title: The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single-center study in 200 children.
abstract: BACKGROUND
  Totally implantable venous access devices (TIVAD) facilitate repeat intravenous therapy for children. Many children recover and the device may be removed. Although removal should be a simple procedure via a single incision, in our experience, this has not been the case.
  
  
  METHODS
  Two hundred consecutive cases of removal of TIVAD from September 2000 to January 2004 at Sophia Children's Hospital, Rotterdam, were reviewed.
  
  
  RESULTS
  Average patient age was 5.9 years. The commonest indication for placement was administration of chemotherapy (88%); commonest indication for removal was remission of disease (70%). The median duration in situ of the catheter was 29 months (range, 0.4-91 months). Complications with removal of the polyurethane catheter of the TIVAD were experienced in 16% of cases. To enable removal, a second incision was required in 28 patients, venotomy in 5; the catheter could not be removed in 3. For all complicated removals the catheter had been in situ for longer than 20 months.
  
  
  CONCLUSIONS
  Long-term implantation of TIVAD with polyurethane catheter appears unsuitable owing to a high incidence of complication at time of removal.
authors.affiliation: Department of General Surgery, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. guinwilson@yahoo.com
authors.forename: Guineva J P
authors.initials: GJ
authors.lastname: Wilson
authors.forename: M M
authors.initials: MM
authors.lastname: van Noesel
authors.forename: W C J
authors.initials: WC
authors.lastname: Hop
authors.forename: C
authors.initials: C
authors.lastname: van de Ven
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D013997:Time Factors; D014656:Vascular Surgical Procedures