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Complicated vascular access port removals: incidence, antecedents and avoidance

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Abstract

Purpose

Port removal is usually a straightforward procedure delegated to trainees. However, some port removals are complicated by central venous catheter (CVC) fragmentation, a challenge for even experienced surgeons. This study aimed to determine the incidence of, and risk factors for, complicated port removal in children.

Methods

A single-centre study assessed the outcome of removal for all paediatric ports inserted from 1996 to 2012. Data were recorded detailing patient, insertion, device and removal characteristics. Risk factors for complicated removals were scrutinised using Chi-square tests; p < 0.05 significant.

Results

Of 628 ports inserted from 1996 to 2012, 443 were subsequently removed at the same centre. 8/443 (1.8 %) removals were complicated by CVC fragmentation, a median of 3.3 (2.4–3.9) years after insertion. Of complicated cases, 8/8 underwent formal neck dissection, 3/8 intravascular dissection, and 1/8 endovascular retrieval. 2/8 cases have retained intravascular CVC fragments. Risk factors for complication were CVC caliber <6Fr (p < 0.001) and use duration >2 years (p < 0.001).

Conclusion

Greatest care and senior supervision should be ensured when removing ports with CVC caliber <6Fr and/or >2 years since insertion. However, complications also occur with larger CVCs or after shorter durations. Therefore, the key to avoiding complicated port removal may simply be: preparation, preparation, neck preparation.

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Acknowledgments

The authors wish to acknowledge the children, families and surgeons whose cases are represented in this series.

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Authors and Affiliations

  1. Department of Paediatric Surgery, The Royal Children’s Hospital, 50 Flemington Road, Melbourne, VIC, 3052, Australia

    Warwick J. Teague

  2. Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia

    Warwick J. Teague

  3. Department of Paediatrics, Royal Children’s Hospital, University of Melbourne, Parkville, Melbourne, Australia

    Warwick J. Teague

  4. Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK

    Dina Fouad, Fraser D. Munro & Amanda J. McCabe

Authors
  1. Warwick J. Teague
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  2. Dina Fouad
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  3. Fraser D. Munro
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  4. Amanda J. McCabe
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Corresponding author

Correspondence to Warwick J. Teague.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was not supported by any grant bodies, scholarships or other financial support.

Ethical standards

As stated in the manuscript, this project was assessed by the South East Scotland Research Ethics Service and deemed to not need NHS ethical review under the terms of the UK Health Department’s Governance Arrangements for Research Ethics Committees (A Harmonised Edition), 2011.

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Teague, W.J., Fouad, D., Munro, F.D. et al. Complicated vascular access port removals: incidence, antecedents and avoidance. Pediatr Surg Int 31, 859–864 (2015). https://doi.org/10.1007/s00383-015-3754-4

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  • DOI: https://doi.org/10.1007/s00383-015-3754-4

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