Increased complication rates associated with Port-a-Cath placement in pediatric patients: location matters

Area of Science:

• Pediatric Surgery
• Vascular Access Devices
• Medical Device Complications

Background:

• Port-a-Caths (PACs) are common vascular access devices.
• Placement below the clavicle or inframammary line is typical for cosmetic reasons.
• Inframammary PAC placement may increase catheter-related complications due to longer catheter length.

Purpose of the Study:

• To investigate the association between Port-a-Cath placement location and catheter-related complications in pediatric patients.
• To compare complication rates between subclavicular (SC), medial inframammary (MIM), and lateral inframammary (LIM) PAC placements.

Main Methods:

• Retrospective review of pediatric patients with PAC placement from 2007-2009.
• Port placement categorized as SC or inframammary (medial or lateral) via X-ray.
• Analysis of early (<30 days) and late complication rates, catheter survival, and need for intervention.

Main Results:

• Lateral inframammary (LIM) PAC placement was independently associated with higher total complication rates (p<0.001), migration (p<0.001), and operative exchange (p=0.017) compared to SC.
• Catheter survival was significantly decreased in the LIM group versus SC (1021 vs. 1396 days, p=0.005).
• Medial inframammary (MIM) placement showed complication rates similar to SC (17.4% vs. 20.4%, p=0.835) and significantly fewer than LIM (17.4% vs. 44.6%, p=0.001).

Conclusions:

• Lateral inframammary chest wall placement of PACs in children is linked to increased complications and need for operative exchange.
• Subclavicular or medial inframammary PAC placement is recommended for pediatric patients.
• Optimizing PAC placement can reduce catheter-related complications and improve patient outcomes.