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Complications of Port-A-Caths in Children with Hematologic/Oncologic Diseases
Vascular Specialist International 2018;34:14-15
Published online March 31, 2018;  https://doi.org/10.5758/vsi.2018.34.1.14
© 2018 Vascular Specialist International.

Mohamed Zouari, Hamdi Louati, Mohamed Jallouli, and Riadh Mhiri

Department of Pediatric Surgery, Hedi-Chaker Hospital, Sfax, Tunisia
Correspondence to: Mohamed Zouari, Department of Pediatric Surgery, Hedi Chaker Hospital, El Ain Road, 3029 Sfax, Tunisia, Tel: 216-74244422, Fax: 216-74241384, E-mail: zouarimohamed.1982@yahoo.fr, http://orcid.org/0000-0001-9491-816X
Received November 12, 2017; Revised December 8, 2017; Accepted December 13, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Dear Editor:

We have read with keen interest the article titled, “Usefulness of percutaneous puncture in insertion of totally implantable venous access devices in pediatric patients” by Choi et al. [1] published in the September 2017 issue of Vascular Specialist International. We congratulate the authors for extensive research and we would like to share our experience with Port-A-Caths (PACs) in children with hematologic/ oncologic diseases.

PACs are commonly used in children who require long-term central venous access for medications or nutrition [1]. Although these devices are extremely necessary, they pose a serious risk of complications including infection, thrombosis, and mechanical occlusions [24]. Over 8 years period (January 2008-December 2015), we managed 55 children with malignant hematologic disorders who need a PAC placement for chemotherapeutic treatment. Thirty-four patients (61.8%) were male and 21 patients (38.2%) were female. Mean age was 5 years (range, 1–16 years). Fifty patients (90.9%) had acute lymphocytic leukemia, four patients (7.3%) had lymphoblastic lymphoma, and one patient (1.8%) had acute myeloid leukemia. The most common site of insertion was the right internal jugular vein (94.5%) followed by the left internal jugular vein (3.6%) and the right subclavian vein (1.8%) (Fig. 1). All ports were placed under physician-controlled fluoroscopic guidance. Sixteen patients (29.1%) had postoperative complications including infection (n=10), malfunction (n=3), occlusion (n=2), and fracture (n=1). The management of these complications required the removal of the PAC in 8 cases (50.0%) (Table 1). The average duration over which the PAC remained in place was 18 months (range, 4–48 months).

The total complication rate in our series was 29.1%, which is comparable to other reported rates of up to 31.0% [5]. Therefore, there is a need to reduce the catheter related complications by providing sufficient information to patients and nurses, preventing direct or indirect trauma to the chest, strict adherence to aseptic practices in the operating room, and proper anticoagulation before and after device usage. Appropriate follow-up should be made after implantation for the early recognition of complications.

Conflict of interest

None.

Figures
Fig. 1. Port-A-Caths placed in the right jugular vein.
Tables

Postoperative outcomes

ComplicationTotal number of patientAntibiotic therapyPAC removedPAC repaired
Infection10840
Malfunction3021
Occlusion2011
Fracture1010

PAC, Port-A-Cath.


References
  1. Choi, JS, Park, KM, Jung, S, Hong, KC, Jeon, YS, and Cho, SG (2017). Usefulness of percutaneous puncture in insertion of totally implantable venous access devices in pediatric patients. Vasc Spec Int. 33, 108-111.
    CrossRef
  2. Cuellar, LE, Fernandez-Maldonado, E, Rosenthal, VD, Castaneda-Sabogal, A, Rosales, R, and Mayorga-Espichan, MJ (2008). Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica. 24, 16-24.
    Pubmed CrossRef
  3. Fratino, G, Molinari, AC, Parodi, S, Longo, S, Saracco, P, and Castagnola, E (2005). Central venous catheter-related complications in children with oncological/ hematological diseases: an observational study of 418 devices. Ann Oncol. 16, 648-654.
    Pubmed CrossRef
  4. Fallon, SC, Larimer, EL, Gwilliam, NR, Nuchtern, JG, Rodriguez, JR, and Lee, TC (2013). Increased complication rates associated with Port-a-Cath placement in pediatric patients: location matters. J Pediatr Surg. 48, 1263-1268.
    Pubmed CrossRef
  5. Babu, R, and Spicer, RD (2002). Implanted vascular access devices (ports) in children: complications and their prevention. Pediatr Surg Int. 18, 50-53.
    Pubmed CrossRef


September 2018, 34 (3)
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