Incidence and outcome of retained Port-A-Cath fragments during removal

Aworanti, Olugbenga Michael; Linnane, Niall; Tareen, Farhan; Mortell, Alan

doi:10.1007/s00383-017-4103-6

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…No additional treatment was offered because the patient remained asymptomatic [4]. This is consistent with the findings of Aworanti et al that suggested that chronic use of CVC is a common factor when retained catheters are encountered [1]. In this study, out of 174 pediatric CVC insertions and 135 subsequent removals, three patients (2.2%) failed removal; all three patients had had their CVC for greater than six years.…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, the CVC erosion into the intima caused an inflammatory response that created a calcified “cast” within the vessel wall. The mechanism behind CVC retention is likely linked to this calcified “cast.” According to Aworanti et al, the typical fibrin sheath that develops around a catheter can undergo epithelialization, calcification, and then adhere to the tunica intima of the vein wall [1]. While vascular calcifications typically occur in arteries, a central vein calcification is rare but has been described [4].…”

Section: Discussionmentioning

confidence: 99%

“…Central venous catheters (CVC) are commonly used across multiple medical specialties and are inserted for various reasons, such as administration of long-term antibiotics, parenteral nutrition, and chemotherapy. A serious, but rare, complication of CVC is fracture and retention of residual catheter, in up to 2.2% of all line insertions [1]. There are multiple case reports describing catheter rupture and migration to the right ventricle (reviewed in [2]).…”

Section: Introductionmentioning

confidence: 99%

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Chronically Retained Central Venous Catheter in Deceased Donor Liver Allograft

Zielsdorf

Kelly²,

Genyk

et al. 2019

Case Reports in Transplantation

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Central venous catheters (CVC) are commonly used across multiple medical specialties and are inserted for various reasons. A known, but rare, serious complication of CVC is fracture and retention of residual catheter. Here we describe a chronically retained catheter within the inferior vena cava (IVC) that was asymptomatic and neither diagnosed nor addressed until time of deceased donor liver donation. Prior to transplantation into the recipient, the retained catheter was removed, and a venoplasty of the suprahepatic IVC, middle hepatic vein, and left hepatic vein was performed with no significant issues after transplant in the recipient. With the persistent shortage of suitable organs for transplant leading to patients dying on the waiting list, every good quality organ should be carefully considered. Thus, even though a chronically retained, fractured CVC in a deceased organ donor presents a unique challenge, it can be managed surgically and should not be considered a contraindication to organ utilization.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronically Retained Central Venous Catheter in Deceased Donor Liver Allograft

Zielsdorf

Kelly²,

Genyk

et al. 2019

Case Reports in Transplantation

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“…The incidence of stuck catheters is not exactly known, and different results have been reported with an incidence ranged from 0.3 to 2.2% [21]. The long duration of the catheter was the main predisposing factor to this complication [22,23]. To facilitate removal, a second incision was required in 4 patients and venotomy in 2 patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and clinical outcome of the port-a-cath in children: a tertiary care-center experience

Bawazir

Banoon

2020

World J Surg Onc

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Background Implanted vascular access devices play an essential role in the management of pediatric patients. The objectives of this study were to assess our experience with port-a-cath insertion in pediatric patients, report its complications, and compare open versus percutaneous approaches. Methods We performed a retrospective cohort study, including 568 patients who underwent port-a-cath insertion between 2013 and 2019 in our center. We grouped the patients according to the technique of insertion into two groups: group 1 (n = 168) included patients who had the open approach and group 2 (n = 404) included patients who had the percutaneous technique. (p < 0.001). Results Patients in group 1 were younger (4.10 ± 3.45 years) compared to patients in group 2 (5.47 ± 3.85 years). The main indications of insertion were hematological malignancy 57.74% (n = 328), solid organ malignancy 25.18% (n = 143), pure hematological diseases 5.46% (n = 31), metabolic diseases 2.64% (n = 15), and others for poor vascular access 8.8% (n = 50). The most common site for insertion in group 1 was the left external jugular (n = 136; 82.98%) and the left subclavian in group 2 (n = 203; 50.25%). Two hundred and two patients had a central line before catheter insertion (36.6%). Complications during insertion were comparable between both groups (p = 0.427). The catheter got stuck in 6 patients; all required additional incision and two needed venotomy. The most common reason to remove the catheter was the completion of the treatment (63.69% and 61.14%, in groups 1 and 2, respectively). The duration of the catheter was comparable between the two groups (13.14 ± 14.76 vs. 14.44 ± 14.04 months in group 1 vs.2; p = 0.327). Conclusions Open and percutaneous port-a-cath insertions are safe in children with chronic diseases. Port-a-cath improved patients’ management, and complications are infrequent. The most common complications are infection and catheter malfunction, which can be managed without catheter removal in some patients.

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“…The vasculature around the indwelling catheter can be distorted with collaterals impinging on arterial vessels [25] . This makes port-a-caths difficult to remove, and fragments are often retained in the central vein following an attempt at removal [26] .…”

Section: Discussionmentioning

confidence: 99%

The use of port-a-caths in adult patients with Lysosomal Storage Disorders receiving Enzyme Replacement Therapy-one centre experience

McLoughlin

Stępień

McNelly

et al. 2017

Molecular Genetics and Metabolism Reports

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Port-a-cath is a widely used device in patients with long-term venous access demand such as frequent or continuous administration of medications such as Enzyme Replacement Therapy (ERT), chemotherapy delivery, blood transfusions, blood products, and fluids. Patients with Lysosomal Storage Diseases (LSDs) often require recurrent courses of ERT. We reviewed our experience of using port-a-caths in patients with LSDs with the focus on challenges and complications associated with these catheters. Among 245 adult patients who were treated with ERT, twenty patients (8.2%) had a port-a-cath inserted due to poor venous access. Six patients were using their first port whereas five other patients had their port-a-caths replaced at least once. The remaining six patients had inactive port-a-caths. The majority of patients with active port-a-caths never missed more than one consecutive infusion, although one patient missed 2 consecutive infusions whilst on holiday. We identified significant gaps in patients' and their families' understanding of the management of port-a-caths and risks associated with them. It resulted in producing a leaflet and designing an educational program for our LSD patients.

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Incidence and outcome of retained Port-A-Cath fragments during removal

Abstract: Port-A-Caths that are retained after attempted removal is a complication encountered predominantly in catheters that have been in use for a prolonged duration. Furthermore, factor replacement therapy in haemophiliacs may be a risk factor for this complication.

Cited by 10 publications

References 18 publications

Chronically Retained Central Venous Catheter in Deceased Donor Liver Allograft

Chronically Retained Central Venous Catheter in Deceased Donor Liver Allograft

Efficacy and clinical outcome of the port-a-cath in children: a tertiary care-center experience

The use of port-a-caths in adult patients with Lysosomal Storage Disorders receiving Enzyme Replacement Therapy-one centre experience

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