Central Venous Catheter-Associated Deep Venous Thrombosis in Critically Ill Children in Tanta Pediatric Intensive Care Unit

Abstract

Background: The largest prevalence of CVC-related thrombosis occurs in infants under the age of one year, which is likely due to the infant's smaller diameter vessels.  In addition, CVC-related thromboses are more likely to occur in patients with malignancy, critical illness, congenital heart disease, systemic infection, total parenteral nutrition, trauma, and in patients admitted to the Neonatal Intensive Care Unit. Central line occlusion or frequent central line infections are sometimes the first sign of thrombosis and should increase suspicion of a VTE. In neonates with catheter-related thrombosis, thrombocytopenia may be the presenting sign. At least 18% of critically ill children with a CVC develop radiologically confirmed catheter-associated thrombosis (CAT). Clinically apparent thrombosis occurs in 17.5% of critically ill children with a CVC. Methods: This prospective observational study was carried out on 55 pediatric patients admitted to PICU, Tanta University Hospital. The duration of research was conducted from December 2020 to December 2022.  They were subdivided into: Group I: Fifteen patients with Factor VIII (FVIII) activity <100 % Group II: Twenty patients with FVIII activity from 100 % to 150 % (high normal) Group III: Twenty patients with FVIII activity >150 %. After correction of dehydration (if present); All patients in the three groups: FVIII and D-dimer, were collected on the day of insertion of central venous line (all patients from the start received thromboprophylaxis in the form of (Enoxaparin Sodium ®) with dose (0.5 mg/kg subcutaneous every 12 hours) and after one week of enrollment. Twenty patients received Alteplase® dosing for CVC occlusion based on patient weight category and the volume of the affected catheter lumen. Results: FVIII activity was a significant predictor for central venous line thrombosis with cut-off value>152, sensitivity100, specificity 80, PPV 93.7, and NPV 100. Conclusion: F VIII activity was a significant predictor for central venous line thrombosis. Enoxaparin sodium® was effective as thromboprophylaxis with a dose (of 0.5 mg/kg subcutaneously every 12 hours) within the normal range of factor VIII (up to 150%). Alteplase® dosing for CVC occlusion based on patient weight category and the volume of the affected catheter lumen with an efficacy of 73.33%.