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Totally implantable system for venous access in children with cystic fibrosis
J Cassey1, W D Ford, L O'Brien
1Department of Surgery, Adelaide Children's Hospital, South Australia.
Insights
Totally implantable reservoirs offer a viable option for delivering intravenous antibiotics in children with cystic fibrosis. While complications can occur, these systems are well-accepted and aid in managing the condition.
Area of Science:
- Pediatric Medicine
- Surgical Innovation
- Infectious Disease Management
Background:
- Cystic fibrosis (CF) often necessitates long-term intravenous antibiotic therapy.
- Repeated venous access can be challenging and burdensome for pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of totally implantable reservoirs for antibiotic delivery in pediatric cystic fibrosis patients.
- To assess patient and parent acceptance of this long-term venous access device.
Main Methods:
- Surgical implantation of totally implantable reservoirs in thirteen pediatric CF patients.
- Administration of 47 courses of intravenous antibiotics over 832 treatment days.
- Monitoring for device-related complications and patient outcomes.
Main Results:
- Catheters remained in place for an average of 463 days.
- Three patients experienced complications: catheter separation, occlusion, and fracture with migration.
- Successful retrieval of a migrated catheter was achieved percutaneously.
- High acceptance rates by patients and parents were reported.
Conclusions:
- Implantable reservoir systems provide a valuable management option for pediatric cystic fibrosis patients requiring prolonged intravenous antibiotics.
- Despite moderate expense and potential complications, the benefits of consistent access and improved quality of life are significant.
- Further research into optimizing device longevity and minimizing complications is warranted.
Abstract:
Thirteen children with cystic fibrosis had a totally implantable reservoir surgically inserted for repeated courses of intravenous antibiotics. The youngest patient was 17 months at the time of implantation. The catheters have been in place for an average of 463 +/- 200 days. Forty seven courses of intravenous antibiotics have been given over a total of 832 treatment days. Three patients had complications. One experienced catheter separation from the portal, one catheter became occluded, and a third catheter fractured and migrated to the right atrium but was successfully retrieved percutaneously. The catheters were accepted well by patients and parents. We conclude that implantable reservoir systems, although moderately expensive and not totally free of complications, offer another modality in the management of cystic fibrosis patients.