Risk profile of subcutaneous port placement in small children. J Pediatr Surg 2021 Jan;56(1):183-186
Date
11/03/2020Pubmed ID
33131779DOI
10.1016/j.jpedsurg.2020.09.034Scopus ID
2-s2.0-85094601676 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
BACKGROUND/PURPOSE: Long-term central venous access is a safe and common procedure in children. However, complications with devices are a reality. Smaller children are thought to have a higher rate of complication after port placement, and some surgeons avoid placing ports with an arbitrary weight cutoff out of concern for surgical site morbidity.
METHODS: We performed a multi-institutional retrospective review of 500 patients less than 5 years of age undergoing port placement at three large volume children's hospitals from 2014 to 2018. Patients were divided by weight greater than or less than 10 kg at the time of insertion. Statistical analysis was performed to evaluate for differences in outcomes between the two groups.
RESULTS: The majority of ports were placed for chemotherapy access (71.8%). Other indications included long-term infusions (18.8%) and difficult chronic IV access (9.4%). Of the 500 charts reviewed, 110 (22%) experienced some documented complication (28.9% <10 kg, 20.6% >10 kg, p = 0.096). There were no differences between the two groups in terms of the type or timing of complications. Overall, 16.3% of ports required removal prior to the end of therapy owing to a complication. Complication rate per day with the port in place was not different between the two groups (<10 kg: 0.68 complications/1000 port-days vs >10 kg 0.44 complications/1000 port-days, p = 0.068).
CONCLUSION: Weight less than 10 kg was not associated with a significantly higher incidence of any type of port complication in our cohort. This suggests that concern for complications should not exclude children less than 10 kg from port placement.
TYPE OF STUDY: Multi-institutional retrospective review.
LEVEL OF EVIDENCE: Level III.
Author List
Overman RE Jr, Casar Berazaluce AM, Van Arendonk K, Wagner ML, Kartal T, Witte A, Rymeski B, Speck KEMESH terms used to index this publication - Major topics in bold
Body WeightCatheterization, Central Venous
Catheters, Indwelling
Central Venous Catheters
Child, Preschool
Female
Humans
Incidence
Infant
Male
Retrospective Studies
Risk Factors
Vascular Access Devices