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Ding JY, Li L, Fu XR, Xu L, Ding PX, Lee EW. A Stepwise Interventional Strategy for the Removal of Adherent Totally Implanted Central Venous Access Port Catheters. Ann Vasc Surg 2024; 106:162-167. [PMID: 38821477 DOI: 10.1016/j.avsg.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND To evaluate the safety and effectiveness of a stepwise interventional strategy for the removal of adherent totally implanted central venous access port catheters, consisting of a guidewire support, antegrade coaxial separation, and retrograde coaxial separation with increasing technical complexity. METHODS This study has a retrospective design. Thirty-two patients who had failed routine removal of the port catheter and were then transferred to interventional radiology between November 2017 and December 2023 were reviewed. The technical success and complication rates were recorded. RESULTS All adherent catheters were successfully removed without catheter fragmentation, using guidewire support (n = 21), antegrade coaxial separation (n = 5), and retrograde coaxial separation (n = 6). The technical success rate was 100%, and no complications occurred. CONCLUSIONS The proposed stepwise interventional strategy successfully removed adherent port catheters, with good safety and high effectiveness. It appeared to reduce the incidence of catheter fracture during the removal of adherent totally implantable central venous access port catheters.
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Affiliation(s)
- Jia-Yin Ding
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lei Li
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiao-Rui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Luo Xu
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Peng-Xu Ding
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Crook JL, Lu Z, Wang X, Henderson N, Proctor KE, Maller VG, Prajapati HJ, Gold RE, Abdelhafeez AH, Talbot LJ, Pui CH, Davidoff AM, Hoffman JM, Murphy AJ. Why do subcutaneous ports get stuck? A case-control study. J Pediatr Surg 2022; 57:229-233. [PMID: 34456040 DOI: 10.1016/j.jpedsurg.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We sought to identify clinical features associated with difficult subcutaneous port removals in children. METHODS Ports placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were difficult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations. RESULTS 57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5-2.6] versus 0.8 years [IQR 0.5-1.4]; p < 0.001). On univariate analysis, procedural and device features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0001). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis. CONCLUSION Polyurethane central venous catheters placed for the two-year treatment of acute lymphoblastic leukemia may become difficult to remove. This constellation of factors warrants more extensive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time.
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Affiliation(s)
- Jennifer L Crook
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Xiaoqing Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Nan Henderson
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kimberly E Proctor
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Vinod G Maller
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Hasmukh J Prajapati
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Robert E Gold
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Lindsay J Talbot
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - James M Hoffman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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Rassam J, Bough G, Ito G, Mullins W, Long AM. Retained intravascular catheter fragment at removal of implantable vascular access device: Incidence, risk factors, and outcomes. J Pediatr Surg 2022; 57:224-228. [PMID: 34903357 DOI: 10.1016/j.jpedsurg.2021.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retained intravascular catheter fragments (RICF) are a rare complication of implantable vascular access device (IVAD) removal for which there is limited understanding of aetiology. There is a varied approach to management among the currently published literature. AIMS The aim of this study was to establish incidence, risk factors, and outcomes for RICF after attempted removal of IVADs. METHODS A single institution retrospective review was undertaken of individuals ≤ 25 years undergoing removal of IVADs from October 2014 to June 2019. Risk factors for RICF were explored using univariable logistic and Cox regression analysis. RESULTS Six cases of RICF were identified among 654 line removal episodes (0.92% (95% CI 0.37-2%)) in patients aged 6-17 years (median 11, IQR 6-15 years). The main risk factor for RICF at removal was found to be line duration (OR 3.5/year, 95% CI 2.1-5.84, p < 0.0001). No RICFs occurred in lines indwelling for < 3 years. Five children with RICF ≤ 16 years were discussed with a paediatric cardiothoracic centre, and all were left in situ with 4 remaining asymptomatic. One had the fragment tip extruded through a wound, which required trimming. The other (17 years of age) developed an infected sinus for which partial removal with open excision followed by full removal with endovascular snare retrieval was performed by the adult vascular surgeons. CONCLUSION IVADs in-situ for longer than a three-year period are at greatest risk of RICF upon removal. Management with transfixion of line fragments to surrounding muscle seems prudent while invasive attempts at retrieval appear unwarranted.
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Affiliation(s)
- Joseph Rassam
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Georgina Bough
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Go Ito
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - William Mullins
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Anna-May Long
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
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Teague WJ, Fouad D, Munro FD, McCabe AJ. Complicated vascular access port removals: incidence, antecedents and avoidance. Pediatr Surg Int 2015. [PMID: 26224323 DOI: 10.1007/s00383-015-3754-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Port removal is usually a straightforward procedure delegated to trainees. However, some port removals are complicated by central venous catheter (CVC) fragmentation, a challenge for even experienced surgeons. This study aimed to determine the incidence of, and risk factors for, complicated port removal in children. METHODS A single-centre study assessed the outcome of removal for all paediatric ports inserted from 1996 to 2012. Data were recorded detailing patient, insertion, device and removal characteristics. Risk factors for complicated removals were scrutinised using Chi-square tests; p < 0.05 significant. RESULTS Of 628 ports inserted from 1996 to 2012, 443 were subsequently removed at the same centre. 8/443 (1.8%) removals were complicated by CVC fragmentation, a median of 3.3 (2.4-3.9) years after insertion. Of complicated cases, 8/8 underwent formal neck dissection, 3/8 intravascular dissection, and 1/8 endovascular retrieval. 2/8 cases have retained intravascular CVC fragments. Risk factors for complication were CVC caliber <6Fr (p < 0.001) and use duration >2 years (p < 0.001). CONCLUSION Greatest care and senior supervision should be ensured when removing ports with CVC caliber <6Fr and/or >2 years since insertion. However, complications also occur with larger CVCs or after shorter durations. Therefore, the key to avoiding complicated port removal may simply be: preparation, preparation, neck preparation.
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Affiliation(s)
- Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Melbourne, VIC, 3052, Australia,
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A Dedicated Protocol and Environment for central venous Catheter removal in Pediatric Patients Affected by Onco-Hematological Diseases. J Vasc Access 2014; 15:486-91. [DOI: 10.5301/jva.5000277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The removal of long-term central venous catheters (CVCs) is not performed according to evidence-based guidelines, thus conveying the message that it is a procedure of secondary importance. Our study aims at comparing the experience at Bambino Gesù Pediatric Hospital before and after the implementation of a dedicated protocol and the identification of a specific area to perform such a procedure under the so-called nonoperating room anesthesia (NORA). Methods Starting on January 1, 2010, an appropriate protocol regarding long-term CVC removal was applied. Then, data from all patients who underwent CVC removal under NORA regimen were compared with patients who have undergone the same procedure before the beginning of such protocol in terms of complication rate, duration of procedure, and costs. Results Between January 2010 and December 2012, 266 patients were evaluated for long-term CVC removal under a NORA regimen. Of these, 194 underwent the procedure. In the period from January 2007 to December 2009, 60 out of 82 patients scheduled for elective removal of long-term CVC in the operating theatre were eligible for this study. Median procedure time was 7 min for removal in NORA and 10 min for the operating theatre (p=0.016); no complications occurred. Conclusion Long-term CVC removal is an often-neglected procedure, carrying a small, but definite rate of complications. Our study shows that CVC removal performed in NORA regimen is safe and feasible, also allowing multiple procedures in the same session with prompt management of possible complications and reduction of the anxiety and pain associated with the procedure.
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Chan BKY, Rupasinghe SN, Hennessey I, Peart I, Baillie CT. Retained central venous lines (CVLs) after attempted removal: an 11-year series and literature review. J Pediatr Surg 2013; 48:1887-91. [PMID: 24074662 DOI: 10.1016/j.jpedsurg.2013.01.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 01/09/2013] [Accepted: 01/26/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Central venous lines (CVLs) are frequently used in the management of many neonatal and pediatric conditions. Failure to remove the luminal part of the line (retained CVL) is rare. Consequently, there is lack of experience and consensus in its optimal management. AIM To document the incidence and management of retained CVLs in a tertiary pediatric surgical centre with access to interventional cardiology services. To review the literature and report efficacy/morbidity of attempted extraction of retained CVLs. METHODS Children with retained CVLs were identified from departmental morbidity and mortality records over an 11-year period. A literature search was performed in PubMed and Scopus to identify studies reporting retained CVLs (earliest date to 1 January 2012). This was supplemented by scanning bibliographies of retrieved articles. RESULTS The 11-year incidence of retained CVL was 0.3% (n=10; median duration in-situ 66.5 {range 47-146} months). The underlying pathology in 8 was cystic fibrosis. Antegrade transfemoral snare retrieval was successful in 6 of 7 attempts. In the remaining 3, a conservative approach was adopted following consultation with the family. None of the 4 with retained CVL developed complications (median follow-up 7.5 {range 1-53} months). The literature describes 38 pediatric index cases (including 10 from the current series). Seventeen (49%) were managed conservatively either intentionally or by default after failed endovascular removal attempt (n=4). No complications directly attributed to retained CVLs have been reported (median follow-up 40 {range 1-120} months). Reported morbidity associated with endovascular retrieval includes: procedural failure 30%, line embolization 8%, and intra-operative thrombo-embolism 8%. CONCLUSION Literature regarding management of retained CVLs is anecdotal. Although uncommon, the complication should feature in consent for removal of CVLs. Conservative management carries long-term risks of infection, thrombosis, and even migration, albeit unquantified over a child's lifetime. Endovascular retrieval is feasible with appropriate expertise.
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Affiliation(s)
- B K Y Chan
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool L12 2AP, United Kingdom.
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