Background: Central venous catheters (CVC) are essential in a critical care setting. Thrombosis is one of the very important associated complications that lead to increased morbidity and mortality.
Objectives: The aim is to find out the incidence of catheter related thrombosis in pediatric intensive care unit with the help of color Doppler sonography, its extent, risk factors and clinical impact
Methods: 70 patients admitted in the pediatric intensive care unit having central line inserted for more than 48 hours were included in this prospective study. Color Doppler Ultrasonography was performed on the 2nd and 7th days after CVL insertion and weekly until catheter removal. The size of the thrombus was noted. Presence of history of deep venous thrombosis, history of previous central line insertion, lumen number and the clinical probability of Well Deep score were noted.
Results: Thrombus was detected in 46 of 70 (65.70%) patients. The incidence in males was 79.3% and in females was 20.7%. Males had a significantly higher incidence of thrombus (p=0.013), with Doppler at day 2 Well Deep score and history of previous DVT were more significant associated findings. With day 7 Doppler pitting edema, positive CRP, increased platelet count and positive blood culture were associated with increased risk. Weekly Doppler showed significant risk with immobilization, positive blood and CVL tip culture and previous DVT.
Conclusion: CVC-related thrombosis is common and has the potential for serious complications. The presence of positive history of previous DVT and presence of CVL infection were the most associated risk factor for the development of catheter related thrombosis. Color Doppler sonography provides an easily available, noninvasive means of detecting a thrombus. More studies are needed to establish a consensus for prophylaxis and treatment of asymptomatic CVC-related thrombosis.
Beleidy Ahmed, El-Sherbini Seham, Elgebaly Heba and Eid Salwa