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Central venous catheter with subcutaneous injection port (Port-A-Cath): clinical experience with children
F Wesenberg1, C Anker, H Sommerschild
1Department of Pediatrics, University Hospital, Bergen, Norway.
Insights
Port-A-Cath (PAC) devices provide safe and effective long-term venous access for children, reducing treatment-related stress. These central venous catheters are suitable even for infants, with careful implantation and handling being essential.
Area of Science:
- Pediatric Surgery
- Vascular Access Devices
- Oncology Support
Background:
- Central venous catheters (CVCs) are crucial for long-term venous access in pediatric patients.
- Subcutaneous injection ports, such as Port-A-Cath (PAC), offer an alternative for intermittent access.
- Evaluating the safety and efficacy of PACs in a pediatric population is important for treatment management.
Purpose of the Study:
- To assess the safety and efficacy of Port-A-Cath (PAC) devices for long-term intermittent venous access in children.
- To evaluate complications associated with PAC use in pediatric patients receiving various treatments.
- To compare the advantages of PACs with other central venous catheters in pediatric care.
Main Methods:
- A cohort of 26 children received Port-A-Cath (PAC) devices for long-term venous access.
- PACs were utilized for blood sampling and administration of chemotherapy, antibiotics, fluids, total parenteral nutrition (TPN), and blood products.
- Data on duration of use, number of entries, and complications were prospectively collected.
Main Results:
- PACs were in place for a cumulative 10,890 days (20-750 days per patient) with 647 system entries.
- One infection occurred in a severely neutropenic patient, necessitating PAC removal; otherwise, no PAC-related infections were observed during 258 days of neutropenia.
- Two PACs occluded due to TPN-related deposits; other technical or psychological complications were absent.
- Children maintained normal activities, and PAC use reduced emotional stress during treatment.
Conclusions:
- Port-A-Cath (PAC) devices are safe for long-term venous access in children, including infants.
- PACs offer significant advantages over other central venous catheters (CVCs) in pediatric care.
- Strict indications, meticulous implantation technique, and adequate handling are mandatory for successful PAC utilization.
Abstract:
Long-term intermittent venous access was established in 26 children by means of a central venous catheter (CVC) with a subcutaneous injection port (Port-A-Cath) (PAC). As of December, 1985, PACs had been in place for 20-750 days (cumulative 10,890 days) with 647 entries into the system. The PACs were used for blood sampling and administration of chemotherapy, antibiotics, fluids, total parenteral nutrition (TPN), and blood products. One patient with sever neutropenia (absolute neutrophil granulocyte count [ANC] less than 0.1 x 10(9)/L) at the time of the PAC implant developed an infection around the port after 2 days, with subsequent septicemia (Bacillus cereus) necessitating removal of the PAC. Otherwise, no definite PAC-related infections occurred, including 258 days of neutropenia (ANC less than 0.5 x 10(9)/L). Two PACs were found occluded with greyish deposits of fat and organic material after long-term (45 and 61 days) continuous TPN and were removed. Malposition of catheter, extravasation, thrombosis, and other potential technical or psychological complications were not observed. The children continued normal activities, and the easy venous access decreased emotional stress during treatment. Local doctors were trained to use the PACs, with which they administered maintenance chemotherapy. We conclude that the use of PACs in children is safe, even in the first year of life, and has many advantages when compared with other CVCs currently in use. Strict indications, meticulous implantation technique, and adequate handling are, however, mandatory.