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Radiologic placement of implantable chest ports in pediatric patients
J M Lorenz1, B Funaki, T Van Ha
1Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
Insights
Radiologists achieve 100% technical success placing implantable chest ports in children using imaging guidance. This minimally invasive procedure offers long-term central venous access with a low complication rate.
Area of Science:
- Pediatric Interventional Radiology
- Vascular Access Devices
- Medical Imaging
Background:
- Long-term central venous access is crucial for pediatric patients requiring frequent medical interventions.
- Implantable chest ports are a common solution, but their placement requires skilled technique to minimize risks.
- Radiologic guidance is essential for safe and effective port insertion.
Purpose of the Study:
- To evaluate the technical success and complication rates of radiologic placement of implantable chest ports in children.
- To assess the safety and efficacy of using real-time sonography and fluoroscopy for pediatric central venous access.
Main Methods:
- A retrospective review of 29 chest port placements in 28 pediatric patients (age 2-17 years) between 1996 and 2000.
- Procedures utilized real-time sonography and fluoroscopy for guidance, primarily accessing the right internal jugular vein.
- Data collected included technical success, complications, catheter dwell time, and infection rates.
Main Results:
- 100% technical success rate for port placement.
- Low complication rate, with no instances of hematoma, air embolism, central venous thrombosis, malposition, or pneumothorax.
- Catheter-related infection rate was 14% (0.04 per 100 venous access days), with one premature removal due to infection.
Conclusions:
- Radiologists can successfully and safely insert implantable chest ports in pediatric patients using sonographic and fluoroscopic guidance.
- This imaging-guided approach facilitates long-term central venous access with a favorable safety profile.
- The technique demonstrates high technical success and a low incidence of serious complications.
Objective:
We evaluated the technical success and complications associated with radiologic placement of implantable chest ports in children for long-term central venous access.
Materials And Methods:
Between May 1, 1996 and January 11, 2000, 29 chest ports were placed in 28 children (15 girls, 13 boys; age range, 2-17 years; mean, 11.7 years). The patient's right internal jugular vein was used for access in 93% (27/29) of the procedures, and a collateral neck vein was used as a conduit to recanalize the central veins in two procedures because of bilateral jugular and subclavian vein occlusion. All procedures were performed in interventional radiology suites. Both real-time sonography and fluoroscopy were used to guide venipuncture and port insertion. Follow-up data were obtained through the clinical examination and electronic review of charts.
Results:
Technical success was 100%. Fourteen percent of the catheters were removed prematurely, including one catheter removed 17 days after placement because the patient's blood cultures were positive for Candida albicans. No patients experienced hematoma, symptomatic air embolism, symptomatic central venous thrombosis, catheter malposition, or pneumothorax. The median number of days for catheter use by patients was 280 days (total, 9043 days; range, 17-869 days). The rate of confirmed catheter-related infection was 14% or 0.04 per 100 venous access days. One catheter occluded after 132 days.
Conclusion:
In pediatric patients, radiologists can insert implantable chest ports using real-time sonographic and fluoroscopic guidance with high rates of technical success and low rates of complication.
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