CLINICAL-EXPERIENCE WITH TOTALLY IMPLANTE D VENOUS ACCESS SYSTEMS IN PEDIATRIC HEMATOLOGY AND ONCOLOGY

Forty-three children with malignant diseases who received 48 totally i mplanted venous accesses (TIVA) were retrospectively analyzed. More th an half the patients had acute leukemia. Mean age was 6 years 10 month s. Mean duration of use of the TIVA was 473 +/- 50 days (range 28 to 1 285 da ; median 424 days). Removal of the TIVA was required because o f an adverse event in 33 % of cases. Main reasons for removal included infection (22.9 %), thrombosis (6.25 %), and catheter dysfunction (4. 16 %). Catheter-related infections were most often due to staphylococc i (90 %), especially S. epidermidis (63 %). Infection rate was 0.48 pe r 1000 patient-days. Flushing with a vancomycin-heparin solution can b e expected to decrease this rate. Selection of the implantation site i s discussed. In children under 6 years of age, the cephalic vein and e xternal jugular vein are often frail or absent and are therefore less appropriate than the internal jugular vein or subclavian vein.