OC 65.2 - Pediatric venous thromboembolism associated with midline and peripherally inserted central catheters

Background: Most pediatric venous thromboembolism (VTE) events arise from central venous catheters (CVCs), with peripherally inserted central catheters (PICCs) having the highest risk. Midlines, which are non-central catheters with more stability than peripheral intravenous catheters, are increasingly used but data on VTE risk with midline catheters in children are limited.

Aims: We aimed to 1) describe the population and catheter characteristics for each catheter type and 2) determine the incidence of VTE with each catheter type.

Methods: After Institutional Review Board exemption, this single-center cohort study included children at the Children’s Hospital of Philadelphia with a PICC or midline catheter inserted from 5/3/2020 to 11/3/2022. Demographics and catheter characteristics were collected retrospectively from electronic medical records and deep vein thromboses (DVTs) were collected from a quality improvement database. Catheters with incomplete data were excluded. DVT events were reported as a proportion of catheters, compared with a Pearson’s chi-square. DVT incidence rate per 1000 catheter days with 95% confidence interval (CI) was reported for catheters in place >24 hours using a Kaplan-Meier analysis.

Results: A total of 4313 catheters inserted in 2955 patients (658 midlines in 581 patients and 3655 PICCs in 2562 patients) were analyzed. Infants were more likely to have a PICC than a midline catheter and PICCs were in site longer (Table 1). There were 180 VTE in 3655 PICCs (4.9%) and 10 VTE in 658 midlines (1.5%), p< 0.001. The VTE rate with PICCs was 1.9 (95% CI 1.6-2.2) per 1000 catheter days compared with 1.6 (95% CI 0.9-3) per 1000 catheter days in midline catheters, log-rank p=0.78 (Figure 1).

Conclusion(s): The proportion of midlines associated with VTE was less than with PICCs, however the VTE incidence rates were not different, indicating that midline catheters may not limit VTE risk. Analysis of patient and catheter specific VTE risk factors is ongoing.