The Use of Implantable Venous Access Devices (IVADs) in Children with Hemophilia

Perkins, Jack; Johnson, Vicky A.; Osip, Joan M.; Christie, Beverly; Nelson, Stephen C.; Moertel, Christopher L.; Heisel, Margaret A.

doi:10.1097/00043426-199707000-00013

Cited by 48 publications

(93 citation statements)

References 14 publications

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“…CVCs can make these intensive and effective treatment approaches more feasible and more convenient. [20][21][22] However, the widespread use of CVCs is now being re-evaluated because of complications such as infection and thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Catheter-related deep venous thrombosis in children with hemophilia

Journeycake

Quinn

Miller

et al. 2001

Blood

109

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%

Catheter-related deep venous thrombosis in children with hemophilia

Journeycake

Quinn

Miller

et al. 2001

Blood

109

141

View full text Add to dashboard Cite

show abstract

“…In young children it is less threatening to insert a needle in the periphery of the body, and they can avoid the visible profile of the port on the chest. However, peripheral ports have been associated with a higher frequency of thrombophlebitis and thrombosis, and the average time that the patient may benefit from the device is probably shorter [8]. The Percuseal Ò device (Percuseal Medical, Huskvarna, Sweden) is implanted into the subcutaneous tissue, with the top portion protruding from the surface of the skin.…”

Section: Evaluating the Studies On Recordmentioning

confidence: 99%

“…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%

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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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“…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].…”

Section: Outcomes With Prophylaxismentioning

confidence: 99%

Current Issues in Prophylactic Therapy for Persons with Hemophilia

Dunn¹,

Abshire²

2006

Acta Haematol

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Factor VIII or IX replacement in a prophylactic manner is utilized for many patients with moderate to severe hemophilia A or B. Studies have shown it to be effective in reducing or preventing degenerative joint disease in many but not all patients. However, many unanswered questions still exist and optimization of this expensive treatment regimen is needed. This paper recounts the current products that are available for use and explores the literature regarding different treatment regimens. It explores age at initiation, dose, interval between infusions, joint health outcomes, barriers to compliance and age at discontinuation of prophylaxis. Individualized treatment is recommended. Collaborative efforts are needed to improve outcomes for all persons with hemophilia.

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The Use of Implantable Venous Access Devices (IVADs) in Children with Hemophilia

Abstract: Despite being associated with a significant incidence of infection, we believe the benefits of IVADs for children with hemophilia and their families outweigh the risks. Possible explanations for the observed infection rates are discussed.

Cited by 48 publications

References 14 publications

Catheter-related deep venous thrombosis in children with hemophilia

Catheter-related deep venous thrombosis in children with hemophilia

Central venous lines in haemophilia

Current Issues in Prophylactic Therapy for Persons with Hemophilia

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