title: Frequent accesses to totally implanted vascular ports in pediatric oncology patients are associated with higher infection rates.
abstract: OBJECTIVE
  Totally implanted vascular (TIVA) ports are used in children for repeated blood samples or intravenous treatments. We have recently published a prospective evaluation of surgical incidents and early complications associated with these devices. This work is the final part of the same study, assessing late complications over a follow-up of 2 yrs.
  
  
  METHODS
  From January 2006 to January 2008, children older than 1 yr of age with a diagnosis of solid or blood cell malignancy were included. Insertion technique and care of the device were standardized. Every manipulation was prospectively recorded by specialized nurses. Obstruction was documented clinically. When bacteremia was suspected, routine central and peripheral blood cultures were drawn.
  
  
  RESULTS
  Forty-five consecutive patients were enrolled in the study. Mean age at the time of the procedure was 8.5 yrs. There was no catheter-related infection within the first 4 weeks post-surgery. No device had to be removed because of infection or obstruction during follow-up. Frequent accesses to the port (=3 per day over a 10-day period) were associated with an 8-fold risk of infection.
  
  
  CONCLUSIONS
  Insertion and use of TIVA devices were frequently associated with complications. No device had to be removed because of infection or obstruction over the follow-up period, although no prophylactic antibiotic agent was used. Restrictive use of antibiotics may prevent opportunistic infection. Frequent access to the device was significantly associated with line infection (odds ratio=8.43). No risk factor was identified for obstruction which occurred at a rate of 5.3 per 10,000 accesses.
authors.affiliation: Pediatric Surgery, University Hospital of Geneva and Children's Hospital, Geneva, Switzerland. christophe.gapany@hcuge.ch
authors.forename: Christophe
authors.initials: C
authors.lastname: Gapany
authors.forename: Stéphane
authors.initials: S
authors.lastname: Tercier
authors.forename: Manuel
authors.initials: M
authors.lastname: Diezi
authors.forename: Chantal
authors.initials: C
authors.lastname: Clement
authors.forename: Katy
authors.initials: K
authors.lastname: Lemay
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016503:Drug Delivery Systems / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D016017:Odds Ratio; D010372:Pediatrics / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors