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Stuck fragment of totally implantable central venous access ports during removal: risk factor analysis in children
Hanna Jung1, Joon Yong Cho1, Yangki Seok2
1Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea.
Insights
Totally implantable central venous access ports (TICVAPs) can fragment during removal in children, especially those with acute leukemia. Prophylactic exchange is recommended before 46 months of use or 9.9 kg weight change to prevent complications.
Area of Science:
- Pediatric Surgery
- Vascular Access Devices
- Oncology
Background:
- Totally implantable central venous access ports (TICVAPs) are crucial for reliable venous access in pediatric patients.
- Complications associated with TICVAPs, including fragment retention during removal, necessitate further investigation.
Purpose of the Study:
- To identify risk factors for retained TICVAP fragments during removal in children.
- To recommend optimal usage or exchange periods for TICVAPs in pediatric oncology patients.
Main Methods:
- Retrospective review of 147 pediatric TICVAP insertions between January 2010 and July 2020.
- Analysis of 98 TICVAP removals, comparing cases with retained fragments (Group S) to those with complete removal (Group N).
Main Results:
- Eight patients (6.9%) experienced retained TICVAP fragments, all with acute leukemia undergoing chemotherapy.
- Significantly longer indwelling duration and greater body weight change were observed in Group S.
- Indwelling duration (OR 1.13) and body weight change (OR 1.00) showed an increased trend for risk of stuck fragments.
Conclusions:
- Prophylactic catheter exchange is suggested before 46 months of indwelling duration or a 9.9 kg body weight change to prevent fragment retention.
- Close observation is recommended for asymptomatic patients with retained fragments, rather than immediate invasive intervention.
- These recommendations are particularly important for children with acute leukemia due to rapid growth and disease progression.
Background:
Totally implantable central venous access ports (TICVAPs) have increasingly been used in pediatric patients because they provide reliable venous access. However, many complications associated with TICVAPs have been reported. Here, we aimed to analyze the risk factors of stuck fragment of TICVAPs during removal in children and recommend the appropriate periods of use or exchange.
Methods:
We retrospectively reviewed the medical records of 121 patients, including 147 cases of TICVAP insertion, between January 2010 and July 2020.
Results:
Among these, 98 cases in 72 patients involved of TICVAP removal, with 8 patients having had incomplete TICVAP removal resulting in a stuck fragment of the catheter in the central venous system (Group S). All Group S patients were male and had acute leukemia, and their TICVAPs were used for chemotherapy. Compared with the complete removal group (Group N), stuck fragment in Group S were significantly found in patients diagnosed with acute leukemia than those with other diagnoses (p < 0.001). Indwelling duration and body weight change during TICVAP indwelling were significantly longer and larger in Group S, respectively (p < 0.001). In multivariate logistic regression analysis, indwell duration (odds ratio [OR], 1.13; 95% confidence interval [Cl] 1.02-1.37, p = 0.10), body weight change during indwell (OR, 1.00; 95% Cl 0.83-1.18, p = 0.97), and platelet count at TICVAP insertion (OR, 0.98; 95% Cl 0.95-0.99; p = 0.48) showed an increased trend of risk for a stuck catheter.
Conclusions:
We suggest prophylactic catheter exchange before indwell duration of 46 months (area under the curve [AUC], 0.949; 95% Cl 0.905-0.993) and body weight change up to 9.9 kg (AUC, 0.903; 95% Cl 0.840-0.966) to prevent a catheter from becoming stuck, especially in children with rapidly growing acute leukemia. Management of a stuck fragment remains controversial in asymptomatic patients, and we suggest careful, close observation rather than aggressive and invasive treatment.
