A tube fitted inside a vein to allow drug injections for people with cystic fibrosis

Cystic fibrosis blocks the lungs with mucus and causes frequent infections and lung damage. Infections are often treated by giving drugs intravenously (through a vein), but regular injections can damage veins. Another option is to use a totally implantable vascular access device (TIVAD). There are different types of device and people with cystic fibrosis or their families can be shown how to administer drugs through them. TIVADs have no external portion attached when not in use and long-term maintenance is quite easy. Some people feel that the devices improve their self-image while others do not like the way they look. Sometimes TIVADs cause blood clots and infections. We looked for randomised and quasi-randomised controlled trials of these devices in people with cystic fibrosis. The review found no trials to include. Reports of the use of TIVADs in people with cystic fibrosis suggest that they are safe and effective. They also suggest that certain interventions might reduce the risk of complications; however, these issues have not been examined by randomised controlled trials. We think a multicentre randomised controlled trial is needed to assess the efficacy and possible adverse effects of TIVADs in cystic fibrosis.

Authors' conclusions: 

Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Reports of their use in people with cystic fibrosis suggest that they are safe and effective. These reports also suggest that certain interventions might reduce the risk of complications; however, it is disappointing that these reports have not been assessed by randomised controlled trials. This systematic review identifies the need for a multicentre randomised controlled trial assessing both efficacy and possible adverse effects of totally implantable venous access devices in cystic fibrosis.

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Background: 

Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Their use is associated with some complications such as thrombosis, embolism and infection.

Objectives: 

To assess if totally implantable venous access devices provide a safe and effective route for venous access for intermittent administration of intravenous antibiotics in people with cystic fibrosis. Also to assess strategies to reduce possible complications of totally implantable venous access devices (e.g. anticoagulants to reduce the risk of thrombosis).

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.

Date of the most recent search: 05 April 2012.

Selection criteria: 

Randomised and quasi-randomised controlled trials which compared the use of totally implantable venous access devices in people with cystic fibrosis to other means of vascular access, trials which compared the different types of these devices against each other and trials which assessed strategies to reduce complications of these devices.

Data collection and analysis: 

No relevant trials were identified.

Main results: 

No trials were included in this review.

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