(526) Central Venous Catheter Dysfunction and Hospital-Acquired Venous Thromboembolism Risk Among Children

Introduction: Central venous catheter (CVC) dysfunction from thrombotic occlusion may be the only and anecdotally unrecognized precursor of hospital-acquired VTE (HA-VTE) among critically ill children. Pediatric CVC dysfunction, treatment thereof, and associated HA-VTE risk remain ill-described. We sought to estimate the prescription of indwelling tissue plasminogen activator (t-PA) as a surrogate for CVC dysfunction and assess for its association with HA-VTE among critically ill children.

Methods: We performed a multicenter retrospective cohort study using the Pediatric Health Information Systems database of children < 18 years of age admitted to a pediatric intensive care unit with a CVC including peripherally inserted central catheters and non-tunneled central venous lines from January-December of 2023. We excluded children with arterial/venous thrombosis on admission, undergoing systemic or catheter-directed thrombolysis, and undergoing t-PA infusion via thoracostomy or pericardiostomy. The primary outcome was t-PA exposure including indwelling alteplase or urokinase locks. The secondary outcome was cumulative frequency of HA-VTE. Descriptive data included demographics, CVC characteristics, comorbidities, and clinical outcomes. Adjusted logistic regression was employed to assess the association (adjusted odds ratio [aOR] and 95% confidence interval [CI] between t-PA exposure and HA-VTE.

Results: Of 11,104 critically ill children with a CVC, 3,129 (28.2%) were prescribed t-PA. As compared to those not prescribed t-PA, those prescribed tPA more frequently underwent a surgical procedure (64% vs 51%), invasive mechanical ventilation (80% vs 57%), extracorporeal life support (9.3% vs 2.9%), had infection (85% vs 66%), had inpatient mortality (10% vs 6%), and had a longer median length of stay (39 [interquartile range (IQR):21-77] vs 13 [IQR:6-26] days) (all p< 0.001). In an adjusted logistic model, t-PA was independently associated with HA-VTE (aOR:1.9, 95%CI:1.6-2.2, p< 0.001).

Conclusions: In this multicenter cohort study, the presence of CVC dysfunction as measured by t-PA use was common (28.2%) and associated with HA-VTE development among critically ill children. Prospective validation regarding CVC dysfunction and associated HA-VTE risk are needed.