The use of central venous catheters (portacaths) in children with haemophilia

The experience with central venous implantable devices (portacaths) has bee n reviewed in children attending the Auckland Hospital Haemophilia Centre. Fourteen children had 23 portacaths inserted. Thirteen had severe Haemophil ia A, of whom five had high responding inhibitors to factor VIII. All the c hildren were HIV negative. Ages ranged from 4 months to 13 years at the tim e of initial placement and 12 were under 5 years. Indications for portacath placement included primary and secondary prophylaxis, induction of immune tolerance, prophylactic therapy post intracranial haemorrhage and poor veno us access. Catheter-related infections occurred in 48% of cases. Staphyloco ccal species were the most common organisms isolated followed by gram-negat ive bacilli. 63% of the infections were successfully cleared with antibioti cs. Haematoma formation occurred in 17% of catheters, primarily in patients who had high factor VIII inhibitor levels. Mechanical problems including b lockage, leakage and extrusion of the portacath occurred less frequently (1 3%). The significant rate of infection in this immunocompetent population i s consistent with other reports. Despite the obvious benefits of portacaths this complication is potentially serious and causes appreciable morbidity. In contrast, bleeding complication rates were relatively low.