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Experience with the Port-A-Cath in sickle cell disease
C E McCready1, H A Doughty, T C Pearson
1Department of Haematology, St Thomas' Hospital, London, UK.
Clinical and Laboratory Haematology
|June 1, 1996
Summary
Totally implantable venous access devices (TIVADs) pose a high risk of infection in sickle cell disease (SCD) patients. Complications like SBE and thrombosis led to device removal, suggesting TIVADs are unsuitable for SCD patients.
Area of Science:
- Hematology
- Vascular Surgery
- Infectious Diseases
Background:
- Peripheral venous access is challenging in sickle cell disease (SCD) patients.
- Totally implantable venous access devices (TIVADs) are used for long-term venous access in other patient groups.
Observation:
- A Port-A-Cath TIVAD was used in five SCD patients undergoing exchange transfusion.
- All five TIVADs were removed due to complications including infection (SBE, septic arthritis), pulmonary embolism, and axillary vein thrombosis.
Findings:
- Infective complications occurred at a rate of 0.4 per 100 patient days, significantly higher than in HIV or malignancy patients.
- Common pathogens included Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus sp.
- Bone infection was more prevalent in patients with pre-existing infarcted tissue.
Implications:
- The incidence of Port-A-Cath associated infections in SCD patients is unacceptably high.
- TIVADs may not be a suitable long-term venous access solution for patients with SCD.
- Further research is needed to explore safer venous access methods for this population.