Superior and inferior vena caval occlusion in infants receiving total parenteral nutrition.

During the past 23 1/2 years, 510 infants under 12 months of age had 756 Broviac central venous catheters inserted. At first catheter insertion 51 per cent of patients were less than 1 month old. Catheter function ranged from 3 to 1080 days (mean = 90 days). Sites of insertion were saphenous 85 per cent, external jugular 7 per cent, internal jugular 5 per cent, subclavian 2 per cent, cephalic 0.7 per cent, and transthoracic azygos 0.5 per cent. Eighty-nine patients had malabsorption syndromes, 86 had short bowel syndrome, 74 had intractable diarrhea, and 261 required nutritional support for other reasons. Vena caval thrombosis developed in 35 infants; 23 had inferior vena cava (IVC) occlusion (4.5% at risk); six had isolated superior vena cava (SVC) occlusion (11% at risk), and six had both SVC and IVC thrombosis. No major symptoms or complications resulted from isolated IVC thrombosis, whereas all infants with SVC occlusion developed head and neck swelling, 50 per cent developed pleural effusions, and two died. Each of six infants with combined IVC and SVC occlusion died within 6 months. We conclude that SVC occlusion is a very serious complication in infants receiving total parenteral nutrition (TPN) solutions and that infusion via the IVC has fewer and less serious complications.