CONTINUOUS LOW-DOSE HEPARIN INFUSION FOR CATHETER RELATED THROMBOSIS PROPHYLAXIS IN CRITICALLY ILL CHILDREN

Restricted (Penn State Only)
Author:
Bujold, Kenneth Earl
Graduate Program:
Public Health Sciences
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
March 23, 2018
Committee Members:
  • Thomas Allen Lloyd, Thesis Advisor
  • Valerie Brown, Committee Member
Keywords:
  • Pediatric
  • Thrombosis
  • Prophylaxis
  • Central venous catheter
  • venous thromboembolism
  • heparin
Abstract:
Background: Central venous catheters (CVC) are often required in critical care settings to provide a secure point of access for life-sustaining care. Clinical studies identify CVC presence as the single greatest risk factor for deep vein thrombosis (DVT) in children. Venous thromboembolic events (VTE) incidence rates range of critically ill children with a CVC range from 0.3-18% and 0.06-32.5/1000 catheter days depending on the population studied. Per unit protocol, the Penn State Health Children’s Hospital PICU (Hershey, PA) utilizes a low dose continuous infusion of unfractionated heparin (LDUFHI) at 10 units/kg/hr as prophylaxis against CVC-related VTE and to maintain line patency. The efficacy of this approach has never been evaluated. Objectives: To determine if LDUFH for prophylaxis results in lower incidence of CVC-related VTE, catheter dysfunction and central line-associated blood stream infection (CLABSI). Design/Methods: To determine if the incidence of catheter-related VTE is lower than published data, a retrospective chart review was conducted utilizing the institutional electronic medical record for all patients in 2015, aged 0-17.99 years, who had a CVC during a PICU admission. Secondary objectives such as the incidence of catheter dysfunction, CLABSI, and any associated bleeding complications were analyzed. Results: Three hundred and sixty three eligible subjects resulted in 483 central lines. Subjects who received LDUFHI has longer PICU and hospital durations with temporary catheters and femoral location being the most commonly placed. Incidence rates of VTE and CLABSI were higher in LDUFHI lines in comparison to non-LDUFHI lines (2.17 vs. 1.96 per 1000 catheter days [p=0.9], 2.48 vs. 1.96 per 1000 catheter days [p=0.77]). A subset analysis of all non-cardiothoracic surgery subjects, there were lower VTE, CLABSI and catheter dysfunction incidence rates in CVCs receiving LDUFHI (2.73 vs.4.28 per 1000 catheter days [p=0.48], 1.43 vs. 4.28 per 1000 catheter days [p=0.23], 16.67 vs 19.27 per 1000 catheter days [p=0.7]). There were no major bleeding events. Conclusion: LDUFHI is a safe practice and does show some benefit in decreasing the incidence of catheter related VTE, CLABSIs, and catheter dysfunction. This practice should be further investigated in a multicenter, randomized clinical trial with systematic screening to fully determine if the practice is beneficial to all critically ill pediatric patients