Related Experiment Videos
Long-term central venous access in patients with sickle cell disease. Incidence of thrombotic and infectious
A Abdul-Rauf1, M Gauderer, K Chiarucci
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA.
Insights
Central venous access devices (CVAD) are safe for pediatric sickle cell disease (SCD) patients, with complication rates similar to other serious conditions. These devices provide effective venous access for necessary intravenous therapies in this population.
Area of Science:
- Pediatric Hematology
- Vascular Access Devices
- Sickle Cell Disease Management
Background:
- Central venous access devices (CVAD) are increasingly utilized in pediatric care.
- Sickle cell disease (SCD) often necessitates frequent intravenous therapies, posing challenges for peripheral venous access.
Purpose of the Study:
- To evaluate the safety and efficacy of CVAD in pediatric patients with SCD.
- To determine the rates of perioperative complications, thrombosis, and infections associated with CVAD in this cohort.
Main Methods:
- Retrospective review of 25 pediatric patients with SCD who received 31 CVAD placements.
- Data collected over a 4 1/2 year period (February 1987 to April 1992).
- Analysis of perioperative complications, catheter occlusion, bacteremia, and catheter removal due to infection.
Main Results:
- No perioperative complications were observed.
- Catheter occlusion occurred at a rate of 0.29 per 1,000 catheter patient days (8% of patients).
- Catheter-associated bacteremia occurred in 32% of patients (0.86 per 1,000 catheter patient days), with 3 catheters removed due to infection.
Conclusions:
- Complication rates for thrombosis and infection in SCD patients were comparable to those with malignant diseases, cystic fibrosis, and AIDS.
- CVAD are an effective, reliable, and safe option for venous access in select pediatric SCD patients.
- CVAD facilitate essential intravenous therapies for children and young adults with SCD facing limited peripheral venous access.
Purpose:
Central venous access devices (CVAD) have been used with increasing frequency in recent years among pediatric patients. We retrospectively reviewed our experience in 25 children and young adults with sickle cell disease (SCD) over a 4 1/2 year period in an attempt to define occurrence rates of perioperative complications, thrombosis requiring catheter removal, and infectious episodes.
Patients And Methods:
The setting was a university-associated tertiary children's hospital. Patients were 25 children and young adults (ages 8 months to 23 years) with SCD who required CVAD placement between February 1987 and April 1992. A total of 31 catheters (totally implantable ports and partially implanted catheters) were placed for 17,444 patient catheter days.
Results:
Rates of significant perioperative complications, thrombotic events requiring catheter removal, and infectious episodes were recorded. No perioperative complications were noted. Five episodes of catheter occlusion requiring replacement occurred in two patients (0.29 per 1,000 catheter patient days, involving 8% of patients and 16% of catheters). Fifteen episodes of catheter-associated bacteremia occurred in eight patients (0.86 per 1,000 catheter patient days involving 32% of patients and 26% of catheters). Three catheters required removal because of infection unresponsive to antibiotic therapy.
Conclusion:
The occurrence of thrombosis requiring catheter removal and infection in our population of patients with SCD was comparable to that reported in patients with malignant disease, cystic fibrosis and acquired immune deficiency syndrome. CVAD represents an effective, reliable, and reasonably safe means of establishing and maintaining venous access for a selective group of children and young adults with SCD who have limited peripheral venous access and require intravenous therapies.