Abstract
Purpose: Central venous access ports (CVAPs) are implanted to treat children with intestinal dysfunction and malignant disease. This paper aims to clarify problems with CVAP in pediatric patients. Methods: The clinical records of 98 CVAP implanted in children were retrospectively investigated. Age of patients was 4.9±4.2 years old, and 74 patients had malignant diseases. Numerical values are presented as mean ± standard deviation. Results: Body weight was 16.8±10.2 kg. In 98 catheters, 87 were inserted with cut-down procedure, 5 with exchange of a catheter from the same vein, 5 with subclavian venous puncture, and 1 with a purse-string suture. Operative time was 50±18 minutes. Of the total CVAPs, 23 were introduced with difficulty, and 2 could not be advanced to the central vein, because of venou variation. Period that CVAP remained in place was 594±432 days. Operative complications were found in 6 patients (postoperative bleeding, phlebitis, wound laceration, port infection, leakage); late complications in 18 patients (occlusion, catheter infection, leakage, phlebitis, skin necrosis). Reasons of CVAP removal were completion of treatment in 41, death in 19, exchange of a catheter in 5, occlusion in 9, infection in 3, leakage in 2, skin necrosis in 2, a broken port in 1, and unknown in 1. In 66 patients with malignant disease, 20 patients had been treated with anticancer drugs, and 26 patients had fallen in grade 4 bone marrow suppression within 10 days before operation. However, there were no differences between patients with benign disease and those with malignant disease in complication rate or period in place. Conclusions: Although the 23.5% of CVAPs led to difficulties in catheterization, 98.0% were successfully introduced into the central venous vein. Even in infants or patients with severe bone marrow suppression, CVAPs could be safely implanted, and long-term outcome was excellent. We should pay attention to prevention of occlusion and infection.
