Paymun Pezeshkpour1,2, Nicholas C Armstrong3,4, Sanjay Mahant5, Prakash Muthusami3,6, Joao G Amaral3,6, Dimitri A Parra3,6, Michael J Temple3,6, Bairbre L Connolly3,6. 1. Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. paymun.pezeshkpour@sickkids.ca. 2. University of Toronto, Toronto, ON, Canada. paymun.pezeshkpour@sickkids.ca. 3. Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. 4. University of Limerick, Limerick, Ireland. 5. Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada. 6. University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication. OBJECTIVE: To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access. MATERIALS AND METHODS: We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath. RESULTS: Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0). CONCLUSION: Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.
BACKGROUND:Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication. OBJECTIVE: To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access. MATERIALS AND METHODS: We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath. RESULTS: Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0). CONCLUSION:Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.
Authors: Omid Khalilzadeh; Mark O Baerlocher; Paul B Shyn; Bairbre L Connolly; A Michael Devane; Christopher S Morris; Alan M Cohen; Mehran Midia; Raymond H Thornton; Kathleen Gross; Drew M Caplin; Gunjan Aeron; Sanjay Misra; Nilesh H Patel; T Gregory Walker; Gloria Martinez-Salazar; James E Silberzweig; Boris Nikolic Journal: J Vasc Interv Radiol Date: 2017-07-27 Impact factor: 3.464
Authors: Luis Yeste Sánchez; José M Galbis Caravajal; Carlos A Fuster Diana; Enrique Moledo Eiras Journal: Clin Transl Oncol Date: 2006-10 Impact factor: 3.405
Authors: Michal Radomski; Herbert J Zeh; Howard D Edington; James F Pingpank; Lisa H Butterfield; Theresa L Whiteside; Eva Wieckowski; David L Bartlett; Pawel Kalinski Journal: J Immunother Cancer Date: 2016-04-19 Impact factor: 13.751