Department of Hematology, College of Medicine & Health Sciences, Sultan Qaboos University Hospital, Oman.
J Infect Public Health. 2012 Mar;5(1):57-62. doi: 10.1016/j.jiph.2011.10.004. Epub 2011 Dec 6.
Red cell exchange/transfusion is frequently used in the management of patients with medical complications related to acute severe sickle cell disease (SCD). However, peripheral venous access is often difficult without central venous catheters (CVCs) in adult patients with moderate or severe SCD.
To review our experience with the use of the PORT-A-CATH(®) device in sixteen patients with SCD undergoing exchange or simple transfusions.
Among a cohort of 550 patients who frequently visited the inpatient service, sixteen SCD patients required the insertion of a PORT-A-CATH(®) device. These patients included 3 males and 13 females, aged 25-44 years [31.1 ± 2.3; mean ± SD]. A total of 24 PORT-A-CATH(®) devices were implanted in these 16 patients during the study period. Eleven patients had 1 device implanted, three patients had 2 devices, one patient had 3 devices, and one patient had 4 devices implanted.
Out of the 24 devices implanted, 17 required removal, due to either infection associated with sepsis and/or thrombosis. The organisms involved were Candida spp. (3), C. Parapsilosis (2), C. albicans (1), C. famata (1), C. lusitanice (1), Staphylococcus spp. (6), and S. aureus (3), as well as the coagulase-negative Staphylococcus (2), alpha hemolytic Streptococcus (1), Diphtheroid bacilli (2), Pseudomonas aeruginosa (2), Ps. Spp. (3), Escherichia coli (3), Klebsiella oxytoca (1), Klebsiella pneumoniae (1), Klebsiella spp. (1), Serratia liquefaciens (1), Serratia fanticola (1), Achromobacter spp. (2) Chromobacterium violaceum (1), Delftia acidovirans (1), Stenotrophomonas maltophile (1), Alcaligenes faecalis (1), and Enterobacter cloacae (1). Two episodes of documented thrombosis were observed. One case presented with right atrial thrombosis/SVC syndrome and the other case presented with left upper arm thrombosis. Two patients died with ports in situ, while five patients had ports in place at the time of this study. The median working life of the ports was 688.5 days (range: 39-3925). The rate of infective complications was 2.63 infections per 1000 catheter days, and the number of infections was significantly correlated with the number of ports [Pearson's r=0.66; p<0.01].
Our results suggest that patients with SCD suffer infective complications associated with the PORT-A-CATH(®), which often necessitate its removal. Although these devices are extremely useful, their optimal beneficial potential is only realized if the patients receive proper care at special centers well-versed in the maintenance of such devices by experienced staff.
红细胞交换/输血常用于治疗与急性重度镰状细胞病（SCD）相关的医学并发症的患者。然而，在中度或重度 SCD 的成年患者中，如果没有中心静脉导管（CVC），外周静脉通路通常很困难。
回顾我们在 16 例接受交换或单纯输血的 SCD 患者中使用 PORT-A-CATH（®）装置的经验。
在经常就诊于住院服务的 550 例患者队列中，有 16 例 SCD 患者需要插入 PORT-A-CATH（®）装置。这些患者包括 3 名男性和 13 名女性，年龄 25-44 岁[31.1±2.3；平均值±标准差]。在研究期间，共在这 16 例患者中植入了 24 个 PORT-A-CATH（®）装置。11 例患者植入了 1 个装置，3 例患者植入了 2 个装置，1 例患者植入了 3 个装置，1 例患者植入了 4 个装置。
在植入的 24 个装置中，由于与败血症和/或血栓形成相关的感染，17 个需要取出。涉及的生物体包括念珠菌属（3）、近平滑念珠菌（2）、白色念珠菌（1）、弗氏念珠菌（1）、卢氏念珠菌（1）、葡萄球菌属（6）和金黄色葡萄球菌（3），以及凝固酶阴性葡萄球菌（2）、甲型溶血性链球菌（1）、类白喉杆菌（2）、铜绿假单胞菌（2）、假单胞菌属（3）、大肠杆菌（3）、产酸克雷伯菌（1）、肺炎克雷伯菌（1）、克雷伯菌属（1）、液化沙雷菌（1）、奇异变形杆菌（1）、无色杆菌属（2）、紫黑沙雷菌（1）、戴夫特亚酸杆菌（1）、嗜麦芽窄食单胞菌（1）、粪肠球菌（1）和阴沟肠杆菌（1）。观察到 2 例有记录的血栓形成事件。1 例患者出现右心房血栓形成/上腔静脉综合征，另 1 例患者出现左上臂血栓形成。2 例患者死亡时仍保留 PORT-A-CATH（®）装置，5 例患者在本研究时仍保留 PORT-A-CATH（®）装置。PORT-A-CATH（®）的中位工作寿命为 688.5 天（范围：39-3925）。感染性并发症的发生率为每 1000 个导管日 2.63 例感染，感染数量与 PORT-A-CATH（®）装置的数量显著相关[Pearson's r=0.66；p<0.01]。
我们的结果表明，SCD 患者会出现与 PORT-A-CATH（®）相关的感染性并发症，这通常需要将其取出。尽管这些装置非常有用，但只有在患者在专门的中心接受适当的护理，并由经验丰富的工作人员维护这些装置，才能充分发挥其最佳有益潜力。
