Implantable venous access devices in children with hemophilia: A report of low infection rates

Miller, Kim L.; Buchanan, George R.; Zappa, Susan; Cochran, Cindy J.; Laufenberg, J. A.; Medeiros, Desiree; Sanders, J.

doi:10.1016/s0022-3476(98)70386-5

Cited by 60 publications

(76 citation statements)

References 14 publications

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“…[2][3][4][5][6]19 Four of the studies mention catheter occlusion in a total of 8 patients, but only Blanchette and coworkers described venographic evidence of DVT in a single patient. 19 We report herein a specific investigation for DVT using contrast venography in a cohort of unselected patients with hemophilia and long-term CVCs.…”

Section: Discussionmentioning

confidence: 99%

“…Central venous catheters (CVCs) facilitate the infusion of coagulation factors, especially in demanding regimens of primary prophylaxis and induction of immune tolerance in patients with inhibitors. [1][2][3] Many families request CVCs for domiciliary, on-demand infusions as well. Thus, CVCs are an increasingly common adjunct to the therapy of hemophilia.…”

Section: Introductionmentioning

confidence: 99%

“…Published series of hemophilia patients with CVCs have thoroughly described the risk of infection 2,[4][5][6] ; however, the frequency of thrombosis is not adequately documented. Indeed, a CVC is the greatest risk factor for DVT in childhood.…”

Section: Introductionmentioning

confidence: 99%

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Catheter-related deep venous thrombosis in children with hemophilia

Journeycake

Quinn

Miller

et al. 2001

Blood

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108

141

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Central venous catheters (CVCs) are a common adjunct to hemophilia therapy, but the risk of CVC-related deep venous thrombosis (DVT) in hemophiliacs is not well defined. In a previous study, 13 patients with CVCs had no radiographic evidence of DVT. However, recent abstracts and case studies demonstrate that DVT does occur. Therefore, this study sought to determine the frequency of DVT in children with hemophilia and long-term CVCs and to correlate venographic findings with clinical features. All hemophilia patients with tunneled subclavian CVCs in place for 12 months or more were candidates for evaluation. Patients were examined for physical signs of DVT and questioned about catheter dysfunction. Contrast venograms were obtained to identify DVT. Fifteen boys with severe hemophilia were evaluated, including 9 from the initially studied group of 13. Eight patients had evidence of DVT, 5 of whom previously had normal venograms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Catheter-related deep venous thrombosis in children with hemophilia

Journeycake

Quinn

Miller

et al. 2001

Blood

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108

141

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“…Another Table 1. The rate of infection in recent series with haemophilia patients using central venous lines [6,[8][9][10][11]. .…”

Section: Infectionsmentioning

confidence: 99%

“…If the child is treated on demand, the administration of concentrate for a bleed should preferably be done immediately by the parents at home, a situation in which safe and easy access to a vein is necessary. Several reports have been published describing varying experiences with the use of central venous catheters in patients with haemophilia [2][3][4][5][6][7][8][9][10][11][12][13]. There is a diversity of opinions among clinicians concerning the benefits and adverse effects of central venous catheters.…”

Section: Introductionmentioning

confidence: 99%

Central venous lines in haemophilia

Ljung

2003

Haemophilia

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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.

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