Long-term complications of central venous catheters in children

The use of central venous catheters (CVCs) in children is increasing. However, they can cause serious, sometimes life-threatening complications. This review discusses the clinical use of CVCs in children and the thrombotic and infectious complications related to this type of catheter. Percutaneously placed short-term CVCs have been the primary means of central venous access in critically ill children. Long-term CVCs are often used in children with cancer and in those who require total parenteral nutrition. The incidence of CVC-related venous thrombosis (CVC-VT) varies widely and depends on underlying conditions and the diagnostic tests used. Thrombotic symptoms include loss of CVC patency, swelling, pain, discoloration of the limb and signs of CVC-related bloodstream infection (CRBSI). Clinical suspicion of CVC-VT requires urgent proper assessment of the vessel. In cases of CVC-VT, the CVC can remain in situ only if access to the vessel is still required and the CVC is patent. Initial anticoagulation therapies include low molecular weight or unfractionated heparin, followed by vitamin K antagonists or low molecular weight heparin for a minimum of 3 months. The clinical symptoms of CRBSI are scarce and nonspecific. Definite diagnosis is made by examining simultaneous peripheral and CVC blood cultures. There is no clear evidence on whether a CVC should be removed on suspicion of CRBSI. Empirical antibiotic therapy should cover both Gram-positive and Gram-negative micro-organisms.