The use of central venous catheters (portacaths) in children with Haemophilia

Abstract

The experience with central venous implantable devices (portacaths) has been reviewed in children attending the Auckland Hospital Haemophilia Centre. Fourteen children had 23 portacaths inserted. Thirteen had severe Haemophilia A, of whom five had high responding inhibitors to factor VIII. All the children were HIV negative. Ages ranged from 4 months to 13 years at the time of initial placement and 12 were under 5 years. Indications for portacath placement included primary and secondary prophylaxis, induction of immune tolerance, prophylactic therapy post intracranial haemorrhage and poor venous access. Catheter-related infections occurred in 48% of cases. Staphylococcal species were the most common organisms isolated followed by gram-negative bacilli. 63% of the infections were successfully cleared with antibiotics. Haematoma formation occurred in 17% of catheters, primarily in patients who had high factor VIII inhibitor levels. Mechanical problems including blockage, leakage and extrusion of the portacath occurred less frequently (13%). The significant rate of infection in this immunocompetent population is consistent with other reports. Despite the obvious benefits of portacaths this complication is potentially serious and causes appreciable morbidity. In contrast, bleeding complication rates were relatively low.

Catheter-related deep venous thrombosis in children with hemophilia

“…[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.…”

“…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.…”

Current Issues in Prophylactic Therapy for Persons with Hemophilia

“…First the device must be implanted surgically and the patient risks anesthesia and bleeding. Mechanical complications such as leakage and extrusion sometimes occur [56]. These devices are also associated with an increased risk of infection and thrombosis.…”

“…These devices are also associated with an increased risk of infection and thrombosis. Rates of infection vary from 0.14 to 3.4 infections/1,000 catheter days [56,57,58,59,60,61,62,63]. CVADs placed for immune tolerance have higher rates of infection than those placed for prophylaxis [56, 57, 60, 63].…”

Bacterial Endocarditis and Septic Arthritis in a Patient With Severe Hemophilia A

“…Among patients with hemophilia who do not have concomitant human immunodeficiency virus (HIV) infection, approximately 50% have catheter-related infections. 1,2 Staphylococcus organisms are the most common blood culture isolate, followed by Gram-negative bacilli. About 60% of the infections can be successfully treated with systemic antibiotics.…”