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Original research
Thrombosis after umbilical venous catheterisation: prospective study with serial ultrasound
  1. Gerdina H Dubbink-Verheij1,
  2. Remco Visser1,
  3. Arno A Roest2,
  4. Cornelia Heleen van Ommen3,
  5. Arjan B te Pas1,
  6. Enrico Lopriore1
  1. 1 Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 Department of Pediatric Hematology, Erasmus MC Sophia, Rotterdam, The Netherlands
  1. Correspondence to Mrs. Gerdina H Dubbink-Verheij, Neonatology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands; g.h.dubbink-verheij{at}lumc.nl

Abstract

Background Umbilical venous catheters (UVCs) are associated with thrombus formation. Most studies on thrombosis in infants with UVCs focus on only one part of the route, and none assessed a control group of infants without UVCs.

Objective To determine the incidence and location of thrombi in infants after umbilical catheterisation and compare this with a control group of infants without umbilical catheters.

Design Prospective observational study with serial ultrasonography of the UVC route from the umbilico-portal confluence to the heart. Ultrasonography was performed until day 14 after catheterisation in cases and day 14 after birth in controls.

Results Thrombi in the UVC route were detected in 75% (30/40) of infants with UVCs in the study group, whereas no thrombi were detected in the control group of infants without UVCs (0/20) (p<0.001). Six thrombi (20%) were located in the right atrium. Most of these were also partly present in the ductus venosus. Six thrombi (20%) were located in the ductus venosus only, and in 12 infants (40%), the thrombus was at least partly located in the umbilico-portal confluence. Thrombi persisted after UVC removal in 25/30 cases. Two infants with thrombotic events were treated with low-molecular-weight heparin and resolution was found. In the other 23 infants managed expectantly, 2 died due to necrotising enterocolitis, 1 was lost to follow-up and in 20 spontaneous regression was seen.

Conclusions Thrombotic events occur frequently in infants after umbilical catheterisation. Most thrombi were asymptomatic and regressed spontaneously with expectant management. Routine screening for thrombi in UVCs is therefore not advised.

  • neonatology
  • clinical procedures

https://doi.org/10.1136/archdischild-2018-316762

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    Footnotes

    • Contributors GHD-V was the executive researcher of this study. She performed literature search, data collection, data analysis, data interpretation, writing and submitting of the report. RV was involved in study design, data collection and writing of the report. AAR was involved in study design, data collection and critical revision of the content of the report. CHvO was involved in writing and critical revision of the content of the report. ABtP was involved in study design, data collection and interpretation and critical revision of the content of the report. EL was the project leader and performed literature search, coordinated data analysis, data interpretation and writing and editing of the report. All authors gave approval for the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of a part of the work are appropriately investigated and resolved. No honorarium, grant or other form of payment was given to anyone to produce the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The study was approved by the hospital system institutional review board of the Leiden University Medical Center (P16-130/ or NL57948.058.16).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Deidentified participant data are available from the corresponding author.

    • Patient consent for publication Not required.