Implanted vascular access devices (ports) in children: complications and their prevention

Abstract

Implanted vascular access devices (ports) play a major role in the management of children with cystic fibrosis (CF) and many haematological conditions. With the expanding use of ports, new and more frequent complications are being encountered. To retrospectively review the complications associated with ports, the case notes of all patients who underwent insertion of a port between 1997 and 2000 were analysed. Details of the underlying disorder, type of vascular device, nature of use, and complications were recorded; 55 ports were inserted in 41 patients (a second port was required in 12, a third port in 2) during this period. Their underlying diagnoses were CF (11), haemophilia (4), haemolytic anaemias (2), immunological disorders (6), solid neoplasms (8), and leukaemia (10). Thirteen ports (24%) were removed and replaced for various complications: infection (2), blockage (4), leak (2), dislodgement (2), and malposition (3). Including four port-related problems managed conservatively (3 access problems managed by change in access technique; 1 blockage managed by urokinase), the over all complication rate was 31%. Ports thus have a high complication rate with long-term use. Selecting the right port system, proper installation of the port chamber, and efficient handling and maintenance by trained staff could prevent the vast majority of port-related complications.

Long‐term complications in totally implantable venous access devices: Randomized study comparing subclavian and internal jugular vein puncture

“…Since there are no external components, they are less visible and more easily accepted by patients: They cause no restrictions on daily activities; local care is easier; the risk of infection [1][2][3] and thrombosis [4] is lower, they are less costly; and they can be kept in place for longer periods of times. For these reasons, TIVADs have been commonly used in oncological patients, both adults and children.…”

Interventional radiological retrieval of embolized vascular access device fragments

“…Since the first report of an embolized catheter fragment in 1954 (5), the incidence of this complication is reported to be 0.3%-2.9% in adults (6-8) and 1.4%-3.6% in children (9,10). Poor connection between the port and the catheter, angulation or distortion of the anastomosis site, severing of the catheter, improper catheter position, fatigue of the catheter, chronic compression of the catheter between the clavicle and the first rib (pinch-off syndrome) and damage by chemotherapy drugs are the causes of catheter embolism (11,12).…”

Calcified catheter “cast” masquerading as a retained catheter fragment after removal of an implanted venous access device

“…Many children require chronic central venous access for the administration of chemotherapy, long-term antibiotics, and TPN. Since their introduction for use in children in 1985, implanted venous access devices or ports have become more commonly used for these purposes [4]. Additional complications associated with ports include leak, disconnection between the catheter and the port, catheter migration, and hematoma [4][5][6][7].…”

“…Since their introduction for use in children in 1985, implanted venous access devices or ports have become more commonly used for these purposes [4]. Additional complications associated with ports include leak, disconnection between the catheter and the port, catheter migration, and hematoma [4][5][6][7]. All CVCs and implanted venous access devices have the potential to fragment, although this occurs rarely [5,[8][9][10][11]21].…”