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 increasing frequency in recent years among pediatric patients. We retrospectively reviewed our experience in 25 children and young adults with sickle cell disease (SCD) over a 4 1/2 year period in an attempt to define occurrence rates of perioperative complications, thrombosis requiring catheter removal, and infectious episodes. Patients and Methods: The setting was a university-associated tertiary children's hospital. Patients were 25 children and young adults (ages 8 months to 23 years) with SCD who required CVAD placement between February 1987 and April 1992. A total of 31 catheters (totally implantable ports and partially implanted catheters) were placed for 17,444 patient catheter days. Results: Rates of significant perioperative complications, thrombotic events 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 1,000 catheter patient days, involving 8% of patients and 16% of catheters). Fifteen episodes of catheter-associated bacteremia occurred in eight patients (0.86 per 1,000 catheter patient days involving 32% of patients and 26% of catheters). Three catheters required removal because of infection unresponsive to antibiotic therapy. Conclusion: The occurrence of thrombosis requiring catheter removal and infection in our population of patients with SCD was comparable to that reported in patients with malignant disease, cystic fibrosis and acquired immune deficiency syndrome. CVAD represents an effective, reliable, and reasonably safe means of establishing and maintaining venous access for a selective group of children and young adults with SCD who have limited peripheral venous access and require intravenous therapies.