Low Rates of Thrombosis Found for Sickle Cell Patients With Infusion Ports

Chibuzo Ilonze, MD

While infusion ports are effective for patients with sickle cell disease (SCD), there is some concerns for an increased risk of adverse events.

A team, led by Chibuzo Ilonze, MD, Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, assessed the indications, complications, and risk factors in patients with sickle cell disease and infusion ports at the University of Oklahoma Health Sciences Center (OUHSC).

It is difficult to provide peripheral venous access in patients with sickle cell disease over time because of frequent access and scarring. And while infusion ports do provide reliable central venous access, they can also cause deep venous thrombosis and infections.

In the study, the investigators performed a single-institution retrospective chart review between January 2000 and July 2018, as well as a literature review on the use of infusion ports in patients with sickle cell disease.

Infusion Ports

Overall, there were 32 patients with infusion ports placed with a total of 63 devices, 48 for chronic transfusion and 15 for poor venous access. There was a total of 99,272 catheter days, 80.238 for chronic transfusions and 19,034 for poor venous access. The mean age for patients at their first infusion was 8 years.

The investigators identified various complications, including malfunction, infection, thrombosis, difficult access, and pain over the infusion port site and used a Poisson test to test the differences in complication rates between those on chronic transfusions to those who were not.

Of the 48 infusion ports in the chronic transfusion group, 12.5% (n = 6) were for primary stroke prophylaxis, 45.8% (n = 22) for secondary stroke prophylaxis, 35.4% (n = 17) for history of recurrent VOE, and 6.3% (n = 3) for multiorgan failure.

Infections and Other Complications

There was an overall rate of infection of 0.2 per 1000 catheter days and thrombosis was identified in 5% (n = 3) of devices in 9% (n = 3) of patients, with a rate of 0.03 per 1000 catheter days.

There was also no differences in complications by site in either the left or right subclavian vein (P = 1) and the rate of premature removal was 0.36 per 1000 catheter days.

This was higher in patients with infusion ports solely for poor venous access (0.87 per 1000 catheter days) compared to ports for chronic transfusions (0.29 per 1000 catheter days).

“We report that use of infusion ports in the pediatric sickle cell patient population was not associated with a significantly higher rate of thrombosis, infection, or premature removal,” the authors wrote. “The total catheter days in our study are higher than similar studies in pediatric patients and may reflect a more precise estimate of complications of infusion ports in SCD.”

The study, “Use of infusion ports in patients with sickle cell disease: Indications and complications,” was published online in Pediatric Blood & Cancer.