Central venous thrombosis in children with intestinal failure on long-term parenteral nutrition

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• 作者：Jessica Gonzalez-Hernandez^a ; Yahya Daoud^a ; Jennifer Styers^b ; Janna M. Journeycake^c ; Nandini Channabasappa^d ; Hannah G. Piper^b ; ^{Hannah.Piper@childrens.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CVT ; central vein thrombosis ; PN ; parenteral nutrition ; IF ; intestinal failure ; CVC ; central venous catheter ; CLABSI ; central line associated bloodstream infection
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：51
• 期：5
• 页码：790-793
• 全文大小：234 K

文摘

Central venous thrombosis (CVT) is a serious complication of long-term central venous access for parenteral nutrition (PN) in children with intestinal failure (IF). We reviewed thse incidence of CVT and possible risk factors.

Methods

Children with IF on home PN (2010–2014) with central venous imaging were reviewed. Patient demographics, catheter characteristics and related complications, and markers of liver function were compared between children with and without CVT. Serum thrombophilia markers were reviewed for patients with CVT.

Results

Thirty children with central venous imaging were included. Seventeen patients had thrombosis of ≥ 1 central vein, and twelve had ≥ 2 thrombosed central veins. Patients with and without CVT had similar demographics and catheter characteristics. Patients with CVT had a significantly lower albumin level (2.76 ± 0.38 g/dL vs. 3.12 ± 0.41 g/dL, p = 0.0223). The most common markers of thrombophilia in children with CVT were antithrombin, protein C and S deficiencies, and elevated factor VIII. There was a statistically significant correlation between a combined protein C and S deficiency and having > 1 CVT.

Conclusions

Children with IF on long-term PN are at high risk for CVT potentially owing to low levels of natural anticoagulant proteins and elevated factor FVIII activity, likely a reflection of liver insufficiency and chronic inflammation.