CATHETER-RELATED THROMBOSIS IN CRITICALLY ILL CHILDREN - COMPARISON OF CATHETERS WITH AND WITHOUT HEPARIN BONDING

Objective: To compare the incidence of and factors associated with vas cular thrombosis after placement of heparin-bonded and standard femora l venous catheters. Design: Prospective, masked, clinical study. Setti ng: Multidisciplinary, tertiary, pediatric intensive care unit. Patien ts: Consecutive cases (n = 50) of critically ill children admitted to a pediatric intensive care unit in whom either a heparin-bonded (n = 2 5) or a standard (n = 25) femoral venous catheter was placed. Measurem ents and main results: Patients were examined by ultrasonography withi n 3 days of catheter insertion, weekly while the catheter was in place , and after catheter removal for evidence of vascular thrombosis. Data were collected prospectively regarding clinical evidence of catheter thrombosis, infusate composition, and positive blood culture results. Of 50 patients, 13 (26%) had thrombotic complications, 11 (44%) of the 25 patients in the standard-catheter group, in comparison with 2 (8%) of the 25 patients in the heparin-bonded catheter group (p = 0.004). In addition, there was a significantly higher incidence of positive bl ood culture results among patients in the standard-catheter group (24% vs 0%; p = 0.009). Positive catheter blood culture results were obtai ned in 38% of patients with thrombosis versus 3% without thrombosis (p = 0.001). Clinical evidence of thrombosis was found in 69% of patient s with, versus 27% of patients without, ultrasound-proved thrombosis ( p = 0.007). Conclusion: Heparin bonding of catheters is associated wit h significantly fewer thrombotic complications. A reduced incidence of positive catheter-related blood culture results may be associated wit h the absence of thrombosis.