LONG-TERM CENTRAL VENOUS ACCESS IN PATIENTS WITH SICKLE-CELL DISEASE - INCIDENCE OF THROMBOTIC AND INFECTIOUS COMPLICATIONS

Purpose: Central venous access devices (CVAD) have been used with incr easing frequency in recent years among pediatric patients. We retrospe ctively reviewed our experience in 25 children and young adults with s ickle cell disease (SCD) over a 4 1/2 year period in an attempt to def ine occurrence rates of perioperative complications, thrombosis requir ing catheter removal, and infectious episodes. Patients and Methods: T he setting was a university-associated tertiary children's hospital. P atients were 25 children and young adults (ages 8 months to 23 years) with SCD who required CVAD placement between February 1987 and April 1 992. A total of 31 catheters (totally implantable ports and partially implanted catheters) were placed for 17,444 patient catheter days. Res ults: Rates of significant perioperative complications, thrombotic eve nts requiring catheter removal, and infectious episodes were recorded. No perioperative complications were noted. Five episodes of catheter occlusion requiring replacement occurred in two patients (0.29 per 1,0 00 catheter patient days, involving 8% of patients and 16% of catheter s). Fifteen episodes of catheter-associated bacteremia occurred in eig ht patients (0.86 per 1,000 catheter patient days involving 32% of pat ients and 26% of catheters). Three catheters required removal because of infection unresponsive to antibiotic therapy. Conclusion: The occur rence of thrombosis requiring catheter removal and infection in our po pulation of patients with SCD was comparable to that reported in patie nts with malignant disease, cystic fibrosis and acquired immune defici ency syndrome. CVAD represents an effective, reliable, and reasonably safe means of establishing and maintaining venous access for a selecti ve group of children and young adults with SCD who have limited periph eral venous access and require intravenous therapies.