Central venous catheters in children with haemophilia

Infections, thrombosis and technical problems are the most frequent complications when using implantable central venous access devices in patients with haemophilia. There seem to be two major experiences concerning infections in non-inhibitor patients, one is approx. 0.2 infections per 1000 days and the other approx. 1.0(0.7-1.6)/1000 days. Infections are more frequent in inhibitor patients and one can expect approx. one infection per 6-12 months of use. The figures are low for clinically apparent thrombosis in the larger series on record, but routine venograms were not done in most of these series. In studies where this has been done, a high frequency of abnormalities on venograms have been seen in some but not in others. The final decision to use a central line has to be a compromise between the medical goal, the patient's bleeding tendency, the social situation and the expected risk of complications at the particular haemophilia center. Some of the complications may be reduced by adequate aseptic measures both during implantation and in the subsequent use and clear basic routines for surveillance of the systems and repeated education of the users.