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Catheter-Related Deep Venous Thrombosis and Other Catheter Complications in Children With Cancer

Janna M. Journeycake, George R. Buchanan

From the University of Texas Southwestern Medical Center at Dallas, Division of Hematology-Oncology, Department of Pediatrics, and Children's Medical Center Dallas, Dallas, TX

Address reprint requests to Janna M. Journeycake, MD, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9063; e-mail: Janna.Journeycake{at}childrens.com

PURPOSE: Asymptomatic deep vein thrombosis (DVT) is a complication of central venous catheter (CVC) use in children with cancer, but its clinical significance is not well defined. Children with CVCs commonly experience two other CVC-related complications: occlusion and infection. The aim of this study was to determine the frequency of these two complications and their association with DVT.

PATIENTS AND METHODS: We conducted a retrospective cohort study of patients who were diagnosed with cancer. Data collected included number and type of catheter insertions, duration of use, reason for removal, associated catheter complications, and demographic information.

RESULTS: Catheters were placed in 287 patients for a total of 128,403 days (mean, 290 ± 269 days/catheter). Of 21 patients (7%) diagnosed with CVC-related DVT, only five had specific signs or symptoms. Nineteen (90%) of these 21 children had prior history of catheter occlusion, and 10 of the 19 also experienced infection. Ten children (48%) were not identified as having DVT until they had had multiple catheters with recurrent complications. Odds of having DVT were higher in patients who had a single catheter complicated by repeated occlusions (odds ratio [OR], 3.7; P = .001) or infection (OR, 2.2; P = .016). Patients experiencing both infection and occlusion were at 6.4 times (P < .0001) higher risk of developing DVT.

CONCLUSION: Children with CVC-related DVT frequently have recurrent catheter complications. Unrecognized thrombosis may therefore be clinically important. Prospective studies are needed to determine if identification and treatment of occult DVT will prevent additional CVC-related complications and prolong the duration of catheter use.

Supported by National Institutes of Health Institutional National Research Service Award T32 CA09640, Wipe Out Kids Cancer, Children's Cancer Fund, and Children Helping Children Research Fund.

Presented in part at the 44th Annual Meeting of the American Society of Hematology, Philadelphia, PA, December 6-10, 2002.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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