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
ARTICLE HIGHLIGHTS
Research 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. Data on the rate of venous thrombosis in children with single ventricle physiology with upper extremity central venous catheters are limited. Also, there is a wide variation in practice regarding the choice of central access in this population across the centers.

Research motivation

To study the risk of using upper body percutaneously inserted central catheter (PICC) in single ventricle patients. The results of this study could be used to develop a multicenter study to determine the risk and benefit of using this type and location of the catheter in this population.

Research objectives

To describe the incidence of thrombosis associated with the use of PICCs in patients with single ventricle physiology.

Research methods

We retrospectively reviewed the charts of patients with single ventricle physiology who underwent second stage palliation surgery. Data regarding the type and duration of central venous access were collected in addition to the data regarding thrombosis or stenosis.

Research results

We reviewed a total of 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 with a median duration of 10 days (25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs (4%) and 3 of the 17 CVCs (18%) and the incidence of thrombosis was significantly different between the PICCs vs CVCs (P < 0.04). 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.

Research conclusions

The placement of PICC in the upper extremity in children with single ventricle physiology was associated with low risk of clinically significant stenosis or thrombosis and provide a reliable way to have long-lasting central venous access.

Research perspectives

Further research and multicenter studies specifically looking at the incidence of complications with upper body PICCs in single ventricle patients are warranted.