Experience of totally implantable venous access devices (TIV ADs) in adults with cystic fibrosis over a 13-year period

Totally implantable venous intravenous access devices (TIVADs) have an esse ntial role in the frequent delivery of antibiotics in cystic fibrosis (CF) patients. This study at the Royal Brompton Hospital (RBH) reports the exper ience of TIVADs in patients attending the RBH adult CF unit implanted at th e RBH and elsewhere over a 13-year period. The case notes of adult CF patie nts who had undergone TIVAD insertion were reviewed retrospectively. The pa tients were divided into those who had the insertion carried out at the RBH and those who had the device inserted elsewhere. All devices were cared fo r the at the RBH. A total of 115 devices in 74 patients were reviewed. The median duration of function of 109 devices was 1429 days (range 2-3989) or 3.9 years, with a total exposure of 91 188 days or 249.8 years. There was no significant diff erence between devices inserted at the RBH and those inserted elsewhere (P = 0.59). Thirty-four patients had devices installed without complications. Forty patients had complications in 62 devices. The incidence of complicati ons was 34.5% at the devices inserted at RBH and 73.7% elsewhere (P<0.001). Of the 115 devices, mechanical complications occurred in 42 (36%) with a m edian time of diagnosis of 373 days (range 1-2554), infectious complication s occurred in 16 (14%), with a median time of diagnosis of 413 days (range 40-2556) and symptomatic venous thrombosis occurred in four (3.5%). RBH-ins erted devices had significantly fewer mechanical complications (P<0.001) co mpared with those inserted elsewhere. The group as a whole had fewer infect ious complications than in most other reported series. We conclude that TIV ADs provide effective and long-term intravenous access and have fewer compl ications if they are inserted and cared for at a centre with special expert ise in their insertion and management.