Document Detail


Central venous access devices for paediatric patients with haemophilia: a single-institution experience.
MedLine Citation:
PMID:  19149849     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Use of a central venous access device (CVAD) can facilitate early introduction of home-based infusion of factor concentrate for long-term prophylaxis or immune tolerance therapy in children with bleeding disorders. The aim was to review outcomes associated with use of CVAD. Retrospective review of paediatric patients with bleeding disorders was observed at the Mayo Clinic Comprehensive Hemophilia Center. Thirty-seven CVAD were placed in 18 patients (haemophilia A [n = 15], type 3 von Willebrand disease [n = 2] and haemophilia B [n = 1]). Follow-up was for 45 952 CVAD days, and median time that CVAD remained in place was 1361 days per device. Factor VIII (FVIII) inhibitors were present in 4 of the 15 patients. Ten CVAD-related infections occurred (median, 672 days; range, 72-1941 days), of which six were in one patient with FVIII inhibitors. Overall infection rate was 0.22 (95% confidence interval [CI], 0.10-0.40) per 1000 CVAD days, with 0.11 infections in patients without FVIII inhibitors compared with a pooled incidence of 0.66 (95% CI, 0.44-0.97) reported in the literature. Indications for removal of 27 CVAD were blockage, change to peripheral venous access, catheter displacement, infection, leak in the port septum, short catheter and skin erosion. No clinically apparent thrombosis or sequelae of thrombosis were observed. Infection is the most common complication associated with CVAD use and is increased in patients who have inhibitors. The low rate of clinically apparent thrombosis reflects our practice of not screening for thrombosis. The low infection rate reflects our practice of using and reinforcing the aseptic technique.
Authors:
R Titapiwatanakun; C Moir; R K Pruthi; P L Stavlo; K A Schmidt; V Rodriguez
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Haemophilia : the official journal of the World Federation of Hemophilia     Volume:  15     ISSN:  1365-2516     ISO Abbreviation:  Haemophilia     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-19     Completed Date:  2009-08-04     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9442916     Medline TA:  Haemophilia     Country:  England    
Other Details:
Languages:  eng     Pagination:  168-74     Citation Subset:  IM    
Affiliation:
Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, Minnesota, USA. rodriguez.vilmarie@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Bacterial Infections / etiology
Catheterization, Central Venous / adverse effects,  instrumentation*
Catheters, Indwelling / microbiology
Child
Child, Preschool
Equipment Contamination
Factor IX / administration & dosage
Factor VIII / administration & dosage*,  therapeutic use
Hemophilia A / drug therapy*
Hemophilia B / drug therapy
Home Infusion Therapy / adverse effects,  instrumentation*
Humans
Infant
Infusion Pumps, Implantable / microbiology
Infusions, Intravenous
Male
Retrospective Studies
von Willebrand Diseases / drug therapy
Chemical
Reg. No./Substance:
9001-27-8/Factor VIII; 9001-28-9/Factor IX

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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