Pediatric Pulmonology 14:23%242 (1992)

Therapeutic Methods -

Atypical Thrombotic and Septic Complications of Totally Implantable Venous Access Devices in Patients With Cystic Fibrosis Juan E. Sola, MD, Marshall M. Stone, MD, Barbara Wise,

RN, MS,

and Paul M. Colornbani, MD

Summary. The use of vascular access systems in patients with cystic fibrosis (CF) is well accepted, with lower overall complications and maintenance costs than percutaneous silastic catheters. We report our 6 year experience with 22 infusaports in 15 CF patients. Our patients had indwellingcatheters for an average of 539 days per catheter (range, 142,224days). These infusaportswere used for home antibiotic therapy, blood sampling, and total parenteralnutrition. The overall complication rate was relatively low, 1 in every 1,483catheter days. Infectious complications were extremely infrequent at a rate of 1 in 5,929catheter days. The rate of mechanical complicationswas 1 in 1,976catheter days. However, superior vena caval syndrome or deep venous thrombosis was associated with 3 of 22 catheters (13.6%). Due to this high incidence of major thrombotic events with the attendant risk of pulmonary embolism, all patients with CF using infusaports and without evidence of liver disease or bleeding problems receive aspirin prophylaxis. Pediatr Pulmonol. 1992; 14:239-242. o 1992Wiley-Liss, Inc. Key words: Superior vena caval syndrome; deep venous thrombosis; pulmonary emboli; pseudomonas; Klebsiella; fungal sepsis.

INTRODUCTlON

Implantable vascular access systems have gained acceptance as an adjunct in the treatment of patients with cystic fibrosis (CF) who require multiple courses of intravenous (IV) antibiotics for respiratory infections and in whom venipuncture is difficult and traumatic. Percutaneous silastic catheters, although preferable to conventional IV cannulae, require daily heparin flushing, dressing change, and as a result, high maintenance costs. In addition, percutaneous silastic catheters have an overall infection rate of up to 37%.Ip3 Recently, peripherally inserted central venous catheters have been used for short-term (

Atypical thrombotic and septic complications of totally implantable venous access devices in patients with cystic fibrosis.

The use of vascular access systems in patients with cystic fibrosis (CF) is well accepted, with lower overall complications and maintenance costs than...
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