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On the other hand, inserting a central venous catheter is more invasive, which is unideal for child patients. Inserting a centrally-placed line or a tunneled line (TL) is also longer to perform and expensive since a surgeon and an interventional radiologist is needed. The patient is also under anesthesia during the procedure. The study findings
The new study called the Clot Incidence Rates in Central Lines (CIRCLE), compared VTEs in children with newly placed PICC and TLs. The study involved around 1,742 children between six months of age and 18 years with a total of 1,967 newly placed CVCs.
The team found that VTEs linked to CVC happened in about 6 percent of children within the first six months of follow up. In all the CVC cases wherein VTEs occurred, 80 percent were observed in children inserted with a PICC. They concluded that children with PICC were at about 8.5 times more likely to develop a blood clot compared to those inserted with a TL.
"Now we can say definitively that patients who have PICCs have a much higher rate of thrombosis as well as central line-associated bloodstream infections and catheter malfunctions when compared to TLs." Dr. Julie Jaffray, Children's Hospital of Los Angeles
The study was also the first one to take an in-depth look at blood clot formation incidence in children who have CVCs. VTEs are dangerous in children, as they are faced with many complications. These include prolonged hospitalizations, higher rates of death due to pulmonary embolism, and higher hospital costs. Moreover, children may also develop post-thrombotic syndrome, a condition linked to pain and inflammation even after the clot has been removed.
The doctors reiterate that improved diagnosis and treatment procedures in children are necessary. One goal should be to see which children actually need the PICC procedure, and who can survive without having these tubes attached to them. However, the researchers said further research is needed. Journal reference:
Jaffray, J., Witner, C., O’Brien, S., Diaz, R., Ji, L, and Krava, G. (2019). Peripherally Inserted Central Catheters Lead to a High Risk of Venous Thromboembolism in Children. Blood . DOI: https://doi.org/10.1182/blood.2019002260
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