The Incidence of Percutaneous Central Venous Catheter (PCVC) Thrombosis in High Risk Neonates, and the Relationship of Thrombosis to the Occurrence and Persistence of Bacteremia 1420

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Percutaneously inserted central venous catheters (PCVCs) are commonly used in high risk neonates, but may be complicated by the formation of thrombi in the central veins or right atrium, and/or the occurrence of foreign-body induced bacterial blood stream infection. The purpose of this study is to determine the incidence of PCVC-related, central vein and/or right atrial thrombosis in neonates. In addition, the study will assess the relationship of thrombus formation to the subsequent development of bacterial blood stream infection, and determine if the presence of a thrombus is associated with failure of antibiotic treatment to eradicate bacteremia. To date, 47 neonates(mean birth weight 1139.4 grams, mean gestational age 28.1 weeks) have been enrolled in the study. In all subjects, immediately post insertion, a blood culture was drawn from the PCVC. Within 72 hours of insertion, a baseline 2-D echocardiogram with color flow Doppler study was performed. Thereafter, while the catheter was in place, blood cultures were drawn and a follow-up 2-D echocardiogram/color flow Doppler study was done once weekly. If a positive blood culture was detected, two additional, quantitative blood cultures (one from the PCVC; one from a peripheral vein) were obtained prior to initiating antibiotic therapy, and a 2-D echocardiogram/color flow Doppler study was performed within 24 hours. Following initiation of antibiotic therapy, a single, daily blood culture was obtained from the PCVC or peripheral vein depending on access, until three consecutive, daily blood cultures showed no bacterial growth. The median duration of PCVC lines was 37 days. Four neonates(0.09%) had positive blood cultures, at a mean of 25.3 days post-insertion. Neonates had a median of 5 blood cultures performed. Only 1 neonate (0.02%) had evidence of thrombus formation on echocardiogram at 10 days post-insertion. Neonates are continuing to be enrolled in this study. Based on this preliminary data, it appears that, despite the fact that in our unit PCVC lines are not changed, PCVC-related bacteremia and thrombosis are rare complications.