TOTALLY IMPLANTABLE VENOUS ACCESS DEVICES IN CHILDREN WITH CYSTIC-FIBROSIS - INCIDENCE AND TYPE OF COMPLICATIONS

Background-Totally implantable vascular access devices (TIVADs) are ac cepted as a safe and effective method of facilitating long term intrav enous therapy. We report our experience of the use of these devices in children with cystic fibrosis with a particular focus on the incidenc e and type of complications. Methods-The medical records of patients w ith cystic fibrosis who underwent placement of a TIVAD at the Royal Ch ildren's Hospital, Melbourne, Australia from January 1987 to October 1 996 were reviewed. Venous ultrasonography with Doppler was performed i n surviving patients with a TIVAD in situ from November 1996 to April 1997 to detect occult thrombotic complications. Results-A total of 57 TIVADs were implanted in 44 children with a median functional duration of 700 days (range 27-3347 days). Twenty one children had devices ins erted without complications. Forts' eight complications (30 mechanical , 18 infectious) occurred in 36 devices in 23 children during a total functional duration of 53 057 catheter days. Mechanical complications occurred in 53% of devices tone per 1712 catheter days). Symptomatic v enous thrombosis occurred five times in four patients (9%). Infectious complications occurred in 32% tone per 2948 catheter days) while seps is occurred in five devices (9%). Doppler ultrasonography detected uns uspected thrombosis in two of 10 patients examined. Conclusions-While TIVADs provided effective long term intravenous access, septic and thr ombotic complications caused significant morbidity in this population. Careful patient selection, adherence to aseptic technique for access and blood sampling, and periodic ultrasonography with Doppler to detec t early thrombosis may help reduce these risks.