Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

Abstract

Background Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. Objective To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. Materials and methods Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. Results Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. Conclusion Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.

Ultrasound‐guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut

“…Within the follow‐up period, our pediatric patients experienced the postoperative complications at a rate of 0.2 per 1000 catheter‐days within the cumulative 19,723 catheter‐days in the present study. This result is consistent with other published literature on children reporting complication rates ranging from 0.15 to 0.9 per 1000 catheter‐days 25,26 . However, the incidence of complications after TIVAP placement via the BCV approach in adults ranged from 2.83% to 5.08%, 21,22 with one article displaying a complication rate of 0.11 per 1000 catheter‐days 22 .…”

“…8 Likewise, Oulego-Erroz et al 17 This result is consistent with other published literature on children reporting complication rates ranging from 0.15 to 0.9 per 1000 catheter-days. 25,26 However, the incidence of complications after TIVAP placement via the BCV approach in adults ranged from 2.83% to 5.08%, 21,22 with one article displaying a complication rate of 0.11 per 1000 catheter-days. 22 Thus, it is easy to find that pediatric patients are associated with a higher incidence rate of complications 7,27,28 in comparison with adult patients.…”

“…Finally, fluoroscopy time was insufficient to express the procedure-related radiation exposure owing to the lack of the dose area product information. 26…”

“…Furthermore, this study is noncomparative in nature, comparative studies with IJV and/or SCV access are warranted to determine the safety and efficacy of BCV access. Finally, fluoroscopy time was insufficient to express the procedure‐related radiation exposure owing to the lack of the dose area product information 26 …”