A peripherally inserted central catheter (PICC) is a small, thin, and flexible tube inserted into a vein in the upper arm and guided into the superior vena cava to deliver intravenous fluids, chemotherapy drugs, transfusions, and other drugs into the body. Now, a new study has found that children inserted with PICCs are at a higher risk of developing blood clots called venous thromboembolism or VTE.
Image Credit: Africa Studio / Shutterstock.com
Venous thromboembolism or VTE is a condition in which a blood clot develops in the deep veins of the leg, arm or groin (deep vein thrombosis) and travels in the bloodstream, lodging in the lungs, called pulmonary embolism (PE). PE and deep vein thrombosis are life-threatening conditions.
A team of researchers at the University of Southern California and Children's Hospital Los Angeles provides convincing results that using peripherally inserted central catheters (PICC) for drug administration and getting of blood samples in children is tied to a heightened risk of blood clot formation than central venous catheters (CVC), which is directly inserted into the veins in the neck or chest.
The findings of the study, published in the journal Blood, shows a sharp increase of venous thromboembolism (VTE) cases in children, with most of the cases due to central venous catheters. The researchers also found that among CVCs, the number of PICCs used in children had increased. The researchers are concerned that the increasing use of PICCs in children may have contributed to the soaring cases of blood clot formation in children needing CVC.
PICC use increasing
Over the past decades, the cases of children with chronic diseases that need continuous administration of drugs, including infections, congenital heart disease, cancer, and other potentially fatal diseases, have been prevalent. To address this, doctors usually insert catheters into the large central veins for easier administration of intravenous fluids and medicines. In children, PICC use has increased over the past years because it is easier and faster to insert. Furthermore, the procedure can be performed at the bedside by a nurse with just mild sedation.
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.
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