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Pediatr Radiol. 2019 Sep;49(10):1354-1361. doi: 10.1007/s00247-019-04470-w. Epub 2019 Jul 13.

Evaluation of implanted venous port-a-caths in children with medical complexity and neurologic impairment.

Author information

1
Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. paymun.pezeshkpour@sickkids.ca.
2
University of Toronto, Toronto, ON, Canada. paymun.pezeshkpour@sickkids.ca.
3
Image Guided Therapy Centre, Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
4
University of Limerick, Limerick, Ireland.
5
Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
6
University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND:

Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication.

OBJECTIVE:

To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access.

MATERIALS AND METHODS:

We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath.

RESULTS:

Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0).

CONCLUSION:

Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.

KEYWORDS:

Children; Difficult venous access; Interventional radiology; Port-a-cath; Reduced morbidity; Technology dependence

PMID:
31302737
DOI:
10.1007/s00247-019-04470-w

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