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Predictors of thrombosis in hospitalized children with central venous catheters: a multi-center predictive study from the CHAT Consortium

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Predictors of thrombosis in hospitalized children with central venous catheters: a multi-center predictive study from the CHAT Consortium

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Predictors of Thrombosis in Hospitalized Children with Central Venous Catheters: A multi-
center predictive study from the CHAT Consortium

by

Julie Ann Jaffray

A Thesis Presented to the
FACULTY OF THE USC KECK SCHOOL OF MEDICINE
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
CLINICAL, BIOMEDICAL AND TRANSLATIONAL INVESTIGATIONS

December 2021

Copyright 2021 Julie Ann Jaffray

ii
ACKNOWLEDGEMENTS

I would like to acknowledge my fellow collaborators for this research project, Maua
Mosha, MPH, Brian Branchford, MD, Neil A. Goldenberg, MD, PhD, Michael Silvey, DO,
Stacy E. Croteau, MD, MMS, John H. Fargo, DO, James D. Cooper, MD, Nihal Bakeer, MD,
Amy Stillings, Emily Krava, Guy Young, MD and Ernest K. Amankwah, PhD. I would like to
acknowledge Dr. Cecilia Patino-Sutton, MD and Thomas Coates, MD for their review of this
thesis.

iii

TABLE OF CONTENTS

Acknowledgements……………………………………………………………………………ii
List of Tables………………………………………………………………………………….iv
List of Figures…………………………………………………………………………………v
Abbreviations…………………………………………………………………………………vi
Abstract………………………………………………………………………………………vii
Introduction…………………………………………………………………………………….1
Methods………………………………………………………………………………………...2
Results………………………………………………………………………………………….5
Discussion……………………………………………………………………………………..11
References……………………………………………………………………………………..14

iv
LIST OF TABLES

Table 1. Baseline demographics of hospitalized study participants with a central venous catheter
(CVC) across catheter related thrombosis (CRT) status (page 6).

Table 2. Baseline clinical and central venous catheter (CVC) characteristics of study participants
(page 7).

Table 3. Bivariate association between clinical and central venous catheter (CVC) characteristics
and catheter related thrombosis (CRT) (page 9).

Table 4. Multivariate analysis of risk factors for catheter related thrombosis (page 10).

v
LIST OF FIGURES

Figure 1. Participant exclusion justification for the final analysis (page 5).

vi

ABBREVIATIONS

CHAT Children’s Hospital Acquired Thrombosis
CLABSI Central line associated blood stream infection
CRT Catheter related thrombosis
CVC Central venous catheter
DVT Deep vein thrombosis
HA-VTE Hospital-acquired venous thromboembolism
HZ Hazard ratio
OR Odds ratio
PICC Peripherally inserted central catheter
REDCap Research electronic data capture
VTE Venous thromboembolism

vii
ABSTRACT
Background and Objectives: Acutely ill and medically complex children are frequently
reliant on central venous catheters (CVCs) to provide life-sustaining treatment, unfortunately
catheter related thrombosis (CRT) is a serious and common complication. The aim of this study
was to identify clinical risk factors for a CRT in hospitalized children.

Methods: This case-only retrospective cohort study included participants with a CVC
within the Children’s Hospital Acquired Thrombosis (CHAT) Registry of hospital-acquired
venous thromboembolism cases and controls aged 0-21 years from eight U.S. children’s
hospitals. Participants were excluded if they developed a thrombosis prior to CVC insertion or
the insertion date was unknown. Logistic regression models were used to assess associations
between risk factors and CRT.

Results: Within the CHAT Registry there were 1175 participants with a CVC and 1145 s
with a CRT or non-CVC related thrombosis (non-CRT) from January 2012 to December 2019.
Multivariable analysis showed positive associations between CRT in participants with PICCs
[odds ratio (OR)=7.1, 95% confidence interval (CI)=3.2-15.7, p<0.001], temporary untunneled
lines (OR=3.4, 95% CI=1.4-8.0, p=0.006), CVCs inserted in the neck and femoral veins
(OR=2.5, 95% CI=1.1-5.7, p=0.035 and OR=7.1, 95% CI 2.4-21.1, p<0.001), having multiple
CVCs placed (OR=1.3, 95% CI=1.1-1.7, p=0.005) and CVC malfunction (OR=5.4, 95% CI=2.5-
11.4, p<0.001). On the other hand, patients who had CVCs placed on the right versus left side
among CRT were at decreased risk (OR=0.6, 95% CI 0.4-0.8, p=0.007). There were no
confounders identified.
viii

Conclusions: We identified seven independent risk factors for CRT in hospitalized
children using the CHAT Registry. Prevention efforts should be directed at cases where these
CVC characteristics and insertion techniques can be modified to decrease the incidence of CRT
in children.

1

INTRODUCTION
Central venous catheters (CVCs) have become a standard medical device for many
hospitalized children (Duesing, Fawley, & Wagner, 2016). Those who are critically ill requiring
large volume fluid resuscitation, children with cancer needing caustic chemotherapeutic agents
or those with complex medical issues requiring multiple intravenous medications and blood
draws are the most common pediatric patients needing central venous access. In addition to the
life-saving abilities of CVCs, they can also cause serious and life-threatening consequences, such
as central line associated blood stream infections (CLABSI) and venous thromboembolism
(VTE) (Carter, Langley, Kuhle, & Kirkland, 2016; Fratino et al., 2005; Jaffray et al., 2020; Pinon
et al., 2009).

Up to 80% of hospital-acquired VTE (HA-VTE) cases are in children with CVCs (Jaffray
et al., 2021; Takemoto et al., 2014). Among children who have had a CVC inserted, the
incidence of catheter related thrombosis (CRT) has been estimated to range from 2% up to 35%
dependent on the patient population, type of CVC, and diagnostic imaging modality
(Smitherman et al., 2015). Long term consequences of CRT consist of chronic, painful venous
insufficiency from post thrombotic syndrome or venous stenosis leading to decreased vasculature
access and difficulty placing future CVCs (Avila et al., 2014; Goldenberg et al., 2010; Shin,
Towbin, Zhang, Johnson, & Goldstein, 2017). Previous studies have identified high risk groups,
such as those with leukemia, congenital heart disease, are critically ill or having a peripherally
inserted central catheter (PICC) (Athale et al., 2008; Faustino et al., 2013; Jaffray et al., 2020;
Journeycake & Buchanan, 2006). Yet other studies have found children with external tunneled
2
lines, left upper extremity lines or having a multi-lumen CVC are at high risk (Jaffray et al.,
2020; Male et al., 2003). These conflicting study results have made it difficult to identify which
children are at the highest risk of developing a CRT and who would potentially benefit from
thromboprophylaxis.

We sought to address these knowledge gaps by performing an analysis of hospitalized
children with a CVC within the multi-center Children’s Hospital Acquired Thrombosis (CHAT)
Registry through the CHAT Consortium (Jaffray et al., 2018). Our goal was to identify clinical
variables associated with a hospitalized child with any underlying medical condition developing
a CRT with any type of CVC.

METHODS
Study design
This case-only retrospective cohort study included participants with a CVC within the
CHAT Registry through the CHAT Consortium. The CHAT Registry is a multi-center registry of
HA-VTE cases and controls from eight large children’s hospitals throughout the U.S. The study
was approved by each participating hospital’s institutional review board, and a waiver of consent
was given. The Strengthening the Reporting of Observational Studies in Epidemiology
(STROBE) reporting guidelines were followed in the drafting of this manuscript (von Elm E,
2007).

3
Study population
A detailed description of participants included in the CHAT Registry has been previously
published (Jaffray et al., 2021; Jaffray et al., 2018). In summary, the Registry contains children,
aged 0-21 years who were diagnosed with an imaging confirmed HA-VTE (cases) from January
1, 2012, to December 31, 2019. Controls within the Registry were 0-21 years of age and
randomly selected in a 1:1 fashion, matched on year of hospital admission and institution, who
did not develop a HA-VTE.

For this study, only participants with a HA-VTE from the CHAT Registry with a CVC in
place at hospital admission or placed during hospitalization were included (Figure 1). CRT cases
were compared to participants diagnosed with a HA-VTE that were unrelated to a CVC (non-
CRT). Participants were excluded if they did not have a CVC or CVC status was unknown,
admission date was after VTE diagnosis, CVC insertion date was after VTE diagnosis, or the
participant did not develop a VTE.

Data characteristics
Data from the participants were collected from the electronic medical record using
standardized case report forms through Research Electronic Data Capture (REDCap) (Harris et al.,
2019; Harris et al., 2009). Full descriptive details of the data elements collected for all participants
within the CHAT Registry have previously been published (Jaffray et al., 2021; Jaffray et al.,
2018). For this current study, the data variables analyzed included demographics (age, sex, race,
ethnicity, weight, height, body mass index), past medical history/co-morbidities, blood stream
infection/sepsis, CVC characteristics (CVC type, number of lumens), CVC placement procedure
4
(vein accessed, attempts, CVC tip location) and CVC malfunctions. Each participating center was
provided access to REDCap along with detailed data dictionaries to ensure reproducible data
collection. Missing data fields, outliers and incorrect dates were sent to each site for review and
verification through automated monthly data monitoring.

Definitions
A HA-VTE was defined as a VTE diagnosed after hospital admission among patients
without symptoms of a VTE prior to hospital admission and confirmed by radiology imaging,
which consisted of Doppler ultrasonography, computed tomography scan, venography,
echocardiogram or magnetic resonance imaging. A CRT was defined as a deep vein thrombosis
(DVT) found in the same vein where a CVC was inserted or attempted to be inserted. A tunneled
line included a fully implanted Port-a-cath® and external cuffed devices such as a Broviac®,
Hickman®, Medcomp®, and Powerline®. A temporary untunneled line included a temporary
femoral, internal jugular or subclavian line.

Statistical analysis
Demographic and clinical characteristics of participants were summarized using
descriptive statistics. Continuous variables were summarized as means with standard deviations
or medians with range and compared across CRT and non-CRT status using independent t-test or
Kruskal-Wallis test as appropriate. Categorical variables (sex, race and ethnicity) were
summarized as counts with percentages and compared using the Chi-squared test or Fishers exact
test as appropriate. Unadjusted associations between putative risk factors and CRT were assessed
using logistic regression models. Factors with p-values of <0.1 in the unadjusted analyses were
5
included in a multivariable logistic regression model. The results for both the unadjusted and
multivariable models are presented as odds ratios (ORs) and 95% confidence intervals (CIs). All
statistical tests were two-sided and a p-value < 0.05 was considered statistically significant.
Statistical analyses were performed with SAS version 9.4.30 statistical software (Inc, 2016).

RESULTS
Characteristics of Participants
From January 1, 2012, to December 31, 2019, there were 1278 participants with a HA-
VTE within the CHAT Registry, and 1175 HA-VTE participants had a CVC at hospital
admission or placed during their hospitalization (Figure 1). Participants were excluded primarily
due to not having a CVC, leaving 1145 participants for the final analysis. Most of the HA-VTE
participants with a CVC had a CRT, (n=845, 73.8%) and 300 (26.2%) had a thrombosis that was
unrelated to their CVC.

Figure 1. Participant
exclusion justification for
the final analysis.

*HA-VTE, hospital-acquired
venous thromboembolism;
CHAT, Children’s Hospital
Acquired Thrombosis; CVC,
central venous catheter
1175 participants with a CVC
1145 participants included in the final
analysis
14 excluded due to not having a VTE
6 excluded due to VTE diagnosed prior to
admission
10 excluded due to VTE prior to CVC
insertion
Figure 1. Participant exclusion justification from final analysis.
*HA-VTE, hospital acquired venous thromboembolism; CHAT, Children ’s Hospital Acquired Thrombosis; CVC, central venous catheter
1278 HA-VTE participants in the CHAT
Registry
99 excluded due to not having a CVC
4 excluded due to presence of a CVC
unknown
6
The demographic characteristics of the study population are presented in Table 1.
Participants with a CRT were younger (1.2 years, range=0-21.8) compared to non-CRT
participants (3.6 years, range=0-21.4) at the time of hospital admission. The majority of
participants were male, regardless of having a CRT or non-CRT. The total study population
consisted of a high proportion of non-Hispanic (n=611, 53.3%) ethnicity and White (n=483,
42.2%) race.

Table 1. Baseline demographics of hospitalized study participants with a central venous catheter (CVC)
across catheter related thrombosis (CRT) status.
Variable
Participants
Non-CRT
n (%)
300 (26.2)
CRT
n (%)
845 (73.8)
Total
n (%)
1145 (100)
Age at admission, median (range) 3.6 (0-21.4) 1.2 (0-21.8) 1.6 (0-21.8)
Sex
Male 168 (56.0) 465 (55.0) 633 (55.3)
Female 132 (44.0) 380 (45.0) 512 (44.7)
Race
White 109 (36.3) 374 (44.3) 483 (42.2)
Asian 12 (4.0) 57 (6.8) 69 (6.0)
Black or African American 26 (8.7) 61 (7.2) 87 (7.6)
American Indian or Native Alaskan 2 (0.7) 2 (0.2) 4 (0)
Other 18 (6.0) 68 (8.1) 86 (7.5)
Unknown 133 (44.3) 283 (33.5) 416 (36.3)
Ethnicity
Hispanic 93 (31.0) 280 (33.1) 373 (32.6)
White/Non-Hispanic 168 (56.0) 443 (52.4) 611 (53.3)
Not listed 39 (13.0) 122 (14.4) 161 (14.1)
Height (median, range) 98 (31-192) 76 (24-195) 82 (24-195)
Weight (median, range) 15.2 (0.7-133.6) 9.5 (0.4-160) 10.8 (0.4-160)
Body mass index (median, range) 16.4 (6.2-46.8) 15.9 (4.9-53.2) 16 (4.9-53.2)

7
Clinical and CVC characteristics
One hundred and thirty-seven (12%) study participants had cancer and 252 (22%) had
congenital heart disease (Table 2). Participants with a CRT were more frequently diagnosed with
a blood stream infection or sepsis compared to non-CRT participants (21.7% versus 17.7%).

Table 2. Baseline clinical and central venous catheter (CVC) characteristics of study participants.
Variable
Participants
Non-CRT
n (%)
300 (26.2)
CRT
n (%)
845 (73.8)
Total
n (%)
1145 (100)
Co-morbidity
Leukemia 20 (6.7) 48 (5.7) 68 (5.6)
Non-leukemia cancer 34 (11.3) 35 (4.1) 69 (6.0)
Congenital heart disease 63 (21.0) 189 (22.4) 252 (22.0)
Blood infection/sepsis 53 (17.7) 183 (21.7) 236 (20.6)
CVC type
PICC 141 (47.6) 502 (60.0) 643 (56.2)
Tunneled line 62 (21.0) 63 (7.5) 125 (10.9)
Temporary untunneled 59 (19.9) 252 (30.1) 311 (27.2)
Umbilical line 32 (10.8) 11 (1.3) 43 (3.8)
Midline 2 (0.7) 9 (1.1) 11 (1.0)
CVC lumens
One 120 (41.7) 240 (29.8) 360 (31.4)
Two 141 (49.0) 523 (64.9) 664 (58.0)
Three 27 (9.4) 43 (5.3) 70 (6.1)
CVC insertion location
Upper extremity vein 138 (50.6) 340 (41.6) 478 (41.7)
Neck vein 44 (16.1) 99 (12.1) 143 (12.5)
Lower extremity vein 15 (5.5) 39 (4.8) 54 (4.7)
Femoral vein 44 (16.1) 329 (40.2) 373 (32.6)
Umbilical vein 32 (11.7) 11 (1.3) 43 (3.8)
CVC insertion side
Right 152 (56.9) 450 (54.0) 602 (52.6)
Left 115 (43.1) 383 (46.0) 498 (43.5)
8
CVC tip location
SVC/RA
155 (72.8) 375 (57.8) 530 (46.3)
IVC
36 (16.9) 182 (28.1) 218 (19.0)
Upper extremity
13 (6.1) 46 (7.1) 59 (5.2)
Abdominal vein
9 (4.2) 45 (6.9) 54 (4.7)
*CRT, catheter related thrombosis; PICC, peripherally inserted central catheter; SVC, superior vena cava;
RA, right atrium; IVC, inferior vena cava

The most common CVC type in participants with both CRT and non-CRT was a PICC
(60% and 48% respectively). A higher proportion of participants with a CRT (n=252, 30%) had a
temporary untunneled line whereas participants with a non-CRT frequently had tunneled lines
(n=62, 21%) in place. Similar proportions of right-sided access for CVC placement were
observed in CRT (54%) and non-CRT (57%) participants. Although the majority of participants
in both groups utilized upper extremity veins for CVC placement (42% CRT patients, 51% non-
CRT patients), a higher proportion of CRT participants (n=329, 40%) utilized the femoral vein
compared to non-CRT participants (n=44, 16%). The cavo-atrial junction for the CVC tip
location was common in both groups with a higher proportion in non-CRT participants (n=155,
72.8%) than CRT participants (n=375, 57.9%).

The median number of CVCs placed (2, range 1-10) for participants who developed a
CRT was twice that of participants who developed a non-CRT. In addition, participants with a
CRT (n=182, 22%) had a higher proportion of CVC malfunctions than non-CRT participants
(n=18, 6%).

9
Risk factors for CRT
Twenty-five variables were initially screen via unadjusted analysis to evaluate
associations with CRT (Table 3).

Table 3. Bivariate association between clinical and central venous catheter (CVC) characteristics and
catheter related thrombosis (CRT).
Variable N
Odds Ratio
(95% CI)
P-value
Age at admission 1145 0.97 (0.95-0.99) 0.002
Co-morbidities
Leukemia 68 0.77 (0.45-1.33) 0.355
Non-leukemia cancer 69 0.33 (0.20-0.54) <.001
Congenital heart disease 252 1.08 (0.79-1.49) 0.624
Blood infection/sepsis 236 1.29 (0.92-1.81) 0.143
CVC type
PICC 643 3.50 (2.36-5.21) <.001
Temporary untunneled line 311 4.20 (2.68-6.60) <.001
Umbilical line 43 0.34 (0.16-0.73) 0.006
Midline 11 4.43 (0.92-21.32) 0.064
Tunneled line (Ref) 125 - -
Catheter lumen size/ BMI 965 0.83 (0.21-3.30) 0.794
CVC lumens
Multi-lumen 734 1.69 (1.28-2.23) <0.001
One (Ref) 360 - -
CVC insertion side
Right 602 0.89 (0.67-1.17) 0.406
Left (Ref) 498 - -
CVC insertion location
Femoral vein 373 3.03 (2.09-4.40) <.001
Neck 143 0.91 (0.61-1.37) 0.662
Lower extremity 54 1.06 (0.56-1.98) 0.866
Umbilical 43 0.14 (0.07-0.28) <.001
Upper extremity (Ref) 478 - -
CVC tip location
IVC 218 2.09 (1.40-3.13) <.001
Upper extremity 59 1.46 (0.77-2.78) 0.247
Abdomen 54 2.07 (0.99-4.33) 0.054
SVC/RA (Ref) 530 - -
CVC attempts 1145 0.90 (0.84-0.97) 0.003
10
Variable N
Odds Ratio
(95% CI)
P-value
Number of CVCs placed 1145 1.45 (1.26-1.66) <.001
CVC malfunction 200 4.31 (2.60-7.13) <.001
*PICC, peripherally inserted central catheter; SVC, superior vena cava; RA, right atrium; IVC, inferior
vena cava

In multivariable analysis, PICCs (OR=7.1, 95% CI=3.2-15.7, p<0.001), temporary
untunneled lines (OR=3.4, 95% CI=1.4-8.0, p=0.006), CVCs inserted in the neck and femoral
veins (OR=2.4, 95% CI=1.1-5.6, p=0.035 and OR=7.1, 95% CI 2.4-21.1, p<0.001), having
multiple CVCs placed (OR=1.3, 95% CI=1.1-1.6, p=0.005) and having a CVC malfunction
(OR=5.4, 95% CI=2.5-11.4, p<0.001) were independently associated with a CRT (Table 4).
CVCs placed in the right side versus the left side of the body were associated with a decreased
odds of developing a CRT (OR=0.6, 95% CI 0.4-0.8, p=0.004). No confounders were identified
when creating this association model.

Table 4. Multivariate analysis of risk factors for catheter related thrombosis.
Variable
Odds Ratio
(95% CI)
P-value
Age at admission 1.00 (0.97-1.03) 0.853
Co-morbidities
Leukemia 1.28 (0.61-2.69) 0.509
Non-leukemia cancer 0.65 (0.32-1.33) 0.240
Blood infection/sepsis 1.08 (0.65-1.79) 0.777
CVC type
PICC 7.14 (3.23-15.75) <.001
Temporary untunneled line 3.36 (1.41-8.01) 0.006
Midline 2.90 (0.22-39.05) 0.421
Tunneled line (Ref) - -
Catheter lumen size/ BMI 12.66 (0.77-208.45) 0.076
CVC lumens
Multi-lumen 0.99 (0.65-1.53) 0.975
One(Ref) - -
11
Variable
Odds Ratio
(95% CI)
P-value
CVC insertion side
Right 0.56 (0.37-0.83) 0.004
Left (Ref) - -
CVC insertion location
Femoral vein 7.07 (2.37-21.10) <.001
Neck 2.45 (1.06-5.63) 0.035
Lower extremity 0.83 (0.30-2.28) 0.718
Upper extremity (Ref) - -
CVC tip location
IVC 0.87 (0.37-2.02) 0.738
Upper extremity 1.49 (0.67-3.30) 0.326
Abdomen 0.50 (0.14-1.76) 0.282
SVC/RA (Ref) - -
CVC attempts 0.93 (0.83-1.05) 0.258
Number of CVCs placed 1.34 (1.09-1.64) 0.005
CVC malfunction 5.37 (2.53-11.39) <.001
*CVC, central venous catheter; CRT, catheter related thrombosis; PICC, peripherally inserted central
catheter; SVC, superior vena cava; RA, right atrium; IVC, inferior vena cava

DISCUSSION
Hospitalized children with a CVC are at a high risk of developing a VTE, specifically a
CRT. Our study, using participants with a CVC within the CHAT Registry, identified
participants with a PICC, a temporary untunneled line, a CVC inserted in the neck or femoral
vein, multiple CVCs, a CVC malfunction, or a CVC placed on left side of the body as having an
increased association with a CRT. Our study also found participants with a CRT were more
frequently younger, diagnosed with a blood stream infection or sepsis during their hospitalization
and had a CVC with the tip location out of the cavo-atrial junction compared to non-CRT
participants.

Our work substantiates previous studies regarding VTE risk in children with CVCs, such
as PICCs having previously been shown to have an increased risk for CRT compared to other
12
CVCs (Revel-Vilk et al., 2010). A recent multicenter, prospective study identified PICCs as
having a significantly increased risk of CRT compared to tunneled lines with a hazard ratio (HR)
of 8.5 (95%CI: 3.1, 23, p<0.001); in addition this study also identified CVCs with a previous
malfunction to have an increased risk of CRT, similar to our current results (Jaffray et al., 2020).
Our results also support an increased thrombosis risk with temporary untunneled lines,
specifically temporary femoral lines, in studies of children with single-ventricle heart disease or
critically ill neonates (Aiyagari, Song, Donohue, Yu, & Gaies, 2012; Gray et al., 2012). CVCs
placed in the right extremity has also been identified in a previous study of children with right
upper extremity tunneled lines with acute lymphoblastic leukemia (Male et al., 2003).

This work differs from previous studies by focusing only on hospitalized children (as
opposed to primarily ambulatory patients), who are at the highest risk of developing a VTE
(Raffini, Huang, Witmer, & Feudtner, 2009; Stein, Kayali, & Olson, 2004). This study also
includes children with any underlying medical condition, admitted to any unit of the hospital
with any type of CVC. In addition to our inclusive subject population, our novel findings include
children who have had multiple CVCs placed during their hospitalization and children with
temporary untunneled lines placed in the neck (as opposed to only the femoral vein) are
associated with a CRT. Although our study identified an increased risk of CRT in participants
with a multi-lumen CVC in univariate analysis (OR=1.69, 95% CI 1.3-2.2, p<0.001), like
previous work (Jaffray et al., 2020), the association was not present in the multivariate model.
This loss of association may have been due to the high number of very young (and small)
neonates who historically have a high risk of CRT (van Ommen et al., 2001)but have single
lumen CVCs.
13
One limitation of this study is the case-only study design. Due to the nature of the CHAT
Registry, non-VTE controls were randomly selected and matched to the HA-VTE cases based on
institution and admission year without consideration of CVC status. Therefore, we were unable
to perform a typical case-control study and instead focused on all participants with a CVC and
compared those who had a CRT to those who had a CVC but developed a VTE unrelated to their
CVC. Another limitation is the institutions within the CHAT Registry are all large children’s
hospitals, and therefore these results may not be valid in smaller, non-tertiary care centers.

In conclusion, CVCs remain the most prominent risk factor for VTE in children besides
being hospitalized. Our group identified seven independent, clinical risk factors found to be
statistically significant for CRT in hospitalized children. Focusing on these modifiable CVC
insertion techniques and CVC types may be beneficial in decreasing the CRT incidence in
children along with incorporating prevention strategies such as mechanical or pharmaceutical
thromboprophylaxis in those with the highest risk of developing a CRT.

14
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Asset Metadata

Creator Jaffray, Julie Ann (author)

Core Title Predictors of thrombosis in hospitalized children with central venous catheters: a multi-center predictive study from the CHAT Consortium

School Keck School of Medicine

Degree Master of Science

Degree Program Clinical, Biomedical and Translational Investigations

Degree Conferral Date 2021-12

Publication Date 11/16/2021

Defense Date 11/16/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag catheter related thrombosis,central venous catheters,Children,OAI-PMH Harvest,Pediatrics,risk factors,venous thromboembolism

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Patino-Sutton, Cecilia (committee chair), Amankwah, Ernest (committee member), Coates, Thomas (committee member), Goldenberg, Neil (committee member), Young, Guy (committee member)

Creator Email jjaffray@chla.usc.edu,juliejaffray2@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC17138508

Unique identifier UC17138508

Legacy Identifier etd-JaffrayJul-10232

Document Type Thesis

Format application/pdf (imt)

Rights Jaffray, Julie Ann

Type texts

Source 20211117-wayne-usctheses-batch-897-nissen (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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