Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2020; 12(10): 484-491
Published online Oct 26, 2020. doi: 10.4330/wjc.v12.i10.484
Upper body peripherally inserted central catheter in pediatric single ventricle patients
Santosh Kaipa, Christopher W Mastropietro, Hamza Bhai, Riad Lutfi, Matthew L Friedman, Mouhammad Yabrodi
Santosh Kaipa, Christopher W Mastropietro, Hamza Bhai, Riad Lutfi, Matthew L Friedman, Mouhammad Yabrodi, Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
Author contributions: Kaipa S, Mastropietro CW, Lutfi R, Friedman ML and Yabrodi M was involved in concept designing, data collection, data analysis, drafting the article and critical revision of article; Bhai H was involved in data collection, data analysis, drafting the article and critical revision of article.
Institutional review board statement: The results in this manuscript were accepted in abstract form at the annual meeting of the Pediatric Cardiac Intensive Care Society, London, UK November 2019.
Informed consent statement: Our Study was retrospective chart review and was an exempt from IRB and we did not use any PHI, so we did not require informed consent.
Conflict-of-interest statement: None of the authors have conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Santosh Kaipa, MD, MSc, Academic Fellow, Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, 705 Riley Hospital Drive, Phase 2, Rm 4911A, Indianapolis, IN 46303, United States. santoshkaipa@gmail.com
Received: March 19, 2020
Peer-review started: March 19, 2020
First decision: July 5, 2020
Revised: July 19, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: October 26, 2020
Abstract
BACKGROUND

There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement. This complication is more serious among patients with single ventricle physiology, as it might preclude them from undergoing further life-sustaining palliative surgery.

AIM

To describe complications associated with the use of upper extremity percutaneous intravenous central catheters (PICCs) in children with single ventricle physiology.

METHODS

A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure. Clinical data including ultrasonography, cardiac catheterization, echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels. Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter (CVC), and use of anticoagulation were recorded.

RESULTS

Seventy-six patients underwent superior cavopulmonary anastomoses, of which 56 (73%) had an upper extremity PICC at some point prior to this procedure. Median duration of PICC usage was 24 d (25%, 75%: 12, 39). Seventeen patients (30%) with PICCs also had internal jugular or subclavian central venous catheters (CVCs) in place at some point prior to their superior cavopulmonary anastomoses, median duration 10 d (25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs (4%) and 3 of the 17 CVCs (18%). All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients. No patients developed clinically significant venous stenosis.

CONCLUSION

Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheter-associated thrombosis.

Keywords: Thrombosis, Central venous catheters, Catheterization peripheral, Univentricular heart, Children

Core Tip: There is a wide variation in practice in terms of the preferred central venous access site and catheter-type for patients who undergo surgery for single ventricle heart disease. Thrombosis is a serious concern in patients with single ventricle physiology. This study aims to describe the use of upper body percutaneously inserted central catheters in patients with single ventricle physiology prior to their superior cavopulmonary anastomosis procedure at our institution. Our study shows that upper body percutaneous intravenous central catheters are associated with a low rate of clinically significant catheter-related thrombosis.