(661) Temporary Femoral CVC Tip Malposition in Children Is Not Associated With Venous Thromboembolism

Introduction: Temporary central venous catheters (CVC) enable lifesaving therapies but are associated with complications, including venous thromboembolism (VTE). Upper circulation CVC tip position is not associated with increased odds of VTE in children, but it is unknown if femoral CVC tip position is associated with VTE. We hypothesized that temporary femoral CVC tip malposition is frequent, but that tip malposition would not be associated with VTE.

Methods: We conducted a multi-center, retrospective cohort study of children (age < 18 years) admitted to the pediatric intensive care unit (PICU) between 1/1/2016 and 12/31/2021 who had a temporary femoral CVC inserted during the admission. Four investigators determined CVC tip position by interpretation of abdominal radiographs that were clinically obtained. Femoral CVC tip was considered appropriate if located between the L2 and L5 vertebral body; otherwise, it was considered malpositioned. Logistic regression was performed to test for association between clinical factors (i.e., age, sex, CVC length) and CVC tip malposition, adjusting for center. Two one-sided t-tests assessed for equivalence (-0.10 to 0.10) in VTE rates in the malpositioned versus appropriately positioned femoral CVC tip groups.

Results: 980 subjects were included: median age was 5.4 years (IQR 1.7 to 12.5) and most (54%) were male. Respiratory and Infectious were the most common primary diagnosis categories. Most (63%) CVCs were placed on the right, and the median CVC duration was 4 days (IQR 2 to 7). CVC tip malposition was common, occurring in 67% of patient. After adjusting for center, age at PICU admission was significantly associated with CVC tip malposition. For every additional year of age at admission, the risk of malposition increased 1.13-fold (95% CI: 1.10, 1.16; p< 0.001). Catheter-associated VTE was the most common complication, occurring in 8.9% patients. The rate of VTE was equivalent between the malpositioned (8.7%) and appropriately positioned (9.2%) CVC tip groups.

Conclusions: Temporary femoral CVC tip malposition was frequent in critically ill children, especially in older patients, in this large, multi-center retrospective cohort study. Catheter position was not associated with development of VTE, but the high rate of VTE in this cohort warrants further study.