Analysis Of High Risk Factors Associated With Catheter-related Thrombosis In Children With Central Venous Catheterization

Background and purpose:Central venous catheterization(CVC)is widely used in intensive care unit(ICU),surgical anesthesia procedure,and cardiovascular intervention because CVC is convenient for infusion,long period catheterization,and avoiding the pain caused by repeated puncture.With the increasing of CVC application,CVC related complications have become more and more important.Among these complications,the incidence of catheter-related thrombosis(CRT)is especially height,and thrombus detachment may lead to pulmonary embolism.In the pediatric intensive care unit(PICU),CVC is widely used because of the critical condition and cumbersome treatment.This study aims to analyze the incidence of CRT in children with CVC and its related high risk factors,and provide theoretical basis for clinically safe selection and use of central venous catheterization.Methods:338 children with CVC were enrolled during the hospitalization of PICU in Zhejiang University Children's Hospital from January 2016 to December 2016.Doppler ultrasonography was performed on the catheter site,to find the incidence of CRT.The time of CRT was observed.According to the occurrence of CRT,they were divided into thrombosis group and non-thrombosis group.The factors that may be associated with CRT were compared between the two groups:gender,age,primary disease,indwelling site,catheter type,ultrasound demarcated catheterization,catheter-related infection,the use of glucocorticoids,parenteral nutrition,and prophylactic use of anticoagulants.Statistics and analysis were used to explore the high risk factors for the formation of CRT.Results:87 cases of CRT were found of 338 children with CVC.The incidence of CRT was 25.7%,with symptomatic thrombosis was 3.8%and asymptomatic thrombosis was*21.9%.CRT could be formed within 24 hours after catheterization,and the highest incidence of CRT was 4-7 days after catheterization(P=0.013).Univariate analysis showed that age,catheter type(PICC and non-tunneled CVC),the use of glucocorticoids,and parenteral nutrition were associated with CRT formation(P<0.05);Logistic multivariate analysis showed catheter type[OR=1.662,95%CI(1.106,2.498),P value=0.014],the use of glucocorticoids[OR=2.088,95%CI(1.239,3.517),P value=0.006],and intravenous nutrition[OR=2.398,95%CI(1.260,4.564),P=0.008]were independent risk factors for CRT in patients with central venous catheterization in the PICU.Conclusions:In Zhejiang University Children's Hospital,the incidence of CRT in children with PICU was 25.7%,and most of them were asymptomatic thrombosis.Four-Seven days after catheterization was most dangerous period with the high incidence of CRT.Types of catheterization,the use of glucocorticoids,and parenteral nutrition are independent risk factors for CRT.