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Complications experienced with central venous catheters in children with congenital bleeding disorders
P W Collins1, K S Khair, R Liesner
1The Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children NHS Trust, London.
Insights
Central venous catheters (CVCs) enable home treatment for children with bleeding disorders. However, CVC use in these patients is associated with significant line-associated infections, particularly in those with inhibitors.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Medical Devices
Background:
- Central venous catheters (CVCs) are crucial for managing children with coagulation disorders, facilitating home treatment, prophylactic blood product replacement, and immune tolerance induction.
- Prior literature suggested a low incidence of infective complications associated with CVC use in this pediatric population.
Purpose of the Study:
- To evaluate the incidence and characteristics of line-associated infections in children with bleeding disorders who utilize CVCs.
- To compare infection rates between children with and without inhibitors to factor VIII.
Main Methods:
- Retrospective review of 23 pediatric patients with bleeding disorders who had 32 CVCs inserted.
- Median follow-up of 27 months (range 1-92 months).
- Documentation and analysis of all line-associated infections, including bloodstream infections and port site infections, and CVC removal reasons.
Main Results:
- A total of 25 line-associated infections were documented, with 23 cases of bacteremia (1 episode per 26 patient-months at risk).
- Infections occurred in 48% of patients, with Gram-positive organisms being the most common pathogens.
- Patients with inhibitors to factor VIII experienced significantly higher infection rates (1 episode per 8.3 months) compared to those without inhibitors (1 episode per 50 months) (P<0.03).
Conclusions:
- Despite a higher-than-expected rate of CVC-associated infections, CVCs remain a favored option for families managing children with bleeding disorders.
- Close collaboration between families and experienced Hemophilia Center staff is essential for optimizing CVC safety and patient outcomes.
- The findings highlight the need for vigilant infection surveillance and management strategies in pediatric patients with bleeding disorders using CVCs, especially those with inhibitors.
Abstract:
The use of central venous catheters (CVC) in children with coagulation disorders allows home treatment, the use of prophylactic blood product replacement and induction of immune tolerance. Previous reports have suggested an almost complete lack of infective complications in this patient group. We reviewed 2 3 patients with bleeding disorders who have had 32 CVC inserted at this institution with a median follow-up of 27 months (range 1-92 months). There were 25 documented line-associated infections, including two subcutaneous infections at the port site, and 23 bacteraemias (one episode per 26 patient months at risk). There were 15 Gram-positive, nine Gram-negative and one mixed infection. Infections occurred in 48% of the patients. 15 CVCs were removed: one for erosion through the skin, two for line blockage and 12 for infection. Five patients with inhibitors to factor VIII suffered 14 infections in 12 lines (one per 8.3 months) whereas the 18 without inhibitors suffered 11 infections in 20 lines (one per 50 months) (P<0.03). The use of CVCs is favoured by families of children with bleeding disorders in spite of these complications, but close liaison between families and experienced staff at a Haemophilia Centre is essential to ensure that patients gain the benefits of a CVC as safely as possible.