Incidence and Diagnosis of Thrombosis in Children With Short-Term Central Venous Lines of the Upper Venous System

OBJECTIVES. Deep venous thrombosis in children is frequently related to central venous lines. Study objectives were to determine objectively the incidence of deep venous thrombosis in children with short-term central venous lines and to assess the diagnostic value of venography, venous ultrasonography, and echocardiography, in a prospective cohort study. METHODS. Consecutive children with congenital heart disease requiring short-term central venous lines in the upper venous system were screened systematically for deep venous thrombosis by using venography, venous ultrasonography, and echocardiography, according to standardized protocols. RESULTS. The study population consisted of 90 children (median age: 2.7 years; range: birth to 18 years). Most central venous lines (97%) were located in the jugular veins. The overall incidence of deep venous thrombosis was 25 cases (28%) among 90 children. Venography identified deep venous thrombosis located in the subclavian and central veins but missed most deep venous thrombosis in the jugular veins. Venous ultrasonography had good sensitivity in the jugular veins but did not detect deep venous thrombosis in central veins. Echocardiography detected only 1 case of central deep venous thrombosis. CONCLUSIONS. The incidence of central venous line-related deep venous thrombosis in children with short-term central venous lines is high and comparable to reports for children with long-term central venous lines. Sensitivities of venography, venous ultrasonography, and echocardiography in children vary depending on the affected venous segment. A combination of diagnostic tests is required for sensitive detection of central venous line-related deep venous thrombosis in the upper venous system. Pediatrics 2008; 122: 1284-1291