Thrombosis and embolism in long-term central venous access for parenteral nutrition

• Published in: The Lancet (British edition) Vol. 344; no. 8929; pp. 1043 - 1045
• Main Authors: Dollery, C.M, Sullivan, I.D, Bull, C, Bauraind, O, Milla, P.J
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 15.10.1994; Lancet; Elsevier Limited
• Subjects: Adolescent; Adolescents; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants; Biological and medical sciences; Catheterization, Central Venous - adverse effects; Catheters; Child; Child, Preschool; Children; Children & youth; Digestive system; Embolism; Embolisms; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Fatalities; Health risk assessment; Humans; Infant; Infant, Newborn; Intensive care medicine; Lungs; Medical disorders; Medical research; Medical sciences; Nutrition; Parenteral nutrition; Parenteral Nutrition - adverse effects; Patients; Perfusion; Pulmonary Embolism - etiology; Pulmonary Embolism - mortality; Pulmonary Embolism - surgery; Screens; Silicones; Surgery; Survival; Teenagers; Thromboembolism; Thrombosis; Time Factors; Venous access; Vascular disease; Pulmonary embolism; Human; Nutrition; Respiratory disease; Heart disease; Cardiovascular disease; Complication; Right atrium; Thrombosis; Resuscitation; Parenteral administration
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(94)91707-8

Summary Although the use of silicone catheters for long-term central venous access is widespread, little is known about the incidence of pulmonary thromboembolic complications. We studied clinical events, lung perfusion scans, and echocardiographic screens in 34 children and adolescents with gut failure who had received cyclical parenteral nutrition for 2 months to 9 years. Major thrombosis and/or embolism was identified in 12 patients and 4 died as a consequence. Actuarial survival free from thrombosis was 53% at 5 years (95% Cl, 30-77%). Survival free from fatal pulmonary thromboembolic events was 74% at 5 years (48-99%). 3 patients required surgery to remove right atrial thrombus or pulmonary emboli. Major right atrial thrombosis and pulmonary embolism are common and potentially fatal complications of parenteral nutrition by long-term venous access in childhood. Anticoagulation is recommended.