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Evaluation of implanted venous port-a-caths in children with medical complexity and neurologic impairment
Paymun Pezeshkpour1,2, Nicholas C Armstrong3,4, Sanjay Mahant5
1Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. paymun.pezeshkpour@sickkids.ca.
Insights
Implanted port-a-caths significantly reduce venous access attempts and hospital visits for children with complex medical needs and neurological impairment. This improves patient care by minimizing painful procedures and healthcare utilization.
Area of Science:
- Pediatric Interventional Radiology
- Vascular Access Devices
- Complex Pediatric Care
Background:
- Children with medical complexity and neurological impairment often experience challenges with venous access.
- Urgent intravenous fluid and medication administration is frequently required for these patients.
Purpose of the Study:
- To evaluate the effectiveness of implanted port-a-caths in pediatric patients with medical complexity and neurological impairment.
- To analyze the impact of port-a-cath use on venous access attempts, complications, and healthcare utilization.
Main Methods:
- A single-center observational study was conducted on port-a-cath placements in children with medical complexity and neurological impairment.
- Data collected included peripheral intravenous access attempts, complications, alternative device use, port-a-cath insertions, and hospital admissions, comparing the year before and after port-a-cath placement.
Main Results:
- Port-a-cath placement in 21 children resulted in a significant reduction in peripheral intravenous attempts, skin punctures, and the need for alternative venous access devices.
- A significant decrease was observed in emergency department visits, admissions from the emergency department, and total inpatient admissions post-port-a-cath insertion.
- Adverse events associated with port-a-caths were predominantly mild to moderate.
Conclusions:
- Implanted port-a-caths are effective in reducing venous access difficulties and associated healthcare utilization in children with medical complexity and neurological impairment.
- The benefits of port-a-cath placement, including reduced procedures and hospitalizations, should be weighed against potential device-related adverse events.
Background:
Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication.
Objective:
To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access.
Materials And Methods:
We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath.
Results:
Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0).
Conclusion:
Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.
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