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Complications associated with totally implantable access ports in children less than 1 year of age

  • Author Footnotes
    ⁎ Equal contribution to work
    Aaron B. Ross
    Correspondence
    Corresponding author at: The University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, United States.
    Footnotes
    ⁎ Equal contribution to work
    Affiliations
    College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States
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  • Author Footnotes
    ⁎ Equal contribution to work
    Eva Rouanet
    Footnotes
    ⁎ Equal contribution to work
    Affiliations
    Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA 02115, United States

    Department of Surgery, Brigham & Women's Hospital/Harvard Medical School, Boston, MA 02115, United States
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  • Andrew J. Murphy
    Affiliations
    Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, United States
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  • Christopher B. Weldon
    Affiliations
    Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA 02115, United States

    Department of Pediatric Oncology, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA 02115, United States

    Department of Anesthesiology, Critical Care & Pain Medicine, Children's Hospital/Harvard Medical School, Boston, MA 02115, United States
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  • Brent R. Weil
    Affiliations
    Department of Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA 02115, United States

    Department of Pediatric Oncology, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA 02115, United States
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  • Author Footnotes
    ⁎ Equal contribution to work
Published:December 10, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.12.004

      Highlights

      • Long-term central venous access is crucial for many pediatric patients, and there is no consensus regarding the safety of port placement in infants under 1-year of age.
      • This study demonstrates a low- or acceptable-risk of intra- and early post-operative complications associated with port placement in infants.

      Abstract

      Background

      Long term central venous access is necessary for the treatment of several conditions affecting young children. Totally implantable access ports (ports) offer the advantage of containing no external components, thus simplifying their care and maintenance. However, there is no consensus on the safety of port placement in infants (birth to 1-year of age). The aim of this study was to describe complications associated with port placement in infants, including which specific factors may be associated with risk for developing complications among these patients, and thereby assess the safety of port placement in this young population.

      Methods

      A two-institution, retrospective cohort study identified patients under 1-year old who underwent port placement. Intraoperative, early postoperative (within 30 days), and late postoperative (greater than 30 days) complications were recorded. Multivariate logistic regression models were employed to assess factors associated with port-related complications.

      Results

      Among 121 patients who received a port, 36 (30%) experienced a complication with a median time to complication of 299.5 days [IQR 67.5–440.75]. Of those, 26 required unplanned port removal. Only 3 patients (2.5%) experienced an intraoperative complication, and 3 patients (2.5%) experienced a complication within 30 days of port placement. A diagnosis of cancer was found to be protective against early catheter malfunction (OR=0.31, p = 0.03). A non-statistically significant trend associated with increased complications for large caliber devices (>6.0Fr) and weight <7-kg (OR 2.20, p = 0.06 and OR=2.26, p = 0.11 respectively) was observed.

      Conclusions

      Port placement appears to be safe for most infants with low or acceptable rates of intra- or post-operative complications. Smaller patient size (< 7 kg) and larger-sized catheters (> 6.0Fr) may be associated with an increased risk for complications among this population.

      Level of evidence

      III

      Keywords

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      References

        • van den Bosch C.H.
        • van der Bruggen J.T.
        • Frakking F.N.J.
        • et al.
        Incidence, severity and outcome of central line related complications in pediatric oncology patients; A single center study.
        J Pediatr Surg. Sep 2019; 54: 1894-1900https://doi.org/10.1016/j.jpedsurg.2018.10.054
      1. Nam S.H., Kim D.Y., Kim S.C., et al. Complications and risk factors of infection in pediatric hemato-oncology patients with totally implantable access ports (TIAPs). Pediatr Blood Cancer. Apr 2010;54(4):546–51. doi:10.1002/pbc.22286.

      2. Ribeiro R.C., Abib S.C., Aguiar A.S., et al. Long-term complications in totally implantable venous access devices: randomized study comparing subclavian and internal jugular vein puncture. Pediatr Blood Cancer. Feb 2012;58(2):274–7. doi:10.1002/pbc.23220

      3. Kulkarni S., Wu O., Kasthuri R., et al. Centrally inserted external catheters and totally implantable ports for the delivery of chemotherapy: a systematic review and meta-analysis of device-related complications. Cardiovasc Intervent Radiol. Aug 2014;37(4):990–1008. doi:10.1007/s00270-013-0771-3.

        • Carraro F.
        • Cicalese M.P.
        • Cesaro S.
        • et al.
        Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP).
        Ann Hematol. Oct 2013; 92: 1405-1412https://doi.org/10.1007/s00277-013-1794-1
        • Acord M.
        • Cahill A.M.
        • Krishnamurthy G.
        • et al.
        Venous Ports in Infants.
        J Vasc Interv Radiol. Apr 2018; 29: 492-496https://doi.org/10.1016/j.jvir.2017.10.017
      4. Ullman A.J., Marsh N., Mihala G., Cooke M., Rickard C.M. Complications of Central Venous Access Devices: A Systematic Review. Pediatrics. Nov 2015;136(5):e1331–44. doi:10.1542/peds.2015-1507.

        • Krul E.J.
        • van Leeuwen E.F.
        • Vos A.
        Continuous venous access in children for long-term chemotherapy by means of an implantable system.
        J Pediatr Surg. 1986; 21: 689-690
        • Janik J.E.
        • Conlon S.J.
        • Janik J.S.
        Percutaneous central access in patients younger than 5 years: size does matter.
        J Pediatr Surg. Aug 2004; 39: 1252-1256https://doi.org/10.1016/j.jpedsurg.2004.04.005
        • Fallon S.C.
        • Larimer E.L.
        • Gwilliam N.R.
        • et al.
        Increased complication rates associated with Port-a-Cath placement in pediatric patients: location matters.
        J Pediatr Surg. Jun 2013; 48: 1263-1268https://doi.org/10.1016/j.jpedsurg.2013.03.020
        • Wilson G.J.
        • van Noesel M.M.
        • Hop W.C.
        • et al.
        The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single-center study in 200 children.
        J Pediatr Surg. Oct 2006; 41: 1694-1698https://doi.org/10.1016/j.jpedsurg.2006.05.065
        • Overman R.E.
        • Casar Berazaluce A.M.
        • Van Arendonk K.
        • et al.
        Risk profile of subcutaneous port placement in small children.
        J Pediatr Surg. Jan 2021; 56: 183-186https://doi.org/10.1016/j.jpedsurg.2020.09.034
        • Fu A.B.
        • Hodgman E.I.
        • Burkhalter L.S.
        • et al.
        Long-term central venous access in a pediatric leukemia population.
        J Surg Res. 2016; 10 (205): 419-425https://doi.org/10.1016/j.jss.2016.06.052
        • Sola J.E.
        • Stone M.M.
        • Colombani P.M.
        Totally implantable vascular access devices in 131 pediatric oncology patients.
        Pediatr Surg Int. Mar 1996; 11: 156-158https://doi.org/10.1007/BF00183752
        • Dillon P.A.
        • Foglia R.P.
        Complications associated with an implantable vascular access device.
        J Pediatr Surg. Sep 2006; 41: 1582-1587https://doi.org/10.1016/j.jpedsurg.2006.05.022
        • Naik V.M.
        • Mantha S.S.P.
        • Rayani B.K.
        Vascular access in children.
        Indian J Anaesth. Sep 2019; 63: 737-745https://doi.org/10.4103/ija.IJA_489_19
        • Blanco-Guzman M.O
        Implanted vascular access device options: a focused review on safety and outcomes.
        Transfusion. 2018; (0258 Suppl 1): 558-568https://doi.org/10.1111/trf.14503
        • Vidal M.
        • Genillon J.P.
        • Forestier E.
        • et al.
        Outcome of totally implantable venous-access port-related infections.
        Med Mal Infect. Feb 2016; 46: 32-38https://doi.org/10.1016/j.medmal.2015.12.006
        • Sola J.E.
        • Stone M.M.
        • Colombani P.M.
        Totally implantable vascular access devices in 131 pediatric oncology patients.
        Pediatr Surg Int. Mar 1996; 11: 156-158https://doi.org/10.1007/BF00183752
        • Santacruz E.
        • Mateo-Lobo R.
        • Riveiro J.
        • et al.
        Infectious complications in home parenteral nutrition: A long-term study with peripherally inserted central catheters, tunneled catheters, and ports.
        Nutrition. 2019; (0258): 89-93https://doi.org/10.1016/j.nut.2018.06.016
        • Merrer J.
        • De Jonghe B.
        • Golliot F.
        • et al.
        Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial.
        JAMA. 2003; (08286): 700-707https://doi.org/10.1001/jama.286.6.700