Cephalic vein cutdown for totally implantable central venous port in children: A retrospective analysis of prospectively collected data

Abstract

The goal of this study was to evaluate the feasibility of a totally implantable central cephalic vein port (TICVP) cutdown in children for whom percutaneous techniques are not practical and to improve the success rate of this procedure. The authors gave 143 children (90 boys, 53 girls) a TICVP between 2002–2006 inclusive who were followed until March 2007; the median age was 52 months. The indications for the port implantation were chemotherapy, long-term intravenous antibiotics and total parenteral nutrition. All patients had an attempted cephalic vein (CV) cutdown for which the authors defined an arbitrary cutoff point at 8 months of age and a body weight of 15 kg. Port-a-Cath (Jan 2002–2005) and Celiste (Jan 2006-Dec 2006) were used and the median port duration was 568 days. All of the procedures were performed under general anesthesia. The incision started from the delto-pectoral triangle and ran for 4–5 cm medially, parallel to the inferior margin of the clavicle. The CV was located in the delto-pectoral groove. The single incision has a cosmetic advantage over the 2-incision approach that is usually required for the external jugular vein (EJV) or the internal jugular vein (IJV). The length of the catheter was determined so that the tip was located at the junction of the superior vena cava and right atrium and this was confirmed intra-operatively by chest x-ray. If the CV was absent or its caliber was too small for the catheter, an EJV cutdown was attempted; if the latter failed, an IJV cutdown was the final option. Of the 143 cases, CV accounted for 73 (51%), EJV 39 (27%) and LIV 31 (22%). The overall success rate for the CV cutdown was 61.9%. Intra-operative complication rates are consistently lower with surgical methods compared with the fluoroscopy-guided percutaneous subclavian puncture by interventional radiologists. There were 8.2% postoperative complications, mostly infections. The most frequent cause of failure was small caliber CV; the success rate would be improved by avoiding the small caliber CV on the basis of the authors’ reference body weight of 15 kg.