Catheter-related thrombosis in children with cancer

doi:10.1067/mpd.2001.111272

The Journal of Pediatrics

Volume 138, Issue 2, February 2001, Pages 255-259

https://doi.org/10.1067/mpd.2001.111272 Get rights and content

Abstract

Objective: The prevalence of asymptomatic catheter-related thrombosis of the upper venous system in children with cancer has not been determined. We evaluated patients with cancer and implantable central venous catheters (ports) for this complication. Study Design: Children with cancer undergoing port removal were eligible for this study. Vessel patency was evaluated by contrast venography. We examined each child for physical stigmata of thrombosis and retrospectively assessed catheter-related mechanical difficulties and infections. Results: Thirty-one ports had been placed in 24 children (aged 20 months to 18 years; median age, 9 years) with diagnoses of leukemia/lymphoma (n = 10), solid tumor (n = 12), and histiocytosis (n = 2). Venography showed abnormalities in 12 of the 24 patients. Physical examination revealed dilated superficial veins on the chest in 3 patients. Venograms showed abnormalities in all 3 children with prominent superficial thoracic veins. Nine of the 21 other patients had clinically occult central venous occlusion. Conclusion: Fifty percent (95% CI, 30% to 70%) of children who had implantable ports removed during or after treatment of cancer exhibited deep venous thrombosis at the site of catheter placement. Future studies should determine the contribution of inherited and other acquired risk factors for thrombosis and assess measures to prevent and/or treat catheter-related thrombosis in this population. (J Pediatr 2001;138:255-9)

Section snippets

Patients and Methods

Patients with cancer at Children’s Medical Center of Dallas who were less than 21 years of age and who had a tunneled subcutaneous access central venous catheter or implanted port in place were eligible for this prospective study, which was approved by the institutional review board at the University of Texas Southwestern Medical Center at Dallas. Ports had been placed, while patients were under general anesthesia, for the purpose of long-term access for chemotherapy and supportive care.

Results

Five patients (age range, 4-16 years) participated in the pilot study between July 1, 1996, and March 31, 1997. Patient characteristics and venogram results are listed in the Table.Indication for venography was end of therapy in 4 patients and thrombus seen coincidentally on chest computed tomographic scan in 1. Four of 5 venograms revealed thrombosis, with obstruction of flow or a filling defect with extensive collateral vessels.

Between July 1, 1997, and June 30, 1998, 30 additional patients

Discussion

Despite an increased awareness of the complications of the use of central venous catheters and concerns regarding upper venous thrombosis, to our knowledge this is the first study to use venography to determine the actual prevalence of catheter-related thrombosis in children being treated for cancer.

We have identified catheter-related upper venous system thrombosis in 50% of 24 children being treated for cancer. Three of the children had physical findings consistent with thrombosis, so the

Acknowledgements

We thank Jill Steele, RN, MSN, and Suzanne Sander, RN, for their assistance with data collection.

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To understand the epidemiology, management, and outcomes of uVTE in children.
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^☆: Supported in part by National Institutes of Health T32 Training Grants CA09640 and CA64640 and by the Children’s Cancer Fund of Dallas, Inc.

^☆☆: Reprint requests: George R. Buchanan, MD, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235-9063.

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Original ArticlesCatheter-related thrombosis in children with cancer☆,☆☆

Abstract

Section snippets

Patients and Methods

Results

Discussion

Acknowledgements

J Pediatr

J Pediatr

Blood

J Pediatr

Thromb Res

J Pediatr Surg

J Pediatr

J Pediatr

J Pediatr

Thromb Res

Lancet

A prospective study of Hickman/Broviac catheters and implantable ports in pediatric oncology patients

J Clin Oncol

Complications of indwelling venous access lines in the pediatric hematology patient: a prospective comparison of external venous catheters and subcutaneous ports

Am J Pediatr Hematol Oncol

A prospective evaluation of the Port-a-Cath implantable venous access system in chronically ill adults and children

Surg Gynecol Obstet

The complications of central venous access systems: a study of 218 patients

Eur J Surg

Diagnosis and treatment of venous thromboembolism in children and adolescents

Thromb Haemost

Original Articles
Catheter-related thrombosis in children with cancer☆,☆☆