Determination Of Prevalence Of Thrombosis And Predisposing Factors In Patients Followed Up With A Central Venous Catheter In Pediatric Intensive Care Unit

Objective: Objective of this study is determination of prevalence of thrombosis and predisposing factors in critically ill patients with central venous catheter (CVC) placement in Pediatric Intensive Care Unit. Material and method: Of 76 cases with CVC placement aged between 1 month to 18 years; venous structures at the extremity where the CVC was placed and their symmetrical equivalents were prospectively examined by using Doppler ultrasonography (DUSG) at days 0, 3, 7, 14 and 28. Results: Median age of the cases included in the study was 19 (2-201) months. Of the cases; 49 (64.5%) was male and 27 (35.5%) was female, with a male/female ratio of 1.81:1. 55 (72.3%) of the cases had an underlying disease. Most common accompanying diseases were neurological and neuromuscular diseases (35.5%), followed by inborn errors of metabolism (14.4%). More than one catheters were placed for 26 (34.2%) of the cases. A total of 107 catheters were placed. Median catheter dwelling time was 12 (2-46) days. Most commonly placed catheters were of Seldinger type (90%). As an early complication, arterial embolism was observed in one (0.9%) case and pneumothorax in one (0.9%) case. As a late complication during the period with a catheter placed, six (7.8%) cases developed catheter infections and 11 (14.4%) cases developed catheter-induced thrombosis. Four (36.3%) of the cases which developed thrombosis were symptomatic. In six (54.4%) of the cases, thrombosis was determined to occur within first three days. When the cases were evaluated in regard to risk factors for thrombosis other than CVC placement, a significant association of CPR application (p= 0.004) and multiple catheter placement (p< 0.001) with thrombosis was determined in uni- and multivariate analyses. 72.7% of the cases with thrombosis were examined for hereditary risk factors and no significant evidence was determined. Conclusion: Our study reveals that multiple catheter placement and CPR application significantly increases risk of thrombosis. Even in absence of any clinical finding, routine evaluation with DSUG within first seven days following catheter placement is useful. Our results suggest that screening for hereditary risk factors which may cause predisposition to thrombosis in all patients with thrombosis in presence of acquired risk factors is unnecessary.