Abstract

BackgroundTotally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients.MethodsFrom January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery.Results45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3–15.6; SD ± 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection.ConclusionProspective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.

Highlights

  • Implanted vascular access (TIVA) devices are frequently used in children with long-term requirements for blood samples or intravenous treatments [1,2]

  • Platelet count under 60 × 109/L ; absolute neutrophil count under 500/mm3; International Normalized Ratio (INR) above 1.25 or an activated partial thromboplastin time greater than 40s were all considered temporary contra-indications for surgery

  • The right subclavian vein was chosen in 64% of cases, right internal jugular vein in 25%, left subclavian vein in 11%

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Summary

Introduction

Implanted vascular access (TIVA) devices are frequently used in children with long-term requirements for blood samples or intravenous treatments [1,2]. The rate of TIVA-associated complications seems related to the duration of implantation, type of perfusion (bolus vs slow perfusion), and skin commensal germs [8]. No pediatric studies so far has addressed the relationship between the complication rates and the number of accesses to the TIVA device. Implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients

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