Use of central venous catheters in children with severe congenital coagulopathy.
From two U.K. centres 23 children with severe congenital coagulopathy had a total of 27 port-a-cath devices inserted to facilitate factor VIII or IX prophylaxis (eight patients), domiciliary therapy (seven patients), immunotolerance (four patients), or a combination thereof (four patients). Six children had a factor VIII inhibitor at the time of insertion. The mean age at operation was 30 months, with a range of 9-76 months. The cumulative length of follow-up is 639 months with a mean of 27.8 months and a range of 5-79 months. Haemostasis was achieved peri- and post-operatively with high-purity concentrate in the majority of patients without an inhibitor. All those with an inhibitor had porcine factor VIII, except one who had recombinant factor VIIa. The post-operative complication rate was 27% (6/23): three had a port-site haematoma (one required removal and replacement), two had post-operative infection, and one had swelling caused by extravasation. To date there have been 13 documented infections in 10/23 patients (five with inhibitor): a rate of 0.24 per follow-up year or 0.67 per 1000 patient-days. Six were caused by Gram-positive and seven by Gram-negative organisms. Six infections could not be eradicated by antibiotics and the port-a-cath system had to be removed; in three it was replaced by a second port-a-cath. Although there are risks involved in the use of port-a-caths in this population, both clinicians and parents involved in the care of these children believe that the benefits are considerable and the potential hazards are acceptable.
Liesner
R J
RJ
Haemophilia Comprehensive Care Centre, Great Ormond Street Hospital for Children NHS Trust, London.
Vora
A J
AJ
Hann
I M
IM
Lilleymann
J S
JS
D001778:Blood Coagulation Disorders / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000628:therapy; D002836:Hemophilia B / Q000628:therapy; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D014842:von Willebrand Diseases / Q000628:therapy