Retrospective Investigation On Intervention And Prognosis Of Central Venous Catheter-related Thrombosis In Children

Objective:To explore how the different intervention measures affect the outcome of central venous catheter-related thrombosis(CRT)in children,provide clinical basis for the treatment of central venous catheter-related thrombosis in children.Method:Retrospective analysis the clinical basis of patient with CRT collected from the nursing management system of the children’s hospital affiliated to Zhejiang University School of Medicine which reported by each nursing unit from January 1,2015 to December 31,2015.Design data collection form,consult electronic medical records to improve clinical data.Pearson chi-square test was performed on the results of the four clinical intervention plans after thrombosis.Univariate regression analysis was conducted on the CRT dissolution effect of the children and the relevant clinical factors,and finally multivariate regression analysis was conducted.The differences of effective between the four kinds of intervention were statistically significant.Results:Totally 108 cases were included(72 boys and 36 girls),median age of 24.5 months(ranged from 1 month to 14 years).42.59%(47/108)patients suffered with neurological diseases.55.56%(60/108)CRT was detected in the first week after catheterization.Once CRT conformed,there were four kinds clinical intervention options applied.Intervention 1:Thrombolytic therapy with urokinase combined anticoagulation with nadroparin calcium;Intervention 2:Anticoagulant therapy only;Intervention 3:Thrombolytic therapy alone;Intervention 4:No medications.The single-factor regression analysis was done to each relevant factor.Finally the multivariate regression analysis showed four factors had impacts upon the results.The factors were as follow:Gender(OR 10.400,95%Cl 1.879-57.563,P=0.007);Interval(OR 1.757,95%CI,1.033-2.362,p=0.035),Size of thrombus(OR1.562,95%CI 1.033-2.362,P=0.035;Intervention 2(OR 11.757,95%Cl 2.254-61.327,p=0.003),Intervention 4(OR 35.397,95%Cl 3.493-358.760,p=0.003).Conclusions:1.The size of thrombus is related to thrombolytic effect,which indicates that larger thrombus not only needs longer dissolution time,but also is not easy to dissolve.2.The interval of thrombosis is related to the effect of thrombolysis.The earlier the intervention is found,the better the thrombolysis is.Conventional ultrasonography can detect thrombus more objectively in early stage,and dynamic ultrasonography should be used to monitor thrombus changes when conditions permit.3.Thrombolytic therapy or combined anti coagulation therapy is effective for thrombolysis,but there are risks.If there are no contraindications,anticoagulation therapy should be standardized in the early stage,and combined thrombolytic therapy should be considered when life-threatening.