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Prepublished online as a Blood First Edition Paper on January 30, 2003; DOI 10.1182/blood-2002-09-2731.
Submitted September 6, 2002
Accepted January 14, 2003
Central venous line-related thrombosis in children: association with central venous line location and insertion technique
Christoph Male, Peter Chait, Maureen Andrew, Kim Hanna, Jim Julian, and Lesley Mitchell*
Children's Hospital, University of Vienna, Vienna, Austria
Population Health Sciences, The Hospital for Sick Children, Toronto, ON, Canada
Bayer, Inc., Toronto, ON, Canada
Henderson Research Centre, McMaster University, Hamilton, ON, Canada
* Corresponding author; email: lmitchel{at}mcmaster.ca.
Background: Venous thromboembolic events (VTE) in children are associated with central venous lines (CVL). The study objective was to assess whether CVL location and insertion technique are associated with the incidence of VTE in children. We hypothesized that VTE would be more frequent with i) CVL location on the left body side, ii) CVL location in the subclavian compared to the jugular vein, and iii) CVL insertion by percutaneous technique compared to venous cut-down. Methods: Prospective, multicentre cohort study in children with acute lymphoblastic leukemia during induction chemotherapy who had a CVL placed in the upper venous system. Characteristics of CVL were documented prospectively. All children had outcome assessment for VTE by objective radiographic tests including bilateral venography, ultrasound, echocardiography, and cranial magnetic resonance imaging. Findings: Among 85 children, 29 (34%) had VTE. There were 28 VTE in the upper venous system and 1 sinovenous thrombosis. Left-sided CVL (odds ratio 2.5, 95% confidence interval 1.0-6.4, p=0.048), subclavian CVL (3.1, 1.2-8.5, p=0.025), and percutaneous CVL insertion (3.5, 1.3-9.2, p=0.011) were associated with an increased incidence of VTE. There was interaction between CVL vein location and insertion technique: subclavian vein CVL inserted percutaneously had an increased incidence of VTE (54%) compared to any other combination (p=0.07). Conclusions: For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk of CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cut-down appears preferable over percutaneous insertion.
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