Use of totally implantable venous port systems in children hematology clinic

Relevance. Reliable and long-term venous access is one of the most important condition for a successful leukemia therapy in children. Safe and convenient access to a central vein allows to provide chemotherapy, adjuvant treatment, parenteral nutrition and blood transfusion. It decreases the likelihood of phlebitis development and reduction of the peripheral venous network in comparison with peripheral venous access. The use of totally implantable venous port systems reduces risks of severe complications associated with re-catheterization of the central vein thus it improves patient’s quality of life.

The purpose of the study is a retrospective assessment of the experience of use and analysis of the complications of totally implantable venous port systems in children with diseases of the blood system.

Materials and methods. The data of 61 patients of the pediatric hematology clinic with venous port systems have been analyzed.

Results. Perioperative complications developed in 3 (4.9 %) patients Median time of using of port systems was 679 catheter-days. Delayed complications requiring removal of the device developed in 8 (13.1 %) patients. Infectious complications were the reason for device removal in 3 (2.9 %) patients, mechanical complications in 5 (8.2 %) patients. No thrombotic complications were found.

Conclusions. The use of venous port systems in children with hematologic diseases for a long period of time is an effective and safe way for central venous access providing.

1. Ince E., Oğuzkurt P., Temiz A., Ezer S.S., Gezer H.Ö., Yazici N., Hiçsönmez A. Complications of total implantable access ports and effi cacy of Taurolidine-citrate lock solution against catheter-related infections. Afr J Paediatr Surg 2014;11(2):138-42. https://doi.org/10.4103/0189-6725.132806.

2. Kornbau C., Lee K.C., Hughes G.D., Firstenberg M.S. Central line complications. Int J Crit Illn Inj Sci 2015;5(3):170-8. https://doi.org/10.4103/2229-5151.164940.

3. Crocoli A., Tornesello A., Pittiruti M., Barone A., Muggeo P., Inserra A., Molinari A.C., Grillenzoni V., Durante V., Cicalese M.P., Zanazzo G.A., Cesaro S. Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology. J Vasc Access 2015;16(2):130-6. https://doi.org/10.5301/jva.5000314.

4. Broviac J.W., Cole J.J., Scribner B.H. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973;136:602-6. PMID: 4632149.

5. Hickman R.O., Buckner C.D., Clift R.A., Sanders J.E., Stewart P., Thomas E.D. A modifi ed right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 1979;148:871-5. PMID: 109934.

6. Nam S-H., MD, Kim D-Y., Kim S-C., Kim I-K. Complications and Risk Factors of Infection in Pediatric Hemato-Oncology Patients With Totally Implantable Access Ports (TIAPs). Pediatr Blood Cancer 2010;54:546-51. https://doi.org/10.1002/pbc.22286.

7. Niederhuber J.E., Ensminger W., Gyves J.W., Liepman M., Doan K., Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 1982;92:706-12. PMID: 7123491.

8. Munro F.D., Gillett P.M., Wratten J.C., Shaw M.P., Thomas A., MacKinlay G.A., Wallace W.H. Totally implantable central venous access devices for paediatric hematology-oncology patients. Med Pediatr Oncol 1999;33:377-81. https://doi.org/10.1002/(sici)1096-911x(199910)33:4<377::aid-mpo6>3.0.co;2-x.

9. Heibl C., Trommet V., Burgstaller S., Mayrbaeurl B., Baldinger C., Koplmuller R., Kuhr T., Wimmer L., Thaler J. Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: a single-centre prospective analysis. Eur J Cancer Care 2010;19:676-81. https://doi.org/10.1111/j.1365-2354.2009.01115.x.

10. Rykov M.Y., Polyakov V.G. Implantable venous ports in pediatric oncology: experience of single institution in Russia. J Vasc Access 2016;17(4):345-7. https://doi.org/10.5301/jva.5000556.

11. Babu R., Spicer R.D. Implanted vascular access devices (ports) in children: Complications and their prevention. Pediatr Surg Int 2002;18:50-3. https://doi.org/10.1007/s003830200011.

12. Samaras P., Dold S., Braun J., Kestenholz P., Breitenstein S., Imhof A., Renner C., Stenner-Liewen F., Pestalozzi B.C. Infectious Port Complications Are More Frequent in Younger Patients with Hematologic Malignancies than in Solid Tumor Patients. Oncology 2008;74:237-44. https://doi.org/10.1159/000151393.

13. Lyanguzov A.V., Kolotilov L.V., Zagoskina T.P. Rhabdomyolysis in Patients with Hemoblastoses during Intensive Chemotherapy. Obshchaya reanimatologiya = General Reanimatology 2009;5(4):60-5. (In Russ.)

14. Napolitano M., Saccullo G., Marietta M., Carpenedo M., Castaman G., Cerchiara E., Chistolini A., Contino L., De Stefano V., Falanga A., Federici A.B., Rossi E., Santoro R., Siragusa S. Platelet cut-off for anticoagulant therapy in thrombocytopenic patients with blood cancer and venous thromboembolism: an expert consensus. Blood Transfus 2018:1-10. https://doi.org/10.2450/2018.0143-18.

15. Rumyantsev A.G., Maschan A.A., Jarkov P.A., Svirin P.V. Federal clinical guidelines for the diagnosis, prevention and treatment of thrombosis in children and adolescents. M, 2015. [Electronic resource]: http://www.nodgo.org/sites/default/fi les/34.%20Trombozy.pdf (appeal date 17.04.2019). (In Russ.)

16. Schoot R.A., van de Wetering M.D., Stijnen T., Tissing W.J., Michiels E., Abbink F.C., Raphael M.F., Heij H.A., Zwaan M., Lieverst J.A., Caron H.N., van Ommen H.; DCOG-Aristocaths Supportive Care Working Group. Prevalence of symptomatic and asymptomatic thrombosis in pediatric oncology patients with tunneled central venous catheters. Pediatr Blood Cancer 2016;63:1438-44. https://doi.org/10.1002/pbc.26036.

17. Lahin R.E., Antipin E.E., Bautin A.E., Zabolotsky D.V., Koryachkin V.A., Teplykh B.A., Uvarov D.N., Ulrikh G.E., Zakirov I.I. Catheterization of the vessels under the control of ultrasound. Clinical recommendations FAR. Approved by the Presidium of FAR on 04.04.2015. [Electronic resource]: http://www.far.org.ru/recomendation (appeal date 11.04.2019). (In Russ.)

18. Dhanger S., Vaidiyanathan B., Tripathy D.K. Internal jugular venous valve: well known, but mostly neglected. Indian J Anaesth 2016;60(8):602-3. https://doi.org/10.4103/0019-5049.187813.

19. Schwartz R.E., Groeger J., Coit D.G. Subcutaneously implanted central venous access devices in cancer patients: a retrospective analysis. Cancer 1997;79:1635-50. PMID: 9118051.

20. Tran H.A., Arellano M, Chamsuddin A., Flowers C., Heff ner L.T., Langston A., Lechowicz M.J., Tindol A., Waller E., Winton E.F., Khoury H.J. Deep venous thromboses in patients with hematological malignancies after peripherally inserted central venous catheters. Leukemia & Lymphoma 2010;51(8):1473-7. https://doi.org/10.3109/10428194.2010.481065.

21. Ignatyev S.V., Zotina E.N., Fokina E.S., Lyanguzov A.V., Lagunova O.R., Ivashkina E.P. Procoagulantive state in patients with non- Hodgkin’s lymphomas. Tromboz, gemostaz i reologiya = Thrombosis, Hemostasis and Rheology 2018;3(75):35-40. (In Russ.)

22. Lorch H., Zwaan M., Kagel C., Weiss H.D. Central venous access ports placed by interventional radiologists: experience with 125 consecutive patients. Cardiovasc Intervent Radiol 2001;24:180-4. https://doi.org/10.1007/s002700001721.

23. Cil B.E., Canyiğit M., Peynircioğlu B., Hazirolan T., Carkaci S., Cekirge S., Balkanci F. Subcutaneous venous port implantation in adult patients: a single center experience. Diagn Interv Radiol 2006;12:93-8. PMID: 16752357.

24. Ilhan B.M., Sormaz İ.C., Türkay R. Pinch-Off Syndrome, a Rare Complication of Totally Implantable Venous Access Device Implantation: A Case Series and Literature Review. Korean J Thorac Cardiovasc Surg 2018;51(5):333-7. https://doi.org/10.5090/kjtcs.2018.51.5.333.

25. Magney J.E., Flynn D.M., Parsons J.A., Staplin D.H., Chin-Purcell M.V., Milstein S., Hunter D.W. Anatomical mechanisms explaining damage to pacemaker leads, defi brillator leads, and failure of central venous catheters adjacent to the sternoclavicular joint. Pacing Clin Electrophysiol 1993;16(3):445-57. https://doi.org/10.1111/j.1540-8159.1993.tb01607.x.