Central venous lines in haemophilia

Abstract

Summary. Infections and technical problems are the most frequent complications when using implantable central venous access devices in patients with haemophilia. There are two major experiences reported concerning infections in noninhibitor patients: one is approximately 0.2 infections per 1000 days and the other approximately 1.0 (0.7–1.6) per 1000 days. Infections are more frequent in inhibitor patients and approximately one infection per 6–12 months of use can be expected. The figures are low for clinically apparent thrombosis in the larger series on record, but routine venograms were not carried out in most of these series. In studies where this has been done, a high frequency of abnormalities on venograms has been seen in some but not in others. The final decision to use a central line has to take into account the medical goal, the patient's bleeding tendency, the social situation and the expected risk of complications at the particular haemophilia centre. Some of the complications may be reduced by adequate aseptic measures both during implantation and in subsequent use, and by clear basic routines for surveillance of the systems and repeated education of the users.

The principal results of the International Immune Tolerance Study: a randomized dose comparison

“…9,11,12 Potential treatment-related ITI outcome variables include bleeding, central venous catheter device (CVAD) infection, FVIII type, and dosing regimen. Although CVAD infections have been reported repeatedly to adversely affect ITI outcome, [13][14][15][16][17][18] they did not predict ITI outcome in the NAITR. 9 The impact of bleeding has never been examined.…”

The use of short‐term central venous catheters for optimizing continuous infusion of coagulation factor concentrate in haemophilia patients undergoing major surgical procedures

“…The lack of thrombotic complications was reassuring, since thrombotic occlusion of the catheter has been previously attributed to venous devices in haemophilia patients [15]. The lack of thrombotic complications was reassuring, since thrombotic occlusion of the catheter has been previously attributed to venous devices in haemophilia patients [15].…”

Hemophilia A and B

“…Infection is cited as the reason for removal of a port in up to 69.9% of all port removals. 48 The rate of infection is higher in children with inhibitors according to Ljung,49 and a reasonable conclusion that he and others make based on different experience is that patients with inhibitors can expect one Port-a-Cath infection per 6 -12 months of use. He goes on to conclude that in the best of hands, the patient with a Port-a-Cath, without inhibitors and on regular prophylaxis, will have a maximum of one catheter-related infection in approximately 10 years.…”