Understanding infusion and venous access
Prophylactic clotting factor replacement therapy is the cornerstone of haemophilia treatment and involves regular infusions into a vein. Infusions are usually done at home so a stable and uncomplicated way of accessing the bloodstream (known as venous access) is required.
There are two different types of venous access, named according to where the access occurs: peripheral or central venous access.
Peripheral venous access
This involves using the veins that are away from the central part of the body, such as those in the arms or hands. Peripheral venous access is the preferred choice for people with haemophilia, because it is not associated with any risk of severe complications. However, bruising at the injection site can occur.
For peripheral venous access to be an option, peripheral veins must be large enough to withstand regular puncture. However, this may not be the case in very young children. In these cases, central venous access may be the preferred option.
Central venous access
This involves accessing large veins in the centre of the body using what are known as a central venous access devices (CVADs). Two types of CVADs have been used in children with haemophilia: fully implantable devices (referred to as ports) or external lines. Each of these has its own advantages and disadvantages.
Fully implantable devices do require a needle stick, but when compared with external lines, they generally have a longer duration, cannot be accidentally displaced or tampered with, require less day-to-day care, and do not require protective dressings during bathing or swimming. On the other hand, external lines are more easily inserted and removed, and do not require a needle stick.
While CVADs are a useful alternative if peripheral venous access is not possible, their use can be associated with infections. This is particularly the case for external devices and so strict adherence to sterile procedures is required.
When deciding the venous access that is right for you or your child, your doctor will weigh up the pros and cons of each option, and consider how these apply to your individual case. If you have any questions about venous access, speak to your Haemophilia Treatment Centre.