Patrick A Dillon1, Robert P Foglia. 1. Division of Pediatric Surgery, Department of Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110-1077, USA. dillonp@wustl.edu
Abstract
PURPOSE: Implantable vascular access devices (ports) are well accepted in the management of many pediatric conditions. Modifications have improved port function, patient satisfaction, and enhanced compatibility with imaging studies. We reviewed our experience with a port system and identified unique mechanical complications. METHODS: From 1998 to the present, 301 patients underwent 296 port insertions and 175 port removals. We assessed medical records, radiographs, and operative findings. The 6.6F MRI Low-Profile Implanted Port (Bard Access Systems, Salt Lake City, Utah) was used almost exclusively and was assembled by the operating surgeon. Outcome measures included port reservoir leakage, catheter dislodgment, and number of device days until complication. Ports were implanted for multiple medical problems including 74.2% in hematology/oncology patients. RESULTS: For 296 port insertions, 15 complications (5.1%) were identified in 13 patients (mean age, 8.4 years). Eleven leaks (3.7%) in 9 patients were found, with 9 leaks resulting from needle perforation of the port base and 2 leaks seen at the catheter connection site. Average port duration was 425 days (range, 12-1266 days) before leakage. Four patients had catheter dislodgment (1.4%), with 3 of 4 catheters embolizing to the heart or pulmonary artery. Patients were asymptomatic, and catheters were retrieved by interventional radiology. Dislodgment at the catheter-port connection site was seen in 3 of 4 cases, and average port duration was 1075 days (range, 269-2657 days) until catheter separation. Twelve of 13 patients had successful implantation of a new port system. CONCLUSIONS: This study identifies that (1) mechanical port complications (5.1%) are not rare for this device; (2) regardless of port age, the thin plastic base may result in a risk of perforation not seen in other devices; (3) the extended period before embolization likely indicates device wear rather than faulty assembly; and (4) complications could be successfully managed including retrieval of embolized catheters.
PURPOSE: Implantable vascular access devices (ports) are well accepted in the management of many pediatric conditions. Modifications have improved port function, patient satisfaction, and enhanced compatibility with imaging studies. We reviewed our experience with a port system and identified unique mechanical complications. METHODS: From 1998 to the present, 301 patients underwent 296 port insertions and 175 port removals. We assessed medical records, radiographs, and operative findings. The 6.6F MRI Low-Profile Implanted Port (Bard Access Systems, Salt Lake City, Utah) was used almost exclusively and was assembled by the operating surgeon. Outcome measures included port reservoir leakage, catheter dislodgment, and number of device days until complication. Ports were implanted for multiple medical problems including 74.2% in hematology/oncology patients. RESULTS: For 296 port insertions, 15 complications (5.1%) were identified in 13 patients (mean age, 8.4 years). Eleven leaks (3.7%) in 9 patients were found, with 9 leaks resulting from needle perforation of the port base and 2 leaks seen at the catheter connection site. Average port duration was 425 days (range, 12-1266 days) before leakage. Four patients had catheter dislodgment (1.4%), with 3 of 4 catheters embolizing to the heart or pulmonary artery. Patients were asymptomatic, and catheters were retrieved by interventional radiology. Dislodgment at the catheter-port connection site was seen in 3 of 4 cases, and average port duration was 1075 days (range, 269-2657 days) until catheter separation. Twelve of 13 patients had successful implantation of a new port system. CONCLUSIONS: This study identifies that (1) mechanical port complications (5.1%) are not rare for this device; (2) regardless of port age, the thin plastic base may result in a risk of perforation not seen in other devices; (3) the extended period before embolization likely indicates device wear rather than faulty assembly; and (4) complications could be successfully managed including retrieval of embolized catheters.
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