Ultrasound Diagnosis of Thrombotic Complications in Children with Central Venous Access

Central venous access means that a catheter is placed in the vena cava with its tip localized near the right atrium. 40-50 implantations of central catheters (Broviac/Hickmann) via subclavian approach are performed every year in the Department of Pediatrics, Hematology and Oncology at Medical University of Gdansk, Poland. Since 2005, 200-250 ultrasound evaluations of catheters are performed yearly by the Ultrasound and Biopsy Unit of the Department.

Employment of central catheters in the management of patients requiring persistent venous access significantly improves their quality of life. Nonetheless, its placement is an invasive procedure with a considerable number of immediate and distant complications. The term “distant complication” applies to implanted catheters and includes, among other, catheter-related thrombosis.

We report three patients treated at the Department of Pediatrics, Hematology and Oncology of the Medical University of Gdansk who developed thromobotic complications on prolonged central venous access. We present application of ultrasound imagining in detecting complications and evaluation of the efficacy of the treatment. In all presented cases estimation of the size and exact localization of the thrombus was possible allowing successful treatment in two patients. The pathomechanism of catheter-related thrombosis and its risk factors is discussed. The significance of early ultrasound examination in children with catheter presenting first symptoms suggestive of thrombotic complications is emphasized.

Based on personal experience, regardless lack of external validation of the utility of ultrasound imaging in catheter diagnostics, we believe that it is a very promising method worth wide practicing in evaluation of thrombotic complications in patients with central venous access.