Central venous line-related thrombosis in children: association with central venous line location and insertion technique
Central venous line-related thrombosis in children: association with central venous line location and insertion technique
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DOI：
10.1182/blood-2002-09-2731
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发表时间：
2003-06-01
期刊：
影响因子：
20.3
通讯作者：
Mitchell, L
中科院分区：
文献类型：
--
作者：
Male, C;Chait, P;Mitchell, L
儿童静脉血栓栓塞事件（VTE）与中心静脉管路（CVL）相关。研究目的是评估CVL位置和插入技术是否与儿童VTE的发生率相关。我们假设，（1）CVL位于左体侧，（2）CVL位于锁骨下静脉而不是颈静脉，（3）通过经皮技术插入CVL而不是静脉切开，VTE会更常见。这是一项在诱导化疗期间将CVL置于上静脉系统的急性淋巴细胞白血病儿童中进行的前瞻性、多中心队列研究。前瞻性记录了CVL的特征。所有患儿均通过客观影像学检查（包括双侧静脉造影、超声、超声心动图和头颅磁共振成像）进行VTE结局评估。85例患儿中29例（34%）发生静脉血栓栓塞，28例发生在上静脉系统，1例为窦静脉血栓形成。左侧CVL（比值比[OR]，2.5; 95%置信区间，1.0-6.4; P = 0.048）、锁骨下CVL（OR，3.1; 95% CI，1.2-8.5; P = 0.025）和经皮CVL插入（OR，3.5; 95% CI，1.3-9.2; P = 0.011）与VTE发生率增加相关。CVL静脉位置和插入技术之间存在相互作用。经皮锁骨下静脉CVL插入与任何其他组合相比，VTE的发生率增加（54%）（P = 0.07）。对于上部静脉系统中的CVL，将CVL放置在右侧和颈静脉中可降低CVL相关VTE的风险。如果锁骨下静脉的放置是必要的，CVL插入静脉切开似乎优于经皮插入。(C)2003年，美国血液学会。
Venous thromboembolic events (VTEs) in children are associated with central venous lines (CVLs). 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 (1) CVL location on the left body side, (2) CVL location in the subclavian vein rather than the jugular vein, and (3) CVL insertion by percutaneous technique rather than venous cut-down. This was a prospective, multicenter cohort study in children with acute lymphoblastic leukemia who had a CVL placed in the upper venous system during induction chemotherapy. 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. Among 85 children, 29 (34%) had VTE; 28 VTEs appeared in the upper venous system, and 1 was sinovenous thrombosis. Left-sided CVL (odds ratio [OR], 2.5; 95% confidence interval, 1.0-6.4; P = .048), subclavian CVL (OR, 3.1; 95% Cl, 1.2-8.5; P = .025), and percutaneous CVL insertion (OR, 3.5; 95% Cl, 1.3-9.2; P = .011) were associated with an increased incidence of VTE. Interaction occurred between CVL vein location and insertion technique. Subclavian vein CVL inserted percutaneously had an increased incidence (54%) of VTE compared with any other combination (P = .07). For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk for CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cutdown appears preferable over percutaneous insertion. (C) 2003 by The American Society of Hematology.