[Central venous totally implantable access for high dose chemotherapy in children].
BACKGROUND
The feasibility and complication rate of central venous totally implantable access ports (TIAP), used for delivering high-dose chemotherapy (HDC) with autologous stem cell transplantation, have not been fully investigated to date, due to the almost exclusive use of external catheters (EC) in this clinical setting.


METHODS
We retrospectively studied infectious and mechanical complications of 45 TIAP and 19 EC, in 64 children receiving HDC and autologous stem cell transplantation at the Centre Leon-Berard (Lyon) or at the oncology unit of Toulouse children hospital between January 1999 and December 2003.


RESULTS
From the beginning of intensification to 60 days after bone marrow transplantation, 7 catheter-related bloodstream infections (3/19 EC or 15.8% corresponding to 2.69 infections for 1000 days of observation; 4/45 TIAP or 8.9% corresponding to 1.38 infections for 1000 days of observation) and 2 local infections (1/45 TIAP; 1/19 EC) were reported. Seven cases of reversible obstruction (6/7 with TIAP) and no deep venous thrombosis were detected. In 7 cases, another venous access was required either for accidental removal (2 EC), catheter infection (2 TIAP), or admission to intensive care (2 TIAP, 1 EC). TIAP complication rate does not seem to be influenced by factors such as low weight, massive blood product transfusion or prolonged parenteral nutrition. In 8 children, TIAP were used for collection of hematopoietic progenitor cells.


CONCLUSIONS
The use of TIAPs appears as a safe and effective option for HDC. We found more mechanical complications but less infectious complications with TIAP than with EC. Nevertheless, results need to be validated prospectively in a larger study cohort.
Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. conter@lyon.fnclcc.fr
C
C
Conter
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L
Carausu
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Martin
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Rubie
M-P
MP
Castex
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P
Marec-Berard
D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D004866:Equipment Contamination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D018805:Sepsis / Q000209:etiology; D013997:Time Factors