Catheter-related thrombosis in pediatrics.

Venous access devices (VADs) are being used in the pediatric setting with increasing frequency. To care for these devices, clinicians need to be cognizant of the complications that occur. The two most often encountered catheter-related complications are infection and thrombosis. This article begins with an overview of hemostasis as well as the pathway for fibrinolysis. Signs, symptoms, and treatment options available using thrombolytic agents in the three most common catheter-related thromboses are presented including: (a) fibrin sheath obstruction, (b) subclavian vein thrombosis, and (c) superior vena cava thrombosis. Since treatment options using thrombolytic therapy are becoming more widely used, clinicians are expected to be knowledgeable of these agents. A brief overview of the more common investigational agents used for the treatment of catheter-related thrombosis is also provided. VADs in children have played a significant role since being introduced more than 20 years ago. VADs often provide the only means available for the delivery of chemotherapeutic agents, blood products, nutritional support, fluids, antibiotics, and other medications as well as easier access to blood sampling. The convenience of these devices has not only decreased the pain and anxiety of frequent peripheral access for intravenous (i.v.) therapy and blood sampling, but has decreased frequent trips to the clinics or hospitals that are otherwise often required. In recent years family members are using VADs more frequently at home for the delivery of medications.