University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• We place many central lines in the NICU, PICU, and for long-term TPN, outpatient IV antibiotics, and chemotherapy.  What is the incidence and clinical outcome of Catheter-Associated DVT (CA-DVT)?

Clinical Bottom Lines

1. The occurrence of CA-DVT is probably much higher than the index of suspicion.
2. There are not enough studies to determine the clinically significant occurrences of CA-DVT, its complications, or its prevention.
3. There are studies currently underway to help address these issues.

Summary of Key Evidence

1. A collection of patients with DVT's had a significant rate of morbidity and mortality.(1)  However, the incidence of 3.5 per 10,000 admissions was thought to be an underestimate.
2. A prospective study in the PICU setting showed a rate of clinically evident thrombosis at 7.5% and a clinically silent rate of CA-DVT at 18.3%. (2)  Although the study population was small there was no symptomatic PE or mortality from CA-DVT in the group.  Infection in patients with DVT was not reported.  2/12 patients still had symptoms at one month follow-up.
3. A prospective study of 156 children with cancer undergoing ECHOs for anthracycline use systematically looked for and found that 8.8% had right atrial thrombi.(3)  Although no patients were symptomatic, 2 patients underwent thrombectomy, 3 were treated and 7 were observed.  They found a relationship between placement of catheter tip in atrium, diagnosis of ALL (may have been selection bias) and possible trend toward treatment with L-aspariginase.

Additional Comments

• A consensus statement for indications for treatment and prophylaxis based on critical review of published data is available in Chest, 1998; 114(5):748-795.

Citation

1. Massicotte MP.  Central venous catheter related thrombosis in children: Analysis of the Canadian registry of venous thromboembolic complications. Journal of Pediatrics, 1998; 133(6):770-776.
2. Beck C.  Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: A prospective study.  Journal of Pediatrics, 1998; 133(2):237-241.
3. Korones D.  Right atrial thrombus in children with cancer and indwelling catheters.  Journal of Pediatrics, 1996; 128(6):841-846.

CAT Author: Kimberly Stewart, MD

CAT Appraisers: John G. Frohna, MD

Date appraised: May 29, 2000