ABSTRACT
Peripheral venous access in children with sickle cell anaemia (SCA) requiring regular blood transfusions can become difficult over time. Previous reports have suggested the use of totally implantable venous access devices, Portacaths (PAC) in this patient group are associated with unacceptable high rates of complications. We present our experience in seven children with SCA over a 9-year period. Seven devices were placed for a total of 9754 PAC days during the study period. The median age at insertion was 6.3 years (range 3-15 years). The rate of PAC associated infection was 0.2 per 1000 PAC days. There were no episodes of thrombosis. The median length of time in situ during the study period was 3.7 years (range 1.3-7.5 years). Our experience highlights the safe and reliable use of PAC in children with SCA requiring regular blood transfusions when venous access has become a major problem.
Subject(s)
Anemia, Sickle Cell/therapy , Catheters, Indwelling/adverse effects , Erythrocyte Transfusion/instrumentation , Adolescent , Catheter-Related Infections/etiology , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Child , Child, Preschool , Device Removal , Equipment Failure , Female , Humans , Male , Medical Audit , Thrombosis/etiologyABSTRACT
We retrospectively audited children with sickle cell disease (SCD) admitted to paediatric intensive care (PICU) at King's College Hospital between January 2000 and December 2008. Forty-six children with SCD were admitted, on 49 separate occasions. Ages ranged from 4 months to 15 years (median 7.6 years). Three children died in PICU, however two presented to hospital in cardiorespiratory arrest; overall mortality was 6%. The most common reason for admission was acute chest syndrome (43%). 88% of admissions required blood transfusion, of which 74% had exchange blood transfusions. The mortality among children with SCD admitted to PICU is low.
Subject(s)
Anemia, Sickle Cell/therapy , Critical Care/methods , Acute Chest Syndrome/etiology , Adolescent , Anemia, Sickle Cell/complications , Anti-Bacterial Agents/therapeutic use , Blood Transfusion , Cardiotonic Agents/therapeutic use , Child , Child, Preschool , Hospitalization , Humans , Infant , Intensive Care Units, Pediatric , Length of Stay/statistics & numerical data , Respiration, Artificial , Retrospective Studies , Treatment OutcomeABSTRACT
Sickle cell disease (SCD) patients are perceived to have a high mortality when admitted to the Critical Care Unit (CCU). We performed a retrospective analysis of all adult sickle admissions to CCU at a single centre over an 8-year period (1 January 2000 to 31 December 2007). Thirty-eight patients (14 male) were admitted 46 times to CCU; the commonest reasons for admission were acute chest syndrome (14, 30%), multi-organ failure (8, 17%) and planned post-elective surgery (7, 15%). CCU mortality for SCD patients was 19.6%, comparable to a CCU-wide mortality of 17.6% during the study period in the same institution. Re-admission to CCU was high (16% over the 8-year period) but did not increase mortality risk.