Central Venous Catheter Selection, Management, and Treatment of Catheter-Associated Deep Vein Thrombosis in Children Undergoing Cardiac Surgery: A Survey of Pediatric Cardiac Critical Care Consortium Centers
John S. Kim, Heart Institute, Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
Jason T. Patregnani, Barbara Bush Children's Hospital, Maine Health, Tufts University, Portland, ME, USA.
Ashish A. Ankola, Divisions of Pediatric Critical Care and Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Kurt Schumacher, Division of Pediatric Cardiology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Darren Klugman, Department of Pediatrics, John's Hopkins Children's Hospital Medical Center, Baltimore, MD, USA.
Therese M. Giglia, Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Sirine A. Baltagi, Divisions of Pediatric Cardiology and Critical Care, Department of Pediatrics, University of Texas at Southwestern, Children's Medical Center, Dallas, TX, USA.
Jennifer G. Baylor, Division of Pediatric Critical Care Medicine, University of Virginia, Charlottesville, VA, USA.
Erin Bressler, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Laura A. Downey, Division of Pediatric Cardiac Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Jarrett Linder, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Brian S. Marcus, Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Justin Yeh, Division of Pediatric Critical Care, Department of Pediatrics, University of California Irvine, Children's Hospital of Orange County, Orange, CA, USA.
Wenying Zhang, Division of Pediatric Cardiology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Abstract
Children undergoing surgery for congenital heart disease (CHD) are at risk for catheter-associated deep vein thrombosis (CA-DVT). We sought to understand the practice variations which may impact the risk for CA-DVT by conducting a comprehensive survey. Analysis of electronic survey of Pediatric Cardiac Critical Care Consortium (PC) hospitals caring for children undergoing surgery for CHD. Responses from 45 respondent PC4 centers was analyzed; 71% of centers (n = 32) had a prophylactic anticoagulation protocol. Two of the 45 respondent centers utilized a protocol for proactive screening for CA-DVT; 64% of centers (29/45) treated CA-DVT for a duration of 6 to 12 weeks. Internal jugular central vein catheters (CVC) were the most common primary access in children who were 1 to 18 years of age undergoing surgery (89% [40/45] of centers) and in infants 1 to 12 months of age (73% [33/45] of centers). Significant variability CVC-type selection was reported in neonates (<30 days of>age). More than half of centers reported avoiding upper extremity peripherally inserted central catheter placement in patients both prior to and after stage 2 palliation for single ventricle CHD (58% [26/45] and 53% [24/45], respectively). Significant variability in prevention and management of CA-DVT is reported among PC centers. Only half of respondent PC4 centers reported having an established treatment protocol for CA-DVT. Consensus and evidence-based guidelines for the treatment of CA-DVT are not consistently followed with only 62% (28/45) of centers reported treating for the recommended 6 to 12 weeks with anticoagulation. There is high variability in CVC-type and location selection in neonates undergoing CHD surgery.
