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

Abstract

PurposeTotally implantable venous access devices (TIVADs) are commonly used in pediatrics for the administration of chemotherapy, antibiotics, or parenteral nutrition. TIVADs can be implanted using various techniques, including surgical cutdown (SC) and percutaneous puncture (PP). Recently, percutaneous TIVAD became popular in adults, but studies comparing between PP and SC group in pediatric patients are rare.Materials and MethodsData were collected and analyzed retrospectively from 23 patients who underwent TIVAD at a single institution between January 2013 and December 2015. We examined the clinical characteristics, insertion techniques, and clinical outcome. We divided the patients into 2 groups and compared PP with ultrasonography and SC using the insertion technique. We compared success rate, procedural time, and the patency rate between the 2 groups.ResultsEleven TIVADS were inserted using PP, and 12 TIVADs were inserted using SC. No statistically significant difference in characteristics was found between the 2 groups. The procedural time in the PP group was shorter than that in the SC group, but the difference was not statistically significant (P=0.685). During follow-up, 1 patient in the SC group had an occlusion, and 1 patient in the PP group had an infection.ConclusionPP of the internal jugular vein with ultrasonography appears to be the method of choice for TIVAD insertion owing to its similar success rate in terms of implantation and complication rate to that in SC, with shorter procedural times in pediatric patients.

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

“…One study reported USG percutaneous puncture of totally implantable venous devices had similar success rates, procedure times, and complication rates when compared to surgical cutdown methods. 48 Another study found that insertion of totally implantable venous devices by using ultrasound guidance was significantly more effective in reducing complication rates, had shorter procedure times, and was more cost-efficient compared to open surgical cutdown techniques. 71 However, recommendations for other visualization techniques in pediatric populations, including NIR light (vessel visualization) and ECG (catheter-tip confirmation) device use, were scant.…”

Complications of Port-A-Caths in Children with Hematologic/Oncologic Diseases

“…We have read with keen interest the article titled, “Usefulness of percutaneous puncture in insertion of totally implantable venous access devices in pediatric patients” by Choi et al [ 1 ] published in the September 2017 issue of Vascular Specialist International. We congratulate the authors for extensive research and we would like to share our experience with Port-A-Caths (PACs) in children with hematologic/ oncologic diseases.…”

“…PACs are commonly used in children who require long-term central venous access for medications or nutrition [ 1 ]. Although these devices are extremely necessary, they pose a serious risk of complications including infection, thrombosis, and mechanical occlusions [ 2 – 4 ].…”