CENTRAL VENOUS ACCESS CATHETERS IN CHILDREN WITH HEMOPHILIA

Twenty-five central venous lines (two external, 23 subcutaneous ports) were placed in 19 boys with haemophilia A (n=17) or B (n=2). The mean age of the boys was 4.9 years (range 0.2-15.3 years). The haemophilia was severe (factor level <1%) in 18 boys and moderate (factor level 3 %) in one. Three boys had circulating inhibitors and three were positi ve for human immunodeficiency virus (HIV)-1 antibody. Central venous l ines were placed to facilitate intermittent factor replacement therapy (n=6), long-term factor prophylaxis (n=9), induction of an immune tol erance protocol (n=2) or therapy for acquired immunodeficiency syndrom e (AIDS)-related complications (n=2). The ports remained in place for 15 795 days (mean 687 days, range 11-2059 days). The frequency of port -related sepsis xas 48% (11/23 ports in eight boys) or 0.7 port infect ions per 1000 patient days. Ports were removed from five boys with an unresolved infection (four with Staphylococcus aureus sepsis and one w ith Pseudomonas sp. sepsis). Other complications requiring port remova l included a catheter tip placed too high in the venous system (n=1), severe persistent pain associated with needle access of the port (n=1) and a subclavian vein thrombosis (n=1). Both the benefits and risks o f a subcutaneous port should be considered when deciding whether to pl ace this device in a very young child with haemophilia.