MINOR NON-ORTHOPEDIC SURGICAL PROCEDURES Central Venous Access Device (CVAD) Insertion A common minor non-orthopedic procedure that many people with hemophilia will undergo is the insertion or removal of a central venous access device (CVAD). A venous access device such as a single lumen Hickman® catheter or a Port-a-Cath (also called a "line" or a "Port") is often implanted in the upper chest or the arm to allow easy access to a vein for the many injections that are needed to manage hemophilia. The device is a small metal or plastic reservoir with a rubber diaphragm, which is connected to acatheter. The entire device is surgically implanted under the skin with the catheter threaded into a large vein in the chest or arm. Injections are given by inserting a special needle through the skin and into the rubber diaphragm of the reservoir, and the fluid flows through the catheter into the vein. A "Port" makes giving frequent injections easier, eliminating the problems of "finding a vein." However, there are risks, including infection or blood clots. Infections may occur in about half of people using a Port after an average of 5 years of use, with the rate of infection being higher in people with an inhibitor.10 The risk of infection increases with the length of time the Port remains in place, and it is recommended that the Port be used for a few years at most.11 The chance of infection may be reduced by using careful sterile techniques for injections, and having the device monitored routinely by your doctors.12 You and your doctor will weigh the risks and benefits of using a Port in your situation. Implantation or removal of a Port is a surgical procedure, and adequate blood clotting therapy is essential during the procedure.11 For people with hemophilia A or B with an inhibitor this usually means a bypassing agent. Bard, Hickman®, Broviac, Leonard and SureCuff are registered trademarks of C. R. Bard, Inc. or an affiliate. VitaCuff is a registered trademark of Vitaphore Corporation. Copyright 2005 C. R. Bard, Inc. All rights reserved.   Dental procedures and biopsies People with hemophilia may also need to undergo minor procedures, such as dental work, just like people without hemophilia. But it is important to remember that things like dental extractions and biopsies will usually require coagulationtherapy before, during, and after the procedure. Your dentist, and any other physician who is planning to do an invasive procedure, should be aware of your condition and ideally be in contact with your hematologist to ensure that necessary precautions are taken.