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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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Chiaretti A, Pittiruti M, Sassudelli G, Conti G, Rossi M, Pulitanò SM, Mancino A, Pusateri A, Gatto A, Tosi F. Comparison between sedation room and operating room in central venous catheter positioning in children. J Vasc Access 2020; 22:184-188. [PMID: 32564667 DOI: 10.1177/1129729820932415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Placement of central venous access devices is a clinical procedure associated with some risk of adverse events and with a relevant cost. Careful choice of the device, appropriate insertion technique, and proper management of the device are well-known strategies commonly adopted to achieve an optimal clinical result. However, the environment where the procedure takes place may have an impact on the overall outcome in terms of safety and cost-effectiveness. METHODS We carried out a retrospective analysis on pediatric patients scheduled for a major neurosurgical operation, who required a central venous access device in the perioperative period. We divided the patients in two groups: in group A the central venous access device was inserted in the operating room, while in group B the central venous access device was inserted in the sedation room of our Pediatric Intensive Care Unit. We compared the two groups in terms of safety and cost-effectiveness. RESULTS We analyzed 47 central venous access devices in 42 children. There were no insertion-related complications. Only one catheter-related bloodstream infection was recorded, in group A. However, the costs related to central venous access device insertion were quite different: €330-€540 in group A versus €105-€135 in group B. CONCLUSION In the pediatric patient candidate to a major neurosurgical operation, preoperative insertion of the central venous access device in the sedation room rather than in the operating room is less expensive and equally safe.
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Affiliation(s)
- Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giovanni Sassudelli
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Marco Rossi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Silvia Maria Pulitanò
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Angela Pusateri
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Federica Tosi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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