Catheter-related thrombosis in critically ill children: Comparison of catheters with and without heparin bonding,☆☆,

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Abstract

Objective: To compare the incidence of and factors associated with vascular thrombosis after placement of heparin-bonded and standard femoral venous catheters. Design: Prospective, masked, clinical study. Setting: Multidisciplinary, tertiary, pediatric intensive care unit. Patients: Consecutive cases (n = 50) of critically ill children admitted to a pediatric intensive care unit in whom either a heparin-bonded (n = 25) or a standard (n = 25) femoral venous catheter was placed. Measurements and main results: Patients were examined by ultrasonography within 3 days of catheter insertion, weekly while the catheter was in place, and after catheter removal for evidence of vascular thrombosis. Data were collected prospectively regarding clinical evidence of catheter thrombosis, infusate composition, and positive blood culture results. Of 50 patients, 13 (26%) had thrombotic complications, 11 (44%) of the 25 patients in the standard-catheter group, in comparison with 2 (8%) of the 25 patients in the heparin-bonded catheter group (p = 0.004). In addition, there was a significantly higher incidence of positive blood culture results among patients in the standard-catheter group (24% vs 0%; p = 0.009). Positive catheter blood culture results were obtained in 38% of patients with thrombosis versus 3% without thrombosis (p = 0.001). Clinical evidence of thrombosis was found in 69% of patients with, versus 27% of patients without, ultrasound-proved thrombosis (p = 0.007). Conclusion: Heparin bonding of catheters is associated with significantly fewer thrombotic complications. A reduced incidence of positive catheter-related blood culture results may be associated with the absence of thrombosis. (J PEDIATR 1995;126:50-4)

Section snippets

Patients

The study took place prospectively between March and December 1993 in our 16-bed, multidisciplinary unit with more than 1000 admissions each year. Deep venous catheters are used in approximately 20% of the patients admitted to this unit. All patients between birth and the age of 8 years who had 8 to 15 cm femoral venous catheters placed were eligible for entry into the study. Patients were excluded from the study if there was a history of vascular thrombosis, previous femoral venous

RESULTS

Fifty patients were enrolled at a median age of 6.5 months (range, 0.5 to 88 months); 25 were enrolled in the heparin-bonded and 25 in the standard-catheter groups (Table). Patient, infusate, and catheter data did not differ with the exception that one group had heparin-bonded catheters placed and the other group had standard catheters placed. Vascular thrombosis developed in 13 (26%) of 50 patients overall, 11 (44%) of 25 patients in the standard-catheter group and 2 (8%) of 25 patients in the

DISCUSSION

Heparin prevents thrombosis and thrombus extension8, 9, 10 and is therefore a logical coating in attempts to decrease catheter-related thrombosis. Heparin-bonded catheters have been associated with diminished adherent thrombi and fibrin sheath formation around the catheter in adults5, 11 and with decreased vascular thrombosis in an animal model. 12 The effect of heparin-bonded catheters on the formation of mural thrombosis has not been studied in human subjects.

Our patients with heparin-bonded

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    From the Departments of Critical Care and Diagnostic Imaging, Children's National Medical Center, Washington, D.C., and the Departments of Anesthesiology and Pediatrics, George Washington University School of Medicine, Washington, D.C. Submitted in part by a research grant from Cook Incorporated. Presented at the Society of Critical Care Medicine 1994 Educational & Scientific Symposium.

    ☆☆

    Reprint requests: Brian Krafte-Jacobs, MD, Division of Critical Care Medicine, Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229.

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