TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICES IN 131 PEDIATRIC ONCOLOGYPATIENTS

The use of totally implantable vascular access devices (TIVAD) has gai ned acceptance in oncology patients, with lower overall complications and maintenance costs than percutaneous silastic catheters. We inserte d 135 TIVAD in 131 selected pediatric oncology patients (mean age 8.9 years) for chemotherapy of 68 solid tumors, 39 leukemias, and 24 lymph omas. Patients were required to have an absolute neutrophil count of 1 ,000/mu 1 prior to TIVAD insertion. The cumulative duration of access was 45,098 days, with a mean of 334 days per device (range 5 to 981 da ys). At the time of review, 53 (39%) TIVAD were functioning without co mplication, 69 (51%) were removed at the end of therapy or were functi oning at the time of death, and 13 (9.6%) were removed due to complica tions. Complications (n = 23) included 12 episodes of septicemia and 4 pocket infections for an infection rate of 11.8% (1 in 2,819 access d ays). Infections were more common in patients with leukemia compared t o all others (P < 0.001). Coagulase-negative staphylococci were isolat ed in 10 of the 16 infections; 7 infections resolved with antibiotic t herapy. Mechanical complications were associated with 7 (5.2%) devices (1 in 6,443 access days). These data suggest that in selected non-neu tropenic pediatric oncology patients, TIVAD can be utilized with minim al morbidity in the delivery of long-term chemotherapy.