Geremia Caterina, De Ioris Maria Antonietta, Crocoli Alessandro, Adorisio Ottavio, Scrocca Raffaella, Lombardi Mary Haywood, Staccioli Susanna, Stella Pietro, Amendola Paola, Ciliento Gaetano, De Peppo Francesco, Campana Andrea
Pediatrics, University Department of Pediatrics, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome - Italy.
Pediatric Surgery Unit, Department of Pediatric Surgery and Transplantation Center, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome - Italy.
J Vasc Access. 2017 Sep 11;18(5):426-429. doi: 10.5301/jva.5000727. Epub 2017 May 24.
Children with special health-care needs are an emerging and consistent population. In a subset of children with medical complexity (CMC) a continuous access to the central vascular system is advisable to eliminate unnecessary pain and stress and to improve home management and palliative care.
The surgical registry of a tertiary hospital was checked in order to identify CMC who underwent totally implantable venous access device (VAD) placement. Medical records were reviewed.
From October 2009 to August 2014, a totally implantable VAD was placed in 10 children. Seven out of 10 patients were affected by cerebral palsy while 3 presented a genetic syndrome. The median duration of the indwelling catheter was 31 months (range 5 to 77 months). Six catheters are still in place since the first placement. Infectious complications were observed in two patients, respectively, a Candida albicans and a Staphylococcus aureus colonization; in both cases the VAD was removed. In another two cases, removal was planned for reservoir dislodgment within the subcutaneous tissue. No other major complications were observed during the procedure and the follow-up period. Emergency admissions decreased from a median value of 0.4/month (range 0-1.5/month) to 0.2/month (range 0-0.6/month) after the VAD placement.
A totally implanted VAD in CMC is safe and manageable. As expected, infection seems to be the major complication with no infection-related death. Malnutrition and musculoskeletal deformities, which are frequent comorbidities in CMC, should be considered to reduce the risk of dislodgment/migration.
有特殊医疗需求的儿童是一个不断涌现且持续存在的群体。对于一部分患有复杂疾病的儿童（CMC），建议持续接入中心血管系统，以消除不必要的疼痛和压力，并改善家庭管理与姑息治疗。
检查一家三级医院的手术登记记录，以确定接受完全植入式静脉通路装置（VAD）植入的CMC患者。对病历进行回顾。
2009年10月至2014年8月，10名儿童接受了完全植入式VAD植入。10名患者中有7名患有脑瘫，3名患有遗传综合征。留置导管的中位时长为31个月（范围5至77个月）。自首次植入以来，6根导管仍在位。两名患者分别出现感染并发症，白色念珠菌和金黄色葡萄球菌定植；两例均移除了VAD。另外两例因皮下组织内储液器移位而计划移除。在手术过程及随访期间未观察到其他主要并发症。VAD植入后，急诊入院次数从中位值0.4次/月（范围0 - 1.5次/月）降至0.2次/月（范围0 - 0.6次/月）。
在CMC患者中，完全植入式VAD安全且易于管理。正如预期的那样，感染似乎是主要并发症，且无感染相关死亡。应考虑到营养不良和肌肉骨骼畸形这两种CMC常见的合并症，以降低移位/迁移风险。
