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Updated: Jun 27, 2026
Computed Tomography (CT) Guided Implantation of a Totally Implantable Venous Access Port (TIVAP) through Subclavian Vein
Published on: January 13, 2026
Incidents and complications of totally implanted vascular access devices in children: a prospective study
Stéphane Tercier1, Christophe Gapany1, Manuel Diezi2
1Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Insights
Totally implanted vascular access devices in children have a significant rate of early complications, primarily from insertion techniques, but no infections were observed in this study. Further follow-up is pending.
Area of Science:
- Pediatric Surgery
- Vascular Access Devices
- Oncology Support
Background:
- Totally implanted vascular access devices (TIVAs) are crucial for pediatric cancer patients requiring frequent blood sampling or intravenous treatments.
- Identifying complications associated with TIVAs in children is essential for improving patient outcomes and device management.
Purpose of the Study:
- To prospectively identify risk factors for infections, obstructions, and surgical complications of TIVAs in pediatric patients undergoing malignancy treatment.
- To evaluate the incidence of periprocedural and early post-operative complications following TIVA insertion.
Main Methods:
- A prospective study included 45 pediatric patients (age >1 year) with solid or blood cell malignancies from January 2006 to January 2008.
- Standardized protocols for TIVA insertion by anesthesiologists and post-operative care were followed, with meticulous recording of all procedures and complications by dedicated nurses.
- Patients were monitored for complications one month post-surgery.
Main Results:
- Twelve periprocedural adverse events (27%) occurred in 45 procedures, including pneumothoraces (7%), hematomas (7%), and arterial punctures (13%).
- Five post-operative complications (11%) were recorded within one month, such as thrombotic obstructions and pain, with no catheter-related infections observed.
- One patient required catheter repositioning; interventions were needed for two pneumothoraces and one arterial puncture.
Conclusions:
- Prospective data on TIVA insertion in children indicate a notable rate of early complications, predominantly linked to the percutaneous puncture technique.
- No catheter-related infections were identified in this cohort, suggesting the efficacy of current protocols in preventing infection.
- Longer-term follow-up data for this patient population are anticipated to provide further insights into device performance and complications.
Background:
Totally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients.
Methods:
From January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery.
Results:
45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3-15.6; SD +/- 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection.
Conclusion:
Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.
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