Explain a new diagnosis of catheter-related thrombosis and anticoagulation to a parent — OSCE

OSCE communication station: explaining a new diagnosis of central-venous-catheter-related deep vein thrombosis to the parent of a child with leukaemia, the meaning of a provoked clot, the treatment with low molecular weight heparin injections and the anti-factor Xa monitoring, the option of oral rivaroxaban, the warning signs of pulmonary embolism and bleeding, the plan for the central line, and the selective approach to thrombophilia testing.

osce communication and shared planning6 min readVerification in progress

Prompt

A parent whose six-year-old son with acute lymphoblastic leukaemia has just been diagnosed with a femoral deep vein thrombosis around his tunnelled central line wants to know what caused it, what the treatment is, whether it is linked to his cancer, what the warning signs are, and whether the family carries a clotting problem.

Candidate instructions

You are the paediatric registrar. You have eight minutes to speak with Mrs Chen, whose six-year-old son Liam has acute lymphoblastic leukaemia and has just been diagnosed with a right femoral deep vein thrombosis around his tunnelled central line, confirmed on ultrasound. Explain in plain language what a clot is and what caused it, the treatment with blood-thinning medicine and how it is given and monitored, the warning signs that mean coming straight to hospital, what will happen to his central line, and whether the family needs to be checked for an inherited clotting problem. Answer her questions, check her understanding, and agree a plan. [1]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References8Show ledger

[1]Monagle P, Chan AKC, Goldenberg NA, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012.PMID 22315277
[2]Monagle P, Cuello CA, Augustine C, et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2018.PMID 30482766
[3]Raffini L, Huang YS, Witmer C, et al. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics, 2009.PMID 19736261
[4]Male C, Lensing AWA, Palumbo JS, et al. Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial. Lancet Haematol, 2020.PMID 31699660
[6]Thom K, Lensing AWA, Nurmeev I, et al. Safety and efficacy of anticoagulant therapy in pediatric catheter-related venous thrombosis (EINSTEIN-Jr CVC-VTE). Blood Adv, 2020.PMID 33002131
[7]Law C, Raffini L A guide to the use of anticoagulant drugs in children. Paediatr Drugs, 2015.PMID 25711916
[8]van Ommen CH, Nowak-Göttl U Inherited Thrombophilia in Pediatric Venous Thromboembolic Disease: Why and Who to Test. Front Pediatr, 2017.PMID 28352625
[11]Monagle P Diagnosis and management of deep venous thrombosis and pulmonary embolism in neonates and children. Semin Thromb Hemost, 2012.PMID 23034828