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

Abstract

Objective: 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. Methods: Analysis of electronic survey of Pediatric Cardiac Critical Care Consortium (PC ⁴ ) hospitals caring for children undergoing surgery for CHD. Results: 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). Conclusions: Significant variability in prevention and management of CA-DVT is reported among PC⁴ 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.