Thromboprophylaxis in the paediatric setting

Background No evidence for routine VTE risk assessment No evidence to support the routine use of thromboprophylaxis, mechanical or pharmacological

Incidence VTE rarely occurs in the paediatric population Incidence per 100,000 population Peak incidence in neonates and adolescents Prevalence 5.3 per 10,000 hospital admissions.

Recommendations of best practice Early mobilisation Adequate hydration Prompt removal of central venous lines Consider site of insertion of CVL (Femoral vein is associated with highest incidence of thrombosis)

Majority of VTEs are catheter related or have multiple underlying contributing factors such as –Sepsis –Immobility –Malignancy – Surgery – Congenital heart disease – Trauma Contributing factors Ca

When to seek advice If multiple contributing factors are present seek advice from paediatric consultant or paediatric haematologist to consider the risk benefit ratio of using thromboprophylaxis BCSH guideline “Investigation, management, and prevention of VTE in children

Scenario 1 14 year old girl, newly diagnosed leukaemia, neutropenic sepsis, bed-bound, dehydrated What VTE prophylaxis does she require?

Scenario 1 Answer 14 year old girl, newly diagnosed leukaemia, neutropenic sepsis, bed-bound, dehydrated Follow recommendations of best practice, and seek specialist advice.

Scenario 2 14 year old boy with inflamed appendix, no other contributing factors for VTE What VTE prophylaxis does he require?

Scenario 2 Answer 14 year old boy with inflamed appendix, no other contributing factors for VTE Follow recommendations of best practice, no other prophylactic measures required.

Scenario 3 15 year old girl, newly diagnosed sarcoma compressing pelvic and iliac vessels, bed-bound, dehydrated What VTE prophylaxis does she require?

Scenario 3 Answer 15 year old girl, newly diagnosed sarcoma compressing pelvic and iliac vessels, bed-bound, dehydrated Follow recommendations of best practice, and seek specialist advice.

Certificate Thromboprophylaxis in the paediatric setting Completed by ………………………………….. On ……………..