    Article  PubMed  CAS  Google Scholar 

  2. Gibson C, Connolly BL, Moineddin R et al (2013) Peripherally inserted central catheters: use at a tertiary care pediatric center. J Vasc Interv Radiol 24:1323–1331

    Article  PubMed  Google Scholar 

  3. Golan DE, Tashjian AH, Armstrong EJ et al (2012) Principles of pharmacology: the pathophysiologic basis of drug therapy, 3rd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  4. Yang RY, Moineddin R, Filipescu D et al (2012) Increased complexity and complications associated with multiple peripherally inserted central catheter insertions in children: the tip of the iceberg. J Vasc Interv Radiol 23:351–357

    Article  PubMed  Google Scholar 

  5. Greene MT, Flanders SA, Woller SC et al (2015) The association between PICC use and venous thromboembolism in upper and lower extremities. Am J Med 128:986–993

    Article  PubMed  Google Scholar 

  6. Shin HS, Towbin AJ, Zhang B et al (2017) Venous thrombosis and stenosis after peripherally inserted central catheter placement in children. Pediatr Radiol 47:1670–1675

  7. Prandoni P, Polistena P, Bernardi E et al (1997) Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 157:57–62

  8. Baskin KM, Jimenez RM, Cahill AM et al (2008) Cavoatrial junction and central venous anatomy: implications for central venous access tip position. JVIR 19:359–365

    Article  PubMed  Google Scholar 

  9. Raffini L, Huang Y-S, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics 124:1001–1008

    Article  PubMed  Google Scholar 

  10. Monagle P, Adams M, Mahoney M et al (2000) Outcome of pediatric thromboembolic disease: a report from the Canadian childhood thrombophilia registry. Pediatr Res 47:763–766

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  PubMed  PubMed Central  Google Scholar 

  12. Smitherman AB, Alexander T, Connelly M et al (2015) The incidence of catheter-associated venous thrombosis in noncritically ill children. Hosp Pediatr 5:59–66

    Article  PubMed  Google Scholar 

  13. Schmugge M, Bang KWA, Blanchette VS et al (2007) Platelet activation and von Willebrand factor binding to platelets in newborn infants with central venous lines. Acta Haematol 117:145–148

    Article  PubMed  CAS  Google Scholar 

  14. Ters El M, Schears GJ, Taler SJ et al (2012) Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas: a case-control study in hemodialysis patients. Am J Kidney Dis 60:601–608

    Article  Google Scholar 

  15. Aw A, Carrier M, Koczerginski J et al (2012) Incidence and predictive factors of symptomatic thrombosis related to peripherally inserted central catheters in chemotherapy patients. Thromb Res 130:323–326

    Article  PubMed  CAS  Google Scholar 

  16. Chemaly RF, de Parres JB, Rehm SJ et al (2002) Venous thrombosis associated with peripherally inserted central catheters: a retrospective analysis of the Cleveland Clinic experience. Clin Infect Dis 34:1179–1183

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Bonizzoli M, Batacchi S, Cianchi G et al (2011) Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 37:284–289

    Article  PubMed  Google Scholar 

  19. Liem TK, Yanit KE, Moseley SE et al (2012) Peripherally inserted central catheter usage patterns and associated symptomatic upper extremity venous thrombosis. J Vasc Surg 55:761–767

    Article  PubMed  Google Scholar 

  20. Itkin M, Mondshein JI, Stavropoulos SW et al (2014) Peripherally inserted central catheter thrombosis — reverse tapered versus nontapered catheters: a randomized controlled study. J Vasc Interv Radiol 25:85–91

    Article  PubMed  Google Scholar 

  21. Evans RS, Sharp JH, Linford LH et al (2013) Reduction of peripherally inserted central catheter-associated DVT. Chest 143:627–633

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wildgruber M, Lueg C, Borgmeyer S et al (2016) Polyurethane versus silicone catheters for central venous port devices implanted at the forearm. Eur J Cancer 59:113–124

    Article  PubMed  Google Scholar 

  24. Miyagaki H, Nakajima K, Hara J et al (2012) Performance comparison of peripherally inserted central venous catheters in gastrointestinal surgery: a randomized controlled trial. Clin Nutr 31:48–52

    Article  PubMed  Google Scholar 

  25. Thomsen HK, Kjeldsen K, Hansen JF (1977) Thrombogenic properties of arterial catheters: a scanning electron microscopic examination of the surface structure. Catheter Cardiovasc Diagn 3:351–358

    Article  CAS  Google Scholar 

  26. Bourassa MG, Cantin M, Sandborn EB et al (1976) Scanning electron microscopy of surface irregularities and thrombogenesis of polyurethane and polyethylene coronary catheters. Circulation 53:992–996

    Article  PubMed  CAS  Google Scholar 

  27. Tran H, Arellano M, Chamsuddin A et al (2010) Deep venous thromboses in patients with hematological malignancies after peripherally inserted central venous catheters. Leuk Lymphoma 51:1473–1477

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Ralph Gnannt was supported by the Emily Dorothy Lageman Foundation (EMDO) and Helmut-Hartweg Funds.

Author information

Affiliations

  1. Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Ralph Gnannt, Michael Temple, Afsaneh Amirabadi & Bairbre L. Connolly

  2. Pediatric Interventional Radiology, Department of Diagnostic Imaging, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Ralph Gnannt

  3. Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Nicolas Waespe & Leonardo R. Brandão

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Kuan Liu

Authors
  1. Ralph Gnannt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas Waespe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Temple
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Afsaneh Amirabadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonardo R. Brandão
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bairbre L. Connolly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ralph Gnannt.

Ethics declarations

Conflicts of interest

None

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gnannt, R., Waespe, N., Temple, M. et al. Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients. Pediatr Radiol 48, 1013–1020 (2018). https://doi.org/10.1007/s00247-018-4096-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-018-4096-x

Keywords

  • Catheter
  • Children
  • Peripherally inserted central catheter
  • Thrombosis
  • Upper extremity
  • Venous access