Abstract No. 47: Percutaneous transhepatic tunneled catheter for long term venous access in children with short gut syndrome

Abstract

Retrospective review of trans-hepatic catheters placed in children with short gut syndrome in our institution in the past two years. Three males and one female (age 2–12 years, mean 6.75 years) with short gut syndrome and poor venous access had 22 trans-hepatic catheters for TPN (7 new trans-hepatic placements, 12 over the wire exchanges, three replacements through the tract. The success rate and complications of trans-hepatic catheter placement were assessed. Trans-hepatic catheters were placed through right (n=4) or middle hepatic vein (n=2) in right upper quadrant. Left hepatic vein was used in one patient who developed collection around the right lobe of liver. All patients had successful placement, replacement through existing tract or exchange of catheters. The primary functionality of trans-hepatic catheter was 50.4 days and secondary functional rate was 24.93 days. Catheter related infection was the cause of over the wire exchange in 7 instances, and malfunction in 5 instances. The infection rate was 9.6/1000 catheter days and malfunction rate was 20.63/1000 catheter days. One of the patients had three episodes of fungemia in the catheters placed in Right hepatic vein approach n=1, left hepatic vein approach n=1 which was successfully managed with antifungal and over the wire exchanges. Complications associated with trans-hepatic catheter placement included transperitoneal migration of the catheter leading inadvertent spillage and collection of TPN into peritoneal cavity (n=1) which was managed by collection drainage and placement of new left sided transhepatic catheter. Seroma in subcutaneous tissues (n=1) was noted in one patient. Transhepatic central venous catheter can be placed with a high success rate. However catheter related infection rate is high and mechanical problems like clogging, dislodgement rates are high. Replacement of the catheter through existing mature tract is possible without complications. Catheter migration into peritoneum can occur. In patients with fungemia successful exchange of catheter over the wire can be performed after treatment with antifungal agents.