{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:05:01Z","timestamp":1790010301954,"version":"4.0.1"},"reference-count":32,"publisher":"American Society of Hematology","issue":"3","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,1,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Venous thromboembolism (VTE) incidence in children has sharply increased with the majority of cases secondary to central venous catheters (CVCs). Among CVCs, the number of peripherally inserted central catheters (PICCs) placed has risen significantly. In this multicenter, prospective, observational cohort study, we enrolled patients aged 6 months to 18 years with newly placed PICCs or tunneled lines (TLs). We evaluated the incidence of VTE, central line\u2013associated bloodstream infections (CLABSIs), and catheter malfunctions in PICCs and TLs, and risk factors of CVC-related VTE. A total of 1967 CVCs were included in the analysis. The incidence of CVC-related VTE was 5.9%\u00a0\u00b1\u00a00.63%. The majority of the cases, 80%, were in subjects with PICCs, which had a significantly higher risk of catheter-related VTE than subjects with TLs (hazard ratio [HR] = 8.5; 95% confidence interval [CI], 3.1-23;\u00a0P\u00a0&amp;lt; .001). PICCs\u00a0were significantly more likely to have a CLABSI (HR = 1.6; 95% CI, 1.2-2.2;\u00a0P\u00a0= .002) and CVC malfunction (HR = 2.0; 95% CI, 1.6-2.4;\u00a0P\u00a0&amp;lt; .001). Increased risk of CVC-related VTE was found in patients with a prior history of VTE (HR = 23; 95% CI, 4-127;\u00a0P\u00a0&amp;lt; .001), multilumen CVC (HR = 3.9; 95% CI, 1.8-8.9;\u00a0P\u00a0= .003), and leukemia (HR = 3.5; 95% CI, 1.3-9.0;\u00a0P\u00a0= .031). Children with PICCs had a significantly higher incidence of catheter-related VTE, CLABSI, and CVC malfunction over TLs. The results suggest that pause be taken prior to placing CVCs, especially PICCs, due to the serious complications they have been shown\u00a0to cause.<\/jats:p>","DOI":"10.1182\/blood.2019002260","type":"journal-article","created":{"date-parts":[[2020,1,7]],"date-time":"2020-01-07T11:34:27Z","timestamp":1578396867000},"page":"220-226","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":78,"title":["Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children"],"prefix":"10.1182","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1175-7266","authenticated-orcid":false,"given":"Julie","family":"Jaffray","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital Los Angeles, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Char","family":"Witmer","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8855-9746","authenticated-orcid":false,"given":"Sarah H.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital, Columbus, OH;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Diaz","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital, Houston, TX; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2500-1993","authenticated-orcid":false,"given":"Lingyun","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Krava","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Los Angeles, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Young","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Los Angeles, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"4","key":"2020011611593125100_B1","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1177\/0884533616640454","article-title":"Central venous access in the pediatric population with emphasis on complications and prevention strategies","volume":"31","author":"Duesing","year":"2016","journal-title":"Nutr Clin Pract"},{"issue":"8","key":"2020011611593125100_B2","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1017\/ice.2016.83","article-title":"Risk factors for central venous catheter-associated bloodstream infection in pediatric patients: a cohort study","volume":"37","author":"Carter","year":"2016","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"2","key":"2020011611593125100_B3","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/003335490712200205","article-title":"Estimating health care-associated infections and deaths in U.S. hospitals, 2002","volume":"122","author":"Klevens","year":"2007","journal-title":"Public Health Rep"},{"issue":"2","key":"2020011611593125100_B4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1542\/hpeds.2014-0041","article-title":"The incidence of catheter-associated venous thrombosis in noncritically ill children","volume":"5","author":"Smitherman","year":"2015","journal-title":"Hosp Pediatr"},{"key":"2020011611593125100_B5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.thromres.2017.11.019","article-title":"A multi-institutional registry of pediatric hospital-acquired thrombosis cases: the Children\u2019s Hospital-Acquired Thrombosis (CHAT) project","volume":"161","author":"Jaffray","year":"2018","journal-title":"Thromb Res"},{"issue":"4","key":"2020011611593125100_B6","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1542\/peds.2009-0768","article-title":"Dramatic increase in venous thromboembolism in children\u2019s hospitals in the United States from 2001 to 2007","volume":"124","author":"Raffini","year":"2009","journal-title":"Pediatrics"},{"issue":"12","key":"2020011611593125100_B7","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1182\/bloodadvances.2017013292","article-title":"Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014","volume":"2","author":"Carpenter","year":"2018","journal-title":"Blood Adv"},{"issue":"1","key":"2020011611593125100_B8","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1378\/chest.10-2637","article-title":"The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters","volume":"140","author":"Nifong","year":"2011","journal-title":"Chest"},{"issue":"5","key":"2020011611593125100_B9","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.thromres.2013.08.018","article-title":"Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs)","volume":"132","author":"Kanin","year":"2013","journal-title":"Thromb Res"},{"issue":"3","key":"2020011611593125100_B10","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.thromres.2003.10.013","article-title":"Thrombosis in children with acute lymphoblastic leukemia: part I. 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