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Use of central venous catheters in children with severe congenital coagulopathy
Author(s) -
Liesner R. J.,
Vora A. J.,
Hann I. M.,
Lilleymann J. S.
Publication year - 1995
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1995.tb05270.x
Subject(s) - coagulopathy , medicine , consumptive coagulopathy , central venous catheter , intensive care medicine , pediatrics , surgery , catheter
Summary 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 Vila. 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.