Complications associated with central venous access device in children with haemophilia: a nationwide multicentre study in Finland

Abstract

Children with haemophilia require venous access for regular infusion of coagulation factors. A central venous access device (CVAD) ensures long-term access but associates with infectious and non-infectious complications with proposed risk factors of young age at initial CVAD implantation and presence of an inhibitor. Our aim was to evaluate the incidence and risk factors for complications associated with CVAD usage in a retrospective nationwide multicentre study in five Finnish Paediatric Haemophilia Treatment Centers. Our study investigated 106 CVADs in 58 patients with 137 971 CVAD days. The median access survival was 1159 CVAD days, and most often a malfunction led to CVAD removal after a long survival (median of 1640 CVAD days). We detected a very low bloodstream infection rate (0.12/1000 CVAD days). The presence of neutralizing inhibitor was a significant risk factor for infection. Heparin vs. saline flushing did not influence the CVAD outcome. We detected a lower infection rate than previously reported, although 90% of the patients were very young (<2 years) at first insertion (median age = 1.02 year). Port access was frequent after initial implantation: six patients (10%) used the port daily for immune tolerance induction therapy and 74% at least twice weekly for prophylaxis. Young age did not increase the risk of infections, as 59% of the CVAD-related infections were recorded in children over 6 years of age. Our national experience confirms the safety of prophylactic factor concentrate administration via ports even in very young children.

Burden of illness and costs among paediatric haemophilia patients with and without central venous access devices treated in US hospitals

“…Risk factors for infection include young age at time of placement and use of external CVADs . Although some studies report younger age at placement as a risk factor for infections, in our study, frequency of infections was higher among the older children.…”

“…The benchmark estimate for the incidence of infection in this population is based on pooled data from a 2004 meta‐analysis that reported 0.66 catheter‐associated infections per 1000 CVAD days, with a pooled time to the first infection of 295 days (95% CI: 181‐479 days) . A more recent study from Finland of 58 paediatric haemophilia patients with CVADs found a very low bloodstream infection rate (0.12/1000 CVAD days) nationwide . A 1992‐2009 study from Australia reported the overall incidence of confirmed CVAD‐related bloodstream infection was 0.42 per 1000 CVAD days (95% CI: 0.31‐0.58/1000) and that 29 (51.8%) of 56 patients experienced CVAD‐related infections .…”

Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

“…Local infection was defined as catheter insertion local exit-site infection. Catheter-related thrombosis was diagnosed by ultrasound with clinical symptoms or signs of venous thrombosis 15. Mechanical phlebitis was defined as at least one sign or symptom of vein irritation confined to the CVC insertion site 16.…”

Use of Implantable Venous Port Systems in the Treatment of Children with Orphan Diseases (Mucopolysaccharidosis and Pompe Disease): Case Series

“…Так, в нескольких ста-тьях проанализирован опыт применения ИВПС у детей с орфанными заболеваниями [25][26][27]; в 2 -у детей с гемофилиями [28,29]; в 3 -с ВИЧ-инфекциями [30][31][32], однако работы последней группы описыва-ют опыт применения преимущественно у взрослых пациентов, и по этой причине в литературный обзор включены не были. Обращает на себя внимание тот факт, что частота инфекционных осложнений у боль-ных ВИЧ была выше по сравнению с пациентами, кото-рым ИВПС устанавливали для лечения онкологических заболеваний [27].…”

“…Интересно, что анестезия выполнялась с помо-щью внутривенного введения кетамина и мидазолама в сочетании с масочной анестезией закисью азота. Такой вариант анестезиологического пособия, возможно, объ-ясняется тем, что статья датирована 2009 г., поскольку в настоящее время оптимальным считается применение масочной анестезии cевофлураном [29].…”