1
|
Koretsune Y, Sugawara S, Sone M, Higashihara H, Arakawa A, Ogawa C, Kusumoto M, Tomiyama N. Inversion of Central Venous Ports in Children Under Six Years Old: A Retrospective Analysis of 154 Oncology Patients. Cureus 2024; 16:e63106. [PMID: 39055458 PMCID: PMC11271187 DOI: 10.7759/cureus.63106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background Although some reports have evaluated the safety and efficacy of central venous port (CVP) placement in pediatric patients, the data about the inversion rate of the device and its risk factors are scarce. Therefore, this study aimed to evaluate the inversion rates of CVPs and their associated risk factors in pediatric patients. Methodology Between January 2010 and December 2021, 154 consecutive children (75 boys; median age, 28.5 months; range, 2-71 months) who underwent CVP placement at our center were included in this study. The primary outcome was the CVP inversion rate, and the secondary outcomes included technical success rate, intraoperative complications, and infectious complications. Intraoperative complications were evaluated according to the Society of Interventional Radiology guidelines. Patients under two years old were classified as the younger group and those aged ≥two years as the older group. Results The CVP inversion rate was 4.6% (n = 7/153), equivalent to 0.08 × 1,000 catheter-days. The inversion rate was significantly higher in the younger group (under two years old, 11.2%) than in the older group (≥two years old, 1.0%) according to the univariate analysis (p = 0.00576). The technical success rate was 99.4% (n = 153/154), and mild adverse events were observed during the procedure in three (1.9%) patients. Infectious complications were observed in 16 (10.5%) patients, equivalent to 0.19 × 1,000 catheter-days. Conclusions The CVP inversion rate was significantly higher in younger children (under two years old) than in older children (≥two years old).
Collapse
Affiliation(s)
- Yuji Koretsune
- Diagnostic and Interventional Radiology, Osaka University, Osaka, JPN
| | | | - Miyuki Sone
- Diagnostic Radiology, National Cancer Center Hospital, Tokyo, JPN
| | - Hiroki Higashihara
- High Precision Image-Guided Percutaneous Intervention, Osaka University Hospital, Osaka, JPN
| | - Ayumu Arakawa
- Pediatrics, National Cancer Center Hospital, Tokyo, JPN
| | - Chitose Ogawa
- Pediatric Oncology, National Cancer Center Hospital, Tokyo, JPN
| | | | - Noriyuki Tomiyama
- Diagnostic and Interventional Radiology, Osaka University, Osaka, JPN
| |
Collapse
|
2
|
Aguado A. Role of Interventional Radiology in Pediatric Cancer Patients. Curr Oncol Rep 2022; 24:1731-1740. [PMID: 36057070 DOI: 10.1007/s11912-022-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Pediatric interventional radiology (IR) is a growing subspecialty. Here, we review the current role of IR in children with cancer, which uses imaging such as ultrasound, fluoroscopy, and computed tomography to perform minimally invasive procedures. These include biopsy, needle localization, central venous access, thermal ablation, transarterial chemoembolization, transarterial radioembolization with yttrium-90, non-tunneled/tunneled drainage catheter placement, and lymphatic interventions. RECENT FINDINGS Although locoregional therapies for the treatment of cancer in adults are common, they are less common in children, perhaps due to the relative rarity of cancer in children, their typically better performance status, and paucity of comorbidities. Preliminary results from small-scale studies for ablation, transarterial chemoembolization, and transarterial radioembolization with yttrium-90 used in the front-line armamentarium of curative therapy are encouraging. Pediatric IR offers an array of minimally invasive procedures intended to diagnose and treat pediatric cancer patients. However, more research is required to determine the efficacy of locoregional therapy in children and to define the clinical scenarios where benefit is likely to be optimized.
Collapse
Affiliation(s)
- Allison Aguado
- Division of Interventional Radiology, Nemours Children's Health, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| |
Collapse
|
3
|
Ding W, Qiu L, Li T, Su W, Yu Q, Hu T, Wang C, Fan C, Wang W. Ultrasound-guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut. Pediatr Blood Cancer 2022; 69:e29911. [PMID: 35880972 DOI: 10.1002/pbc.29911] [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: 04/05/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the feasibility and safety of ultrasound-guided totally implantable venous access ports (TIVAPs) via the right brachiocephalic vein (BCV) in pediatric patients. METHODS A single-institute retrospective review was performed on 35 pediatric patients with predominantly hematological malignancies (88.6%) who underwent TIVAP implantation via ultrasound-guided right BCV approach from July 2018 to June 2021. The catheter tip was adjusted to be positioned at the cavoatrial junction under pulsed fluoroscopic guidance. Technical success rate, procedural information, and TIVAP-related complications were evaluated. RESULTS All the pediatric TIVAP devices were successfully implanted via right BCV access. Venous access was successful by first attempt in 32 children (91%), two cases (5.7%) required a second attempt, and one patient (2.9%) required a third attempt. The mean procedural time was 44.6 ± 6.4 minutes (range: 34-62 minutes). No intraoperative complications occurred. The average TIVAP indwelling time was 564 ± 208 days (range: 193-1014 days), with a cumulative 19,723 catheter-days. Overall, three patients (8.6%) experienced four postoperative complications (two cases of local hematoma and two catheter dysfunctions) at a rate of 0.2 per 1000 catheter-days. No other complications such as wound dehiscence, delayed incision healing, catheter-related thrombosis (CRT), catheter malposition/fracture, surgical site infection, catheter-related bloodstream infection (CRBSI), pinch-off syndrome, and drug extravasation were observed during follow-up. CONCLUSIONS Ultrasound-guided right BCV access for TIVAP placement in pediatric patients appears to be technically feasible, safe, and effective. Further large-sample, prospective studies are warranted.
Collapse
Affiliation(s)
- Wei Ding
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Lu Qiu
- Department of Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Tianyu Li
- Department of Hematology and Oncology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Weiwei Su
- Department of Cardiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Qian Yu
- Division of Interventional Radiology, Department of Radiology, Medical Center, University of Chicago, Chicago, Illinois, USA
| | - Tianshen Hu
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunxin Wang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chen Fan
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Weidong Wang
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| |
Collapse
|
4
|
Zhang JJ, Nataraja RM, Lynch A, Barnes R, Ferguson P, Pacilli M. Factors affecting mechanical complications of central venous access devices in children. Pediatr Surg Int 2022; 38:1067-1073. [PMID: 35513517 PMCID: PMC9163013 DOI: 10.1007/s00383-022-05130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Factors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications. METHODS Retrospective (2016-2021) review of children (< 18 years old) receiving a CVAD. Data, reported as number of cases (%) and median (IQR), were analysed by Fisher's exact test, chi-squared test and logistic regression analysis. RESULTS In total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p < 0.0001). Hickman lines had a higher incidence of complications compared to implantable port devices [24/91 (26.3%) vs 30/226 (13.3%); p = 0.008]. CONCLUSION Mechanical complications occur in 17% of CVADs at a median of < 6 months after insertion. Risk factors include younger age and lower weight. Implantable port devices have a lower complications rate. LEVEL OF EVIDENCE Level 4: case-series with no comparison group.
Collapse
Affiliation(s)
- Jessica J Zhang
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Amiria Lynch
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia
| | - Peter Ferguson
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia.
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.
| |
Collapse
|