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The use of implantable venous access devices (IVADs) in children with hemophilia
J L Perkins1, V A Johnson, J M Osip
1University of Minnesota Medical School, Minneapolis, USA.
Insights
Implantable venous access devices (IVADs) offer benefits for children with hemophilia, despite infection risks. Patient satisfaction remains high, suggesting IVADs are valuable tools for managing this condition.
Area of Science:
- Pediatric Hematology
- Medical Devices
- Vascular Access
Background:
- Implantable venous access devices (IVADs) are increasingly used in children with hemophilia for managing bleeding and preventing joint damage.
- Potential complications include thrombosis, thrombophlebitis, and infection.
Purpose of the Study:
- To evaluate the benefits versus risks of IVADs in pediatric hemophilia patients.
- To determine if the advantages of IVADs outweigh their associated complications in this population.
Main Methods:
- Retrospective review of medical records for 35 children with hemophilia who received IVADs.
- Data collected from 1992 to 1996 at the University of Minnesota's Comprehensive Hemophilia Center.
Main Results:
- No bleeding or thrombophlebitis observed. One central IVAD removed due to thrombosis.
- Central IVADs had 3% local infection and 33% bacteremia rates. Peripheral IVADs had 25% for both.
- Most infections resolved with antibiotics; ports remained functional. High patient/parent satisfaction reported for both IVAD types.
Conclusions:
- Despite significant infection rates, the benefits of IVADs for children with hemophilia are considered to outweigh the risks.
- High patient and parent satisfaction indicates perceived value in managing hemophilia.
- Further investigation into infection rate causes is warranted.
Purpose:
Implantable venous access devices (IVADs), either centrally or peripherally implanted, have become increasingly popular in children with hemophilia to assist in the early treatment of bleeding episodes and in the prevention of arthropathy. Their use has been associated with complications including thrombosis, thrombophlebitis, and infection. We attempted to better define whether the benefits associated with IVADs in this population outweight the associated risks.
Patients And Methods:
We studied the medical records of 35 children from the University of Minnesota's Comprehensive Hemophilia Center who received IVADs between 1992 and 1996.
Results:
There was no bleeding or thrombophlebitis associated with IVADs in our population. One patient required removal of a central IVAD due to thrombosis. The central IVADs were associated with local infection and bacteremia rates of 3% and 33%, respectively. The rates of local infection and bacteremia associated with peripheral IVADs were both 25%. The majority of infections were cleared with antibiotics, and ports remained intact. Both types of IVADs were associated with a high patient/parent satisfaction.
Conclusion:
Despite being associated with a significant incidence of infection, we believe the benefits of IVADs for children with hemophilia and their families outweigh the risks. Possible explanations for the observed infection rates are discussed.
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