Clinical approaches to removing long-term stuck pediatric ports

In pediatric oncology, totally implantable venous access devices (TIVADs), or ports, are frequently used for long-term intravenous therapy. While insertion-related complications are well documented, difficulties during removal are rare but clinically significant.

A retrospective review involved 851 pediatric patients underwent port removals between July 2012 and July 2024. Patient demographics, insertion site, catheter dwell time, and removal techniques were analyzed, with a focus on catheter removal-related complications.

Removal was uncomplicated among 830 patients (97.5%). However, 21 patients (2.5%) experienced complications due to catheter adherence or migration. These cases required additional interventions, including extensive dissection (n = 10), controlled venotomy (n = 5), interventional radiology (n = 5), and guidewire-assisted stenting (n = 1). The mean catheter dwell time of the port devices in this cohort prior to removal was 39.35 months. Two patients experienced migrated fragments, which were successfully removed. One patient experienced bleeding during venotomy, which was successfully treated.

Long-term central venous catheters removal is often complicated by peri catheter adhesions and calcification. Owing to the risk of significant complications, removal should be performed only when clinically indicated and preferably in specialized centers with access to interventional radiology and cardiac surgery. Comprehensive informed consent is a critical prerequisite for this procedure. This study offers practical guidance for clinicians and an open avenue for future research on preventative strategies and optimized removal protocols.