Totally implantable venous access devices in children with cystic fibrosis: incidence and type of complications
a Department of Thoracic Medicine, b Department of Radiology, c Department
of Surgery, d Royal Children's
Hospital, Parkville, Melbourne, Victoria 3052, Australia
Correspondence to: Dr C Robertson.
Received 12 September 1997; Returned to authors 10 November 1997; Revised version received 3 December 1997; Accepted for publication 23 December 1997
BACKGROUND
Totally implantable vascular access
devices (TIVADs) are accepted as a safe and effective method of
facilitating long term intravenous therapy. We report our experience of
the use of these devices in children with cystic fibrosis with a
particular focus on the incidence and type of complications.
METHODSThe medical records of patients with
cystic fibrosis who underwent placement of a TIVAD at the Royal
Children's Hospital, Melbourne, Australia from January 1987 to October
1996 were reviewed. Venous ultrasonography with Doppler was performed
in surviving patients with a TIVAD in situ from November 1996 to April
1997 to detect occult thrombotic complications.
RESULTSA total of 57 TIVADs were implanted in 44 children with a median functional duration of 700 days (range 27-3347
days). Twenty one children had devices inserted without complications.
Forty eight complications (30 mechanical, 18 infectious) occurred in 36 devices in 23 children during a total functional duration of 53 057
catheter days. Mechanical complications occurred in 53% of devices
(one per 1712 catheter days). Symptomatic venous thrombosis occurred
five times in four patients (9%). Infectious complications occurred in
32% (one per 2948 catheter days) while sepsis occurred in five devices
(9%). Doppler ultrasonography detected unsuspected thrombosis in two
of 10 patients examined.
CONCLUSIONSWhile TIVADs provided effective long
term intravenous access, septic and thrombotic complications caused
significant morbidity in this population. Careful patient selection,
adherence to aseptic technique for access and blood sampling, and
periodic ultrasonography with Doppler to detect early thrombosis may
help reduce these risks.
© 1998 by Thorax
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