title: Complications of implantable venous access devices in patients with sickle cell disease.
abstract: Implantable venous access devices (VADs) are used in sickle cell disease (SCD) for patients with poor venous access to facilitate chronic blood transfusions and manage acute complications. We attempted to define the frequency of bloodstream infections (BSI) and thrombosis in adults and children with SCD and VADs. We performed a single-institution, retrospective review of VAD-associated infection and thrombosis in patients with SCD. Thirty-two patients (median age 20 years, range, 1-59) had 86 VADs placed (median, 2.7 VADs per patient, range, 1-7) with a total of 41,292 catheter days (median, 1,376 days; range, 323-3,999). Mean catheter lifespan in adults (691 days ± 123) was not significantly higher than children (614 days ± 154). A total of 66 VAD-associated BSI (1.59 infections per 1,000 catheter days) occurred in 17 of 32 (53%) patients. Children with VADs had fewer BSI (3 of 10; 30%) than adults (14 of 22; 64%, P = 0.08). 24 catheter-associated thromboses (0.49 thromboses per 1,000 catheter days) occurred in 10 of 32 (41%) of patients. Children also had fewer VAD-associated-thrombosis (1 of 10; 10%) than adults (9 of 22; 40%, P = 0.08). In conclusion, the use of VADs in SCD was linked to a significant rate of infection and thrombosis.
authors.affiliation: Department of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC 27710, USA. nirmish.shah@duke.edu
authors.forename: Nirmish
authors.initials: N
authors.lastname: Shah
authors.forename: Daniel
authors.initials: D
authors.lastname: Landi
authors.forename: Radhika
authors.initials: R
authors.lastname: Shah
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rothman
authors.forename: Laura M
authors.initials: LM
authors.lastname: De Castro
authors.forename: Courtney D
authors.initials: CD
authors.lastname: Thornburg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D001424:Bacterial Infections / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D001803:Blood Transfusion; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005658:Fungi / Q000254:growth & development; D006094:Gram-Positive Bacteria / Q000254:growth & development; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications* / Q000382:microbiology / Q000601:surgery