Incidents and complications of totally implanted vascular access devices in children: a prospective study.
BACKGROUND
Totally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients.


METHODS
From January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery.


RESULTS
45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3-15.6; SD +/- 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection.


CONCLUSIONS
Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.
Tercier
Stéphane
S
Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Gapany
Christophe
C
Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Diezi
Manuel
M
Pediatric oncology and hematology unit, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Clément
Chantal
C
Pediatric oncology and hematology unit, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Lemay
Katy
K
Pediatric oncology and hematology unit, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Joseph
Jean-Marc
JM
Pediatric Surgery, Centre hospitalier universitaire vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.