A Life-threatening Cardiomyopathy following Port-a-Cath Infection under Immune Tolerance Therapy

Wiegand, G.; Rauch, Ralf; Girisch, M.; Hofbeck, Michael

doi:10.1007/978-3-642-18150-4_24

Cited by 2 publications

(6 citation statements)

References 13 publications

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“…Forty‐eight studies reported between 1982 and 2003 with 2704 patients receiving a total of 2973 CVADs were included in the meta‐analysis (Table 1) [2–4,6,7,9–22,27–55]. None of the studies was unpublished.…”

Section: Resultsmentioning

confidence: 99%

“…The design of 15/48 studies (31.2%) was indicated as prospective. Individual patient data were reported for a total of 176 patients among 23 studies [3,[9][10][11][12][15][16][17]20,21,[27][28][29][30][31][32]35,40,41,43,48,53,54]. The remaining data were reported in summary form.…”

Section: Resultsmentioning

confidence: 99%

“…Published data suggest that infection can usually be managed without CVAD removal [2,3,6,7,9,10,[12][13][14][15][16][17][18][20][21][22][27][28][29][30][31][32][33]35,[38][39][40][41][42][43][44]47,49,[53][54][55]. The number of CVAD removals corresponded to only 40.8% (486/1190) of the total infections, which suggests that the majority of infectious episodes can be treated successfully without the loss of the venous access device.…”

Section: Discussionmentioning

confidence: 99%

“…For those patients developing infection, the pooled time to first infection was 295 days (CI, 181-479 days). Infection was most often characterized as systemic [10,14,16,21,27,39,40,43,53]; however, insufficient details were reported to allow reliable separate pooled estimates of systemic and local infection incidence rates. Regularly scheduled surveillance semiquantitative cultures of blood and peri-CVAD tissue samples were described in only one study report [43].…”

Section: Infectionmentioning

confidence: 99%

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Central venous access devices in haemophilia

Valentino

Ewenstein

Navickis³

et al. 2004

Haemophilia

140

182

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Central venous access devices (CVADs) can facilitate repeated and/or urgent administration of coagulation factors in haemophilic patients. We conducted a systematic review and meta-analysis of complication rates and risk factors for poor outcome. Forty-eight studies with a total of 2704 patients and 2973 CVADs were included. The primary indications for CVADs were immune tolerance therapy (34.9% of patients), difficult venous access (31.8%) and prophylaxis (29.1%). Fully implanted CVADs were employed in 77.4% of cases and external CVADs in 22.6%. A total of 1190 infections were reported, and the pooled incidence of infection was 0.66 per 1000 CVAD days [confidence interval (CI), 0.44-0.97 per 1000 CVAD days]. Among patients developing infection, the pooled time to first infection was 295 days (CI, 181-479 days). Presence of inhibitors was an independent risk factor for infection with an incidence rate ratio (IRR) of 1.67 (CI, 1.15-2.43). Infection was less likely in patients >6 years of age (IRR, 0.46; CI, 0.27-0.79) and recipients of fully implanted CVADs (IRR, 0.31; CI, 0.12-0.86). Available information on thrombosis was limited, with only 55 cases being reported. Eventually, 31.3% of CVADs were removed, and infection was the reason for removal in 69.9% of cases and thrombosis in 4.1%. The pooled time period CVADs remained indwelling prior to removal or the expiration of the study observation period was 578 days per CVAD (CI, 456-733 days per CVAD). CVADs can confer major benefits in patients with haemophilia requiring long-term venous access, and serious complications are rare.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Infectionmentioning

confidence: 99%

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Central venous access devices in haemophilia

Valentino

Ewenstein

Navickis³

et al. 2004

Haemophilia

140

182

View full text Add to dashboard Cite

show abstract

“…While complications of CVAD use can be life‐threatening, the reported number of serious complications thought to be related to CVAD use in haemophilia patients is relatively low. Serious infectious complications have been described in two case reports of septic arthritis [54, 55], two of bacterial endocarditis [14, 56] and one of cardiomyopathy with septicaemia [57].…”

Section: Infectionmentioning

confidence: 99%

Consensus recommendations for use of central venous access devices in haemophilia

et al. 2004

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Venous access is essential for delivery of haemophilia factor concentrate. Wherever possible, peripheral veins remain the route of choice, and the use of central venous access devices (CVADs) should be limited to cases of clear need in patients with caregivers able to exercise diligence in CVAD care and should continue no longer than necessary. CVADs are of recognized value for repeated administration of coagulation factors in haemophilia, particularly for prophylaxis and immune tolerance therapy and in young children. Evidence to guide best practices has been fragmentary, and standardized methods for CVAD usage have yet to be established. We have developed management recommendations based upon available published evidence as well as extensive clinical experience. These recommendations address patient and CVAD selection; CVAD placement, care and removal; caregiver/patient guidance; and complications, including infection and thrombosis. In the absence of inhibitors, ports are recommended, primarily because of fewer associated infections than with external catheters. For patients with inhibitors, ports also appear to be associated with fewer infections. Infection is the most frequent complication, and recommendations to prevent and treat infections are supported by extensive clinical data and experience. Strict adherence to handwashing and aseptic technique are essential elements of catheter care. Evidence-based data regarding the detection and treatment of CVAD-related thrombotic complications are limited. Caregiver education is an integral part of CVAD use and the procedural practices of users should be regularly re-assessed. These recommendations provide a basis for sound current CVAD practice and are expected to undergo further refinements as new evidence is compiled and clinical experience is gained.

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A Life-threatening Cardiomyopathy following Port-a-Cath Infection under Immune Tolerance Therapy

Cited by 2 publications

References 13 publications

Central venous access devices in haemophilia

Central venous access devices in haemophilia

Consensus recommendations for use of central venous access devices in haemophilia

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