Stuck fragment of totally implantable central venous access ports during removal: risk factor analysis in children

BackgroundTotally 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.MethodsWe retrospectively reviewed the medical records of 121 patients, including 147 cases of TICVAP insertion, between January 2010 and July 2020.ResultsAmong 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.ConclusionsWe 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.

Automated summary

Totally implantable central venous access ports (TICVAPs) are increasingly used in pediatric patients due to reliable venous access, but complications such as stuck fragments during removal have been reported. This study retrospectively analyzed 121 patients and found that male patients with acute leukemia who used TICVAPs for chemotherapy were more likely to have fragments stuck during removal. Recommendations include prophylactic catheter exchange before 46 months of use and monitoring weight changes to prevent complications, especially in rapidly growing leukemia patients. Management of stuck fragments in asymptomatic patients should involve careful observation rather than aggressive treatment.