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Published on: September 19, 2013
Port-A-Cath insertions in acute leukaemia and childhood malignancies
1Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore. aloh@alumni.nus.edu.sg
Insights
Port-A-Cath insertions in pediatric cancer patients show minimal complications, even in those with leukemia. Catheter-related bloodstream infections (CRBSIs) were infrequent, with Gram-negative organisms increasingly noted.
Area of Science:
- Pediatric Oncology
- Medical Devices
- Infectious Diseases
Background:
- Port-A-Cath (implantable port) devices are crucial for long-term venous access in pediatric cancer patients.
- Catheter-related complications, particularly infections, can significantly impact patient outcomes and treatment continuity.
Purpose of the Study:
- To determine the incidence and profile of complications associated with Port-A-Cath insertions in pediatric cancer patients.
- To identify predictive factors for infection-related port removals in this population.
Main Methods:
- Retrospective case series analyzing 175 Port-A-Cath insertions over 75,000 days (2002-2004).
- Incidence of catheter-related bloodstream infections (CRBSIs) and other complications were compared between acute leukemia and other malignancy subgroups.
- Analysis of factors associated with CRBSI-related port removals.
Main Results:
- An overall CRBSI rate of 0.44 episodes per 1,000 catheter days was observed (18.9% of cases).
- Complication rates were similar between acute leukemia and other malignancy groups, despite differences in preoperative platelet counts.
- Staphylococcus epidermidis and Klebsiella spp. were the most common pathogens isolated from infected ports.
Conclusions:
- Port-A-Cath insertions are associated with minimal complications in pediatric cancer patients, including those who are thrombocytopenic.
- The increasing prevalence of Gram-negative organisms in CRBSIs reflects evolving trends in nosocomial infections.
Objective:
This retrospective case series sought to determine the incidence and profile of catheter-related complications associated with Port-A-Cath insertions in paediatric cancer patients, as well as predictive factors for infection-related port removals.
Methods:
Between January 2002 and December 2004, 175 consecutive Port-A-Cath insertions were followed for a total of 75,000 days (median, 407; range, 6-1,074). Incidence of catheter-related bloodstream infections (CRBSIs), other complications and CRBSI-related port removals were analysed for cases with acute leukaemia versus other malignancies.
Results:
A total of 33 CRBSIs were encountered in 26 cases (18.9%), an infection rate of 0.44 episodes per 1,000 catheter days. While mean preoperative platelet count was 125.34 x 10(9)/L in children with acute leukaemia and 392.11 x 10(9)/L in those with other malignancies (p < 0.01), the incidence of all complications were similar between both subgroups. Staphylococcus epidermidis (23.1%) and Klebsiella spp. (19.2%) were most commonly isolated from infected ports. Median patient age and duration of implantation in CRBSI-related port removals was 1.5 years and 111 days respectively, and 10.0 years and 414 days respectively in CRBSIs without port removal.
Conclusion:
Minimal complications are associated with Port-A-Cath insertions, even in thrombocytopaenic leukaemic patients. The dominance of Gram-negative organisms in CRBSIs parallels the changing trend of nosocomial infectious agents involved in catheter-related infections.
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