When TIVADs Won't Let Go: Lessons Learned From a Pediatric Oncology Cohort in Southern Chile

Totally implantable venous access devices (TIVADs) are essential in pediatric oncology but can cause mechanical complications at removal. Identifying risk factors helps guide management and timing of elective removal. Our objective is to describe the incidence and determinants of mechanical complications that occur during the removal of TIVADs in a Chilean tertiary pediatric oncology center.

We performed a retrospective cross-sectional review of all TIVAD removal episodes at Hospital Guillermo Grant Benavente (Concepción, Chile) between June 2022 and May 2025. Demographic, oncologic, and device variables were collected; univariate comparisons examined associations with mechanical outcomes.

Sixty-eight removals were analyzed. Mechanical complications occurred in 29.4% of procedures: difficult removal in 20 cases (29.4%), catheter retention in 12 (17.6%), and catheter fracture in 3 (4.4%). Mean indwelling time was greater in fractured devices (6.1 ± 0.6 years) compared with non-fractured devices (4.4 ± 1.7 years; p = 0.026), and longer in difficult removals (5.1 ± 1.2 vs. 4.2 ± 1.3 years; p = 0.011). Open technique was borderline associated with difficult removal (p = 0.050).

Prolonged indwelling time and open technique are the principal factors associated with mechanical problems during TIVAD removal. These findings support early recognition of high-risk devices and consideration of timely replacement or elective removal to reduce avoidable complications.