THROMBOSIS AND EMBOLISM IN LONG-TERM CENTRAL VENOUS ACCESS FOR PARENTERAL-NUTRITION

Although the use of silicone catheters for long-term central venous ac cess is widespread, little is known about the incidence of pulmonary t hromboembolic complications. We studied clinical events, lung perfusio n scans, and echocardiographic screens in 34 children and adolescents with gut failure who had received cyclical parenteral nutrition for 2 months to 9 years. Major thrombosis and/or embolism was identified in 12 patients and 4 died as a consequence. Actuarial survival free from thrombosis was 53% at 5 years (95% Cl, 30-77%). Survival free from fat al pulmonary thromboembolic events was 74% at 5 years (48-99%). 3 pati ents required surgery to remove right atrial thrombus or pulmonary emb oli. Major right atrial thrombosis and pulmonary embolism are common a nd potentially fatal complications of parenteral nutrition by long-ter m venous access in childhood. Anticoagulation is recommended.