Totally Implantable Venous Access Devices in Children Requiring Long-Term Chemotherapy: Analysis of Outcome in 122 Children from a Single Institution.

Abstract

Children with malignancy require venous access that is reliable, safe and compliant on a long-term basis. There is little data available on utilization of totally implantable venous access devices (TIVAD) for long term chemotherapy in children in an Indian setting [1]. We report our long-term follow-up results of utilization of totally implantable venous access devices for long-term chemotherapy in children. This was a retrospective analysis of 122 children requiring longterm chemotherapy done between January 2008 and December 2013. Data collected included primary disease process, type of port, site of insertion, intraoperative events, early and late postoperative complications, and issues with utilization, maintenance and removal. 127 ports were placed in 122 children. The follow up ranged from 16 to 50 months. Internal jugular vein was accessed in 96.8 % of cases (123/127). Majority of children (61 %) had hematological malignancy. Early complications occurred in 5 children. Late complications occurred in 18 children which included port pocket infection in 3, port site skin issues in 5, catheter related issues in 3, venous thrombosis in 2 and catheter related bacteremia in 5 children respectively. Only 10 children have been lost to follow-up either due to death or discontinuation of treatment and rest are on follow up. Totally implantable venous access devices usage is safe and reliable for access needs in children for longterm chemotherapy. Their low complication and low cost maintenance should increase their utilization in children requiring long-term chemotherapy. Chemoport placement in children with hematological malignancy can be carried out safely without much impact on complication rates. Though management and compliance of children with malignancy has improved; critical analysis and standardization of port system care through prospective trials are necessary to reduce the morbidity and for cost analysis in these children.

Chemoport-A Savior in Children Who Require Chronic Venous Access: An Observational Study

“…Acute leukemias combined with lymphomas constituted 69% of our study group (Table 1), which is similar to the incidence reported in most of the studies published [7–9]. This is because leukemia is the most common pediatric malignancy, constituting 25% of cases [10].…”

“…The IJV was the preferred vein in most of the studies including ours [1,3,7,9,11]. The advantages of the IJV over the SCV are that it is associated with lower incidence rates of pneumothorax, upper extremity deep vein thrombosis, chylothorax, catheter pinch-off, and no brachial plexus injury [1].…”

“…Port-related bloodstream infection is the most common complication of chemoport use and is the most common indication for premature chemoport removal. The other indications for premature removal are thrombosis of the chemoport or catheter, which causes blockage, thrombosis of the superior vena cava, kinking, decubitus-over-port, exposed chemoport due to the erosion of the overlying skin, and spontaneous disunion of the port and the catheter [1–4,7–9,11,12].…”

“…Overlying skin necrosis exposing the chemoport occurs due to malnutrition, thinning of the skin, and constant pressure by the chemoport. This can be reduced by using low-profile chemoports [7,9].…”

Usefulness of Percutaneous Puncture in Insertion of Totally Implantable Venous Access Devices in Pediatric Patients

“…TIVADs are commonly used in adults and pediatric patients for the administration of chemotherapy, antibiotics, or parenteral nutrition. The use of these devices has improved the compliance of pediatric patients [ 2 , 3 ].…”