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Central venous access devices for paediatric patients with haemophilia: a single-institution experience

R Titapiwatanakun1, C Moir, R K Pruthi

  • 1Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, Minnesota, USA. rodriguez.vilmarie@mayo.edu

Haemophilia : the Official Journal of the World Federation of Hemophilia
|January 20, 2009
PubMed

Insights

Central venous access devices (CVADs) enable home infusions for children with bleeding disorders. Infections are the main complication, particularly in patients with Factor VIII inhibitors, though overall rates remain low with proper technique.

Area of Science:

  • Pediatric Hematology
  • Vascular Access Devices
  • Bleeding Disorders Management

Background:

  • Central venous access devices (CVADs) are crucial for home-based factor concentrate infusions in children with bleeding disorders.
  • These infusions support long-term prophylaxis and immune tolerance therapy.

Purpose of the Study:

  • To review the outcomes and complications associated with CVAD use in pediatric patients with bleeding disorders.
  • To evaluate the safety and efficacy of CVADs in this specific patient population.

Main Methods:

  • Retrospective review of 37 CVADs placed in 18 pediatric patients at the Mayo Clinic Comprehensive Hemophilia Center.
  • Data collected included patient diagnoses (hemophilia A, von Willebrand disease, hemophilia B), CVAD dwell time, and complications.

Main Results:

  • A total of 45,952 CVAD days were recorded, with a median dwell time of 1361 days per device.
  • Ten CVAD-related infections occurred (0.22 per 1000 days), with a higher incidence in patients with Factor VIII inhibitors.
  • No clinically apparent thrombosis was observed; infection was the most common complication.

Conclusions:

  • CVADs are effective for home-based therapy in pediatric bleeding disorders, but infection risk is increased in patients with inhibitors.
  • Strict adherence to aseptic technique is crucial for minimizing infection rates.
  • The study highlights the safety of CVADs when managed with appropriate protocols, despite the absence of routine thrombosis screening.

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