Hickman Catheter Research Articles

Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports.

Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being the preferred route of administration. Peripherally inserted central catheters (PICCs) have been used increasingly, but whether they should be preferred over other types of CVCs is still controversial. The aim of this study was to evaluate catheter-related complications of CVC in patients receiving HPN. All patients treated at our center for HPN from 2007 to 2017 were prospectively included. A specialized intravenous therapy team took care of these patients. Catheter-related bloodstream infections (CRBSI) were confirmed with positive, simultaneous, differential blood cultures drawn through the CVC and peripheral vein and then semiquantitative or quantitative culture of the catheter tip. In all, 151 patients received HPN during the 11-y study period. Of these patients, 95 were women (63%) and 55 were men (37%), with a mean age of 58 ±13 y. Twenty-six were non-cancer patients (17%) and the remaining 125 patients had an underlying malignancy (83%). Regarding the CVC, 116 were PICCs, 18 Hickman, and 36 ports. Confirmed CRBSI per catheter-days showed 0.15 episodes per 1000 catheter-days for PICCs, 0.72 for Hickman, and 2.02 for ports. PICCs had less-confirmed CRBSIs per 1000 catheter-days than ports (φ = 0.54, P = 0.005), but no difference between PICCs and Hickman was found (φ = 0.32, P = 0.110). Confirmed episodes of CRBSI (2 versus 13%, χ2 = 6.625, P = 0.036) were more frequent with multilumen catheters. In our setting, single-lumen PICC and Hickman catheters showed low infectious complications.

CT-Guided Translumbar Placement of Permanent Catheters in the Inferior Vena Cava: Description of the Technique with Technical Success and Complications Data.

To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4months (range 3.4-160months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.

Use of Tunneled-Cuffed Central Catheters in Patients with Cancer: A Single-Center Experience

BackgroundEffective and reliable venous access is among the cornerstones of modern medical therapy in oncology. Materials and MethodsThis was a prospective observational study of collected data of patients with a diagnosis of any cancer, at a tertiary care oncology hospital in Ahmadabad, Gujarat, India, during a 2-year period. ResultsA Hickman catheter was inserted in 200 patients and most commonly used in solid malignancies (n = 103; 51.5%), followed by hematologic conditions (n = 93; 48.5%). Among solid malignancies, hepatoblastoma (n = 21; 10.5%) was the most common indication, whereas in hematologic malignancies acute lymphoblastic leukemia was the most common indication (n = 56; 28%) for Hickman catheter insertion. Hickman catheters were inserted most commonly in the right side (n = 170; 85%) of the venous system. The various complications in the Hickman study group in descending order were 28 patients (14%) developed arrhythmias, 15 patients (7.5%) developed infection, 12 patients (6%) developed bleeding, 8 patients (4%) developed pneumothorax, 7 patients (3.5%) developed catheter blockage, and 6 patients (3%) required premature catheter removal. The median time of Hickman catheter in situ was 207 days. ConclusionsThe most disturbing aspect of treatment of patients with cancer is multiple painful venipunctures made for administration of cytotoxic agents, antibiotics, blood products, and nutritional supplements. The focus of this prospective observational research was to study the various indications for Hickman catheter in different solid and hematologic malignancies as well as the various complications and outcomes in pediatric and adult cancer patients.

BSH Guideline: management of thrombotic and haemostatic issues in paediatric malignancy.

BSH Guideline: management of thrombotic and haemostatic issues in paediatric malignancy.

A Medium-Term Venous Access Alternative for Infants Undergoing Congenital Heart Surgery.

We describe a strategy aimed at maximizing the safety and minimizing the thrombogenicity of central venous lines for neonates with congenital heart defects. Our method involves the use of a tunneled technique to place a 4.2 Fr single-lumen (Broviac) catheter in the subpericardial space, with minimal intravascular course and a tip placed in the lower right atrium. Using this technique, we potentially eliminated the requirement for percutaneous placement of central venous lines postoperatively as well as potentially decreased the risk of intrapericardial bleeding associated with transthoracic lines.

Safety And Cost Effectiveness Of Removal Of Tunnelled Hickman Line U Nder Local Anaesthesia Vs Short General Anesthesia

Safety And Cost Effectiveness Of Removal Of Tunnelled Hickman Line U Nder Local Anaesthesia Vs Short General Anesthesia

A daily topical decontamination regimen reduces catheter-related bloodstream infections in haematology patients

To assess impact of a topical decontamination regimen on rates of catheter-related bloodstream infections (CRBSI) in intensively-treated haematology patients. A historically-controlled cohort study was used to evaluate the effect of applying chlorhexidine or Octenisan® body washes and nasal Prontoderm® ointment for 5 days around the time of Hickman line insertion on the incidence of CRBSI and infection-free catheter time. Lines inserted during a 24 month period prior to implementation of the decolonisation regimen were compared with those inserted during a 12 month period after the intervention was applied. During the post-intervention period, 163 lines were inserted in 147 patients, compared to 303 lines in 242 patients in the pre-intervention period. CRBSI rates in treated and untreated patients respectively were 6.8 and 35.0 cases per 10,000 line-days by 21 days (p=0.009), and 14.4 and 26.0 cases respectively per 10,000 line-days by 180 days (p=0.025). The incidence rate of Staphylococcus aureus CRBSI in treated and untreated patients were 0.0 and 4.6 cases per 10,000 line-days respectively (p=0.012). Multivariable Cox regression estimated an 81% probability (95% confidence interval 74%-85%) that a treated line develops a CRBSI later than an untreated line by 21 days post-insertion. Implementation of this safe and effective topical decontamination regimen enhances routine CRBSI-prevention measures for haematology patients requiring central venous line insertion.

SUN-P141: Is There a Need for Routine Broviac Catheter Replacement in HPN Patients After 10 Years?

SUN-P141: Is There a Need for Routine Broviac Catheter Replacement in HPN Patients After 10 Years?

Paediatric Home Parenteral Nutrition in the Czech Republic and Its Development: Multicentre Retrospective Study 1995-2011

Background: Treatment quality and outcomes of paediatric home parenteral nutrition (HPN) program during its development in the Czech Republic. Methods: A retrospective study of patients receiving HPN from May 1995 till June 2011. Results: Sixty-six patients were treated in 8 centres. In 48 patients, long-term PN began in the first year of life and in 35 of them in the first month. Sixty children had gastrointestinal and 6 had non-gastrointestinal disease. In a majority of the patients, the Broviac catheter was used. Thirty-two (48.5%) patients were weaned from PN after 1-117 months, 21 (32.8%) continued on HPN after 7-183 months, and 13 (19.7%) patients died, all on PN. The mortality in patients with primary gastrointestinal disease was significantly lower than in patients with non-gastrointestinal disease. Thirty-one paediatric patients were receiving HPN for 14,480 catheter days in 2009-2010. Fourteen patients had 23 Catheter Related Blood Stream Infections (CRBSI) episodes. The incidence of CRBSI in 2009-2010 was 1.58/1,000 catheter days. Conclusion: Submitted data showed that even in the absence of expert centres, patient care may achieve results comparable to countries with well-developed HPN program. A majority of Czech HPN patients are at present treated in specialized centres, following the most desirable pattern of care.

Catheter-Related Infection Rate in Patients in Home Parenteral Nutrition

Introduction: Home parenteral nutrition (HPN) is commonly indicated in patients with intestinal failure (IF) and may be a lifesaving therapy[1][2]. Since 1991, the multidisciplinary short-bowel syndrome clinic (AMULSIC) of the Clinics Hospital of the University of São Paulo Medical School (HC-FMUSP) has been following patients with IF offering HPN at no cost to the patient. Long-term central venous access is necessary for HPN and catheter-related infections are within its main complications. The care for the prevention of infections is paramount for patient survival[1][3]. Objective: To analyze the catheter-related infection rate in patients in HPN from 2014 to 2016. Methods: Retrospective study using patients' charts and household follow-up records. Catheter-related blood infection rate is expressed as the number of episodes of infections per 1,000 catheter days. It was used to define the infection rate in HPN patients from January 2014 to December 2016 (4,5). All patients underwent a previous evaluation under cognitive, educational, social and family conditions to begin in the program and received training by a nurse experienced in this care, including issues related to cleaning of the environment and materials, hand hygiene, central catheter care, administration of medications and recognition of complications. These patients remain at home performing catheter self-care or being assisted by trained family members. They return to our clinic in a weekly basis for follow-up and withdrawal of medications and materials. Results: A total of 14 patients were studied, of which 42.9% are female and 57.1% are male. 57.1% of patients used heparinized Hickman's catheter and 42.9% used PICC with catheter salinization orientation. The mean number of catheter infections during the three years was 1.11 for every 1000 catheters/day. In total, the patients had nine catheter infections during this period and four of them occurred with only one patient who did not have good adherence to the program and did not follow the guidelines given even after several meetings with the team. Conclusions: The result found in our research is consistent with that found in the literature where the average catheter-related bloodstream infection is at 1.31/1000 days of catheter, ranging from 0.38 and 4.58/1000 days of catheter[4]. HPN survival is directly related to the number of catheter infections, so patient education is a crucial intervention to ensure good outcomes.

Iatrogenic asymptomatic subclavian arteriovenous fistula after percutaneous catheterizationcutaneous catheterization

A 4-year-old child with chronic enteropathy underwent left percutaneous internal jugular vein Hickman catheter insertion for total parenteral nutrition (TPN) under general anaesthesia. Previously this child had undergone percutaneous Hickman line insertion on the right internal jugular vein in 2013 and the right subclavian vein in 2015. These lines had been removed before due to catheter sepsis. During the present procedure, 6.6 french Hickman line was inserted into the left internal jugular vein by percutaneous peel away technique under ultrasound guidance. Later in the ward it was noticed that Hickman line was not functioning and there was reverse flow of blood into the intravenous (IV) line. Blood gas sample taken from the line showed arterial values and the catheter was subsequently removed. Computed tomography (CT) angiography was done which reported arteriovenous (AV) fistula with pseudoaneurysm of the right subclavian vein. The child was then referred to department of cardiothoracic surgery for further management. From the above case report we can infer that patients who underwent repeated percutaneous central line insertions may develop iatrogenic AV fistula or pseudo aneurysm. These complications can be asymptomatic for years. Failure to recognize this may lead to catastrophe during reinsertion. Hence proper history taking, clinical examination for bruit, thrill over the neck veins and cardiac examination should be done preoperatively if there is past history of multiple insertions. Investigations like venous blood gas sampling, USG doppler for neck veins, echocardiography, and CT angiography should be done in these cases preoperatively.

Central venous access related adverse events after trabectedin infusions in soft tissue sarcoma patients; experience and management in a nationwide multi-center study

BackgroundTrabectedin has shown efficacy against soft tissue sarcomas (STS) and has manageable toxicity. Trabectedin is administered through central venous access devices (VAD), such as subcutaneous ports with tunneled catheters, Hickman catheters and PICC lines. Venous access related adverse events are common, but have not yet been reported in detail.MethodsA retrospective analysis of patient files of STS patients receiving trabectedin monotherapy between 1999 and 2014 was performed in all five STS referral centers in the Netherlands. This survey focused on adverse events related to the VAD and the actions taken in response to these events.ResultsIn the 127 patients included in this analysis, 102 venous access ports (VAP), 15 Hickman catheters and 10 PICC lines were used as primary means of central venous access. The most frequently reported adverse events at the VAD site were erythema (30.7%), pain (28.3%), inflammation (11.8%) and thrombosis (11.0%). Actions taken towards these adverse events include oral antibiotics (17.3%), VAD replacement (15.0%) or a wait-and-see policy (13.4%). In total, 45 patients (35.4%) with a subcutaneous port developed a varying degree of inflammation along the trajectory of the tunneled catheter. In all but three patients, this was a sterile inflammation, which was considered a unique phenomenon for trabectedin. Microscopic leakage of trabectedin along the venous access device and catheter was considered the most plausible cause for this adverse event. Placing the catheter deeper under the skin resolved the issue almost completely.ConclusionTrabectedin infusion commonly leads to central venous access related adverse events. Sterile inflammation along the catheter trajectory is one of the most common adverse events and can be prevented by placing the catheter deeper under the skin.

小児における Broviac カテーテルの使用経験

小児における Broviac カテーテルの使用経験

Three Experiences with Stevens

Three Experiences with Stevens Rachel Hadas WALLACE STEVENS has been a crucial poet for me since around 1980, when I took an idiosyncratic seminar in his poetry at Princeton with a professor, Clarence Brown, whose field was Russian poetry, Mandelstam in particular, but who loved Stevens. Full disclosure: it was in this seminar that I first encountered Glen MacLeod, who, unlike me, went on to become a scholar of Stevens’s work. Perhaps like Clarence Brown, I adore Stevens’s work without feeling myself to be at all expert in it. Over the years, I’ve spoken about Stevens on a panel or two, most recently at the 2006 MLA, where the topic was sound effects in Stevens’s work. In 2010 or 2011, I wrote a little piece for the magazine then known as Shambhala Sun (now Lion’s Roar) on Stevens’s poem “Prologues to What Is Possible.” But I’m no Stevens scholar. Over the course of my career at Rutgers, I’ve certainly taught some Stevens poems to both undergraduate and graduate classes, but not because Stevens is any specialty of mine. His work is hard to talk about, and (but? therefore?) I love it. Students coming to this poetry for the first time, or for the twentieth time for that matter, may be baffled or enchanted or both at once. I know all three feelings. Three Stevens poems stick in my memory as classroom experiences. The first classroom wasn’t at Rutgers; it was in the basement of a building in Chelsea that was the headquarters of the Gay Men’s Health Crisis. This would have been around 1989. Using Kenneth Koch’s remarkable anthology Sleeping on the Wing as a guide, I asked the people in the poetry workshop I was running to imitate “Thirteen Ways of Looking at a Blackbird.” Charles Barber wrote about his Hickman catheter; James Turcotte about his young son. Both their poems were published posthumously in Unending Dialogue: Voices from an AIDS Poetry Workshop, a book I put together in 1991. Stevens would never have written these two poems, never have engaged with such material; but his crystalline blackbird variations generated two vivid and thoughtful lyric poems which navigate emotionally fraught territory by approaching their respective topics from various angles, and do so with clarity and grace and without a touch of sentimentality. “Thirteen Ways of Looking at a Blackbird” is of course a much-anthologized poem. So are (for example) “The Snow Man” and “Anecdote of [End Page 155] the Jar” and “The Emperor of Ice-Cream.” Rather than recall my efforts to explain those three poems, all of which look simple and are anything but, I remember with pleasure teaching “Of Modern Poetry” to more than one class—probably, indeed, to five or ten classes over the years. Undergraduates and graduate students alike grasp that this poem, while beautiful in itself, is also a meditation on aesthetics. It offers an enticing glimpse into the changes wrought, early in the twentieth century, by modernism, or by the death of God, or by whatever one chooses to call certain salient shifts in the way poetry was written or any art was made, or indeed in the way people thought. That poetry can do some of the work of criticism or of cultural history, while never ceasing to be elegant and artful in itself, was a revelation to me when I first encountered Stevens’s work. And I believe this revelation continues to engage students, whether they are puzzling over modernist poetry or are themselves budding poets, or both. Of course, one always has the option, too, of forgetting about the wider cultural scene and simply (or not so simply) reading “Of Modern Poetry” as a meditation inside the poet’s mind about the poet’s mind. Finally, “A Postcard from the Volcano,” a poem which is both gorgeous and foreboding, speaks to students who feel belated. If “Of Modern Poetry” observes that the mind “has not always had / To find” (CPP 218), that the poet’s task used to be easier because an agreed-on scene or scenario was available, “A Postcard from the Volcano” takes place in a...

ヘパリン生食水の flush で断裂し,バスケット鉗子で摘出した Broviac カテーテル塞栓の1例

ヘパリン生食水の flush で断裂し,バスケット鉗子で摘出した Broviac カテーテル塞栓の1例

Don't Focus on Statistics.

Don't Focus on Statistics Mary Fauvre March 12, 1982 was the worst day of my life. Our son was 19 months old and he was diagnosed with acute lymphoblastic leukemia (ALL); our family's lives changed forever. In a space of 24 hours we were told our baby might die, and that if he lived, he probably would be sterile—two predictions of unequal weight but of horrifying impact. I have a Ph.D. in Educational Psychology/Child Development and my husband has four older children from a previous marriage, so we had thought we had some idea about child rearing. But with this terrifying diagnosis, neither of us had any idea how the future would unfold for our beautiful, bright, verbal, jolly little boy. In hindsight, we know we were lucky, but 34 years ago we were devastated. It all started on a Friday morning when I took him to the doctor to check on his unusual pallor and fatigue. Based on stat blood tests, which showed his hemoglobin at 3.4, our pediatrician sent us directly to the closest tertiary care university teaching hospital. We were admitted and he was treated with packed red cells, which improved his energy and color immediately. He felt great: "Shoes on, shoes on. … Go home!" was his mantra, which I will never forget. They did not send us home, but the next day the chief pediatric hematologist/oncologist met with us, and tried to answer our anxious questions. He told us not to pay attention to statistics, but when we pestered him, he reported that based on age and presenting symptoms the "odds of survival" showed our son's case in the 50–50 category. We were even more upset, and we agreed to try not to focus on statistics. While ALL has become one of the more treatable cancers, in the early '80's there were still lots of unanswered questions, and several experimental protocols were under study. We were basically in a state of shock as the doctors explained everything that lay ahead. We knew that information from others who preceded us in this nightmare had already contributed significantly, so we agreed to participate in the current research study. Our son was randomly assigned to a treatment protocol that involved the most intense sequence of drugs: cranial radiation followed by two or three years of monthly IV vincristine and cyclophosphamide on consecutive days, in addition to the standard L–Asparaginase, 6–mercaptopurine, prednisone, and intrathecal methotrexate. We understood that the "experimental" aspect of the protocol was the cyclophosphamide. The most urgent decision related to this regimen was whether to insert a Broviac catheter in order to facilitate the administration of the vincristine and cyclophosphamide. For reasons that escape memory at this point, the decision was made not to do the Broviac. I confess that I was relieved not to have the additional responsibility of cleaning it and maintaining a sterile environment on a busy two year–old boy, but he did get a few vincristine burns over the years. The medical team at the hospital and clinic was an outstanding group of highly trained professionals, including a wonderful nurse practitioner and a psychologist, in addition to the renowned physicians and residents in training. They were patient with us and tried to answer our endless questions, even as they kept emphasizing the importance of "informed consent." Both my husband and I address problems and challenges through education and research, and we immersed ourselves in textbooks that defined all the different types of blood cells and blood diseases and cancers. If the medical team wanted us to be informed but not to focus on statistical outcomes, we thought the least we could do would be to try to understand the biology and chemistry of acute lymphoblastic leukemia. Within a matter of just a few weeks, the doctors told us the disease was in remission, and we all heaved a big sigh of relief. We began to consider how to lead our lives with this "new normal" as something that would be with us forever. The medical team told us there was a strong probability that our son would develop a learning...

Pediatric Broviac カテーテルの使用経験

Pediatric Broviac カテーテルの使用経験

Evaluating the potential for a new specialist central vascular access service – Are we using too many Hickman Lines?

Evaluating the potential for a new specialist central vascular access service – Are we using too many Hickman Lines?

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA.

Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with one-stage revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Between January 2002 and July 2013, 30 patients (30 hips) presented to the senior author for treatment of infected THA. Of those, 21 patients (21 hips) with infected cemented THAs underwent débridement and single-stage revision to cementless total hip implants followed by catheter infusion of intraarticular antibiotics. Nine patients (nine hips) with late-onset acute infections in cementless THA had bone-ingrown implants. These patients were all more than 2 years from their original surgery and had acute symptoms of infection for 4 to 9 days. Seven had their original THA elsewhere, and two were the author's patients. All were symptom-free until the onset of their infection, and none had postoperative wound complications, fever, or prolonged pain suggestive of a more chronic process. They were treated with débridement and head and liner exchange, again followed by catheter infusion of intraarticular antibiotics. During this time period, this represented all infected THAs treated by the senior author, and all were treated with this protocol; no patient underwent two-stage exchange during this time, and no patients were lost to followup. At the time of the surgery, two Hickman catheters were placed in each hip to begin intraarticular delivery of antibiotics in the early postoperative period. Antibiotics were infused daily into the hip for 6 weeks with the tubes used for infusion only. Eleven of the single-stage revisions and four of the hips treated with débridement had methicillin-resistant Staphylococcus aureus. Patients were considered free of infection if they had no clinical signs of infection and had a normal C-reactive protein and erythrocyte sedimentation rate at 1 year. Complications were ascertained by chart review. Twenty of 21 (95%) infections in patients who had single-stage revision for chronically infected cemented THA were apparently free from infection and remained so at a mean followup of 63 months (range, 25-157 months). One case grew Candida albicans in the operative cultures and remained free of signs of infection after rerevision followed by infusion of fluconazole. The nine cementless THAs treated with débridement and head/liner exchange all remained free of signs of infection at a mean followup of 74 months (range, 62-121 months). Few complications were associated with the technique. Four patients had elevated serum levels of vancomycin without renal function changes and two patients had transient blood urea nitrogen/creatinine elevations with normal vancomycin levels that resolved with dosage adjustments. No patient had evidence of permanent renal damage. None of the patients in this study developed a chronic fistula or had significant drainage from the catheter site. Single-stage revision for chronically infected cemented THA and débridement of bone-ingrown cementless THA with late-onset acute infection followed with indwelling catheter antibiotic infusion can result in infection eradication even when resistant organisms are involved. Larger study groups would better assess this technique and prospective comparisons to more traditional one- and two-stage revision techniques for infected THA will likely require multi-institutional approaches. Level IV, therapeutic study.

Use of arteriovenous fistula in children with bleeding disorders

Abstract Haemophilia and associated bleeding disorders are chronic conditions that require easy, accessible, and reliable venous access for treatment. Peripheral venous access is traditionally the first option considered for prophylaxis. The initial introduction of prophylaxis to a child is during the first two years of life, and peripheral access can be problematic. Central venous catheters (CVC), for example port-a-caths, are widely used among this group; however, these devices require surgical insertion and are not without their own complications. Data were collected on venous access methods used at the paediatric centre at the Evelina London Children’s Hospital, where 242 children are registered at the comprehensive care centre, 48 of whom have a severe bleeding disorder. Of these 48, 27 have a CVC currently (PICC n=1, Port-a-Cath n=25, Hickman line n=1) and 3 have an arteriovenous fistula (AVF). Patient 1 is a 12 year-old boy with severe haemophilia A and an intracranial haemorrhage at the age of 9 months. He remains on prophylaxis and had an AVF created 5 years ago following repeated port-a-cath infections and poor venous access. Patient 2 is a 7 year-old boy with severe haemophilia B and an inhibitor, who has also had repeated port-a-cath infections. An AVF was constructed 2 years ago. Patient 3 is a 12 year-old girl with type III von Willebrand disease and an inhibitor. Due to need for regular factor treatment in the context of poor venous access, an AVF was formed. We have had a 100% success rate with all three AVFs at a follow-up period of 8-69 months. Our experience suggests AVF is a viable option of venous access in patients with haemophilia and other bleeding disorders, especially so for children with repeated CVC infections or poor peripheral venous access. However, this is not a straightforward option and further evidence on long-term use based on multicentre research will be beneficial in managing AVF in this group of patients.