Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 41944, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Gumi Hospital, Gumi, 39371, Republic of Korea.
BMC Surg. 2021 Jun 2;21(1):276. doi: 10.1186/s12893-021-01271-7.
Totally implantable central venous access ports (TICVAPs) have increasingly been used in pediatric patients because they provide reliable venous access. However, many complications associated with TICVAPs have been reported. Here, we aimed to analyze the risk factors of stuck fragment of TICVAPs during removal in children and recommend the appropriate periods of use or exchange.
We retrospectively reviewed the medical records of 121 patients, including 147 cases of TICVAP insertion, between January 2010 and July 2020.
Among these, 98 cases in 72 patients involved of TICVAP removal, with 8 patients having had incomplete TICVAP removal resulting in a stuck fragment of the catheter in the central venous system (Group S). All Group S patients were male and had acute leukemia, and their TICVAPs were used for chemotherapy. Compared with the complete removal group (Group N), stuck fragment in Group S were significantly found in patients diagnosed with acute leukemia than those with other diagnoses (p < 0.001). Indwelling duration and body weight change during TICVAP indwelling were significantly longer and larger in Group S, respectively (p < 0.001). In multivariate logistic regression analysis, indwell duration (odds ratio [OR], 1.13; 95% confidence interval [Cl] 1.02-1.37, p = 0.10), body weight change during indwell (OR, 1.00; 95% Cl 0.83-1.18, p = 0.97), and platelet count at TICVAP insertion (OR, 0.98; 95% Cl 0.95-0.99; p = 0.48) showed an increased trend of risk for a stuck catheter.
We suggest prophylactic catheter exchange before indwell duration of 46 months (area under the curve [AUC], 0.949; 95% Cl 0.905-0.993) and body weight change up to 9.9 kg (AUC, 0.903; 95% Cl 0.840-0.966) to prevent a catheter from becoming stuck, especially in children with rapidly growing acute leukemia. Management of a stuck fragment remains controversial in asymptomatic patients, and we suggest careful, close observation rather than aggressive and invasive treatment.
全植入式中心静脉通路端口（TICVAP）因其提供可靠的静脉通路而在儿科患者中越来越多地使用。然而，已经报道了许多与 TICVAP 相关的并发症。在这里，我们旨在分析儿童 TICVAP 取出过程中导管碎片嵌顿的风险因素，并建议适当的使用或更换时间。
我们回顾性分析了 2010 年 1 月至 2020 年 7 月期间 121 例患者（147 例 TICVAP 置入）的病历。
其中 98 例患者（72 例患者）进行了 TICVAP 取出，8 例患者出现不完全 TICVAP 取出，导致导管残端嵌顿于中心静脉系统（S 组）。所有 S 组患者均为男性，患有急性白血病，且 TICVAP 用于化疗。与完全取出组（N 组）相比，S 组患者中诊断为急性白血病的患者明显多于其他诊断（p<0.001）。S 组患者 TICVAP 留置期间导管留置时间和体重变化明显较长和较大（p<0.001）。多变量 logistic 回归分析显示，导管留置时间（比值比 [OR]，1.13；95%置信区间 [CI] 1.02-1.37，p=0.10）、导管留置期间体重变化（OR，1.00；95%CI 0.83-1.18，p=0.97）和 TICVAP 置入时血小板计数（OR，0.98；95%CI 0.95-0.99；p=0.48）呈风险增加趋势。
我们建议在导管留置时间超过 46 个月（AUC，0.949；95%CI 0.905-0.993）和体重变化达 9.9kg（AUC，0.903；95%CI 0.840-0.966）时预防性更换导管，以防止导管堵塞，尤其是在急性白血病生长迅速的儿童中。无症状患者导管碎片嵌顿的处理仍存在争议，我们建议密切观察，而不是积极和侵入性的治疗。
