Intracatheter nitroglycerin infusion fails to prevent catheter-related venous thrombosis: a randomized, controlled trial

Objective: Catheter-related thrombosis is a common problem in the pediatric intensive care unit. Strategies that reduce of thrombosis may have significant clinical advantage. Nitroglycerin (NTG) infusions release nitric oxide (NO). NO is responsible for much of the vasodilating and antithrombotic properties of the vasculature. We hypothesized that an in NTG infusion would reduce the incidence of catheter-related thrombosis. Design: Prospective, randomized, controlled trial. Setting: Pediatric intensive care unit. Patients and participants: Children of 6 years or less with femoral venous catheters who were not on antithrombotic therapy. Interventions: Subjects were randomly assigned to NTG or control groups. NTG group patients received NTG at 0.1 mcg . kg . min in 5% dextrose; control group patients received only 5% dextrose. Infusions were delivered continuously through the catheter until the catheter was removed. Demographic data, physical and laboratory findings, catheter insertion attempts and infusate composition were recorded. Clinical evidence of vascular thrombosis or catheter malfunction was noted. Ultrasound examinations were performed within 2 days of catheter insertion and within 2 days after removal. Measurements and results: Forty-four patients (age 12.0 +/- 2.6 months) completed the study, 21 in the NTG group and 23 in the control group. Duration of catheter placement was 7.5 +/- 0.7 days. Twelve of 44 patients (27%) had thrombi: 7/21 in the NTG group;5/23 in the control group (p = NS). There were no significant differences between children with and without thrombi in age, gender, number of insertion attempts, duration of catheter placement, clinical signs of thrombosis or infections. Conclusions: Catheter-related thrombosis is common after placement of femoral venous catheters in children. Low dose intracatheter NTG infusion does not protect against catheter-related venous thrombosis in children.