Rare cause of extravasation from implantable venous access device

Abstract

Implantable venous access devices are routinely used, but they are not without complications. A 4-year-old male child with B cell acute lymphoblastic leukaemia was planned for chemotherapy. Chemo port was accessed through the right internal jugular vein. Check X-ray was done, which showed the correct placement of the catheter. Two months after chemo port insertion when the patient underwent chemotherapy, he developed a fever and he was started on intravenous antibiotics. On the next two admissions, the patient had a fever with chamber site oedema for which culture was done, which revealed Pseudomonas and Candida, which responded to antibiotic and antifungal therapies. In the successive admission, the patient had immediate local oedema on injecting chemotherapy. Exploration was done, which revealed chamber base perforation. It is an infrequent complication and has been reported in only three studies.

Pacemaker leads as a potential source of problems in patients who might need a central venous access port

“…There is a wide variety of studies that compare the incidence of intraoperative complications (hemothorax, hemopneumothorax or pinch-off syndrome, pneumothorax, nerve damage, arterial puncture and hematoma, wrong tip location in the internal thoracic vein, or in the collateral circulation with subsequent severe consequences) when different safety approaches are used ( 21 , 26 - 31 , 33 , 35 , 37 , 43 , 44 , 46 , 47 ).…”

“…Several investigators have described periprocedural or late complications of venous port implantation ( 21 , 23 , 24 , 26 , 27 , 30 , 32 - 36 , 38 , 41 , 42 , 46 , 47 ). These include: venous thrombosis, infection, catheter-related infection, skin complications at the port site, port infection, post-operative venous access obstruction, central venous stenosis, catheter damage, port and catheter disconnection, flexion at the catheter-port interface, infusion disorders, thrombotic obstruction of the catheter or spontaneous dislocation of the port tip into the azygos or other small veins, and unexpected difficulties during removal of the port ( 22 ).…”