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Implantable central venous access devices in children with metabolic disease
A Al-Bassam1, A Al-Rabeeah, K Fouda
1Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Insights
Totally implantable central venous devices offer a viable solution for long-term venous access in pediatric patients with severe metabolic diseases. Careful management is key to minimizing complications like infection and catheter removal.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Metabolic Disorders
Background:
- Severe metabolic diseases often necessitate long-term central venous access for treatment.
- Managing venous access in pediatric patients with complex metabolic conditions presents unique challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of totally implantable central venous devices in children with severe metabolic diseases.
- To assess complication rates and identify factors influencing device longevity.
Main Methods:
- Retrospective analysis of 20 totally implantable central venous devices inserted in 17 pediatric patients over 43 months.
- Patients had various metabolic disorders including Gaucher's disease, vitamin D-dependent rickets type II, and urea cycle disorders.
- Data collected included patient demographics, underlying pathology, device dwell time, and complications.
Main Results:
- A total of 7,278 patient-catheter days were recorded with no operative complications or deaths.
- Seven complications occurred, including six catheter-related infections and one system occlusion, resulting in an infection rate of 0.8 per 1,000 days.
- Six catheters were removed due to complications and two upon treatment completion.
Conclusions:
- Totally implantable central venous devices are a useful option for long-term venous access in children with metabolic diseases.
- Minimizing catheter-related infections is crucial for reducing device removal rates and improving patient outcomes.
- Further attention to infection prevention strategies is warranted to optimize the use of these devices.
Abstract:
We have inserted 20 totally implantable central venous devices in 17 patients with severe metabolic disease over a 43-month span. Patient ages ranged from 2 months to 17 years (mean, 4.2 years). The underlying pathology was Gaucher's disease in six patients, vitamin D-dependent rickets type II in five, propionic acidemia in two, and methylmalonic acidemia, 3-hydroxyl-3-methylglutaryl coenzyme A (CoA) lyase deficiency, fructose 1,6 diphosphatase deficiency, and urea cycle disorder in one child each. There were seven complications (six due to catheter-related infection and one due to occlusion of the system) during a total of 7,278 patient-catheter days. The infection rate was 0.8 per 1,000 days. Six catheters were removed due to complications and two due to completion of treatment. There were no operative complications or deaths. Our experience demonstrates that a totally implantable device may be useful in children with metabolic disease who need long-term venous access. Attention should be given to minimize the infection rate to reduce the rate of catheter removal.