title: Increased complication rates associated with Port-a-Cath placement in pediatric patients: location matters.
abstract: BACKGROUND
  Port-a-Caths (PACs) are commonly placed below the clavicle or below the inframammary line for cosmesis. We hypothesized that inframammary placement is associated with increased catheter-related complications due to redundant catheter length.
  
  
  METHODS
  A review of pediatric patients with PAC placement from 2007 to 2009 was performed. Port placement was identified as subclavicular (SC) or inframammary by x-ray (below the fifth-intercostal space). Inframammary ports were stratified by the midclavicular line: medial inframammary (MIM) and lateral inframammary (LIM). Early complications (<30 days) and late complications were analyzed.
  
  
  RESULTS
  We identified 167 SC, 46 MIM, and 166 LIM patients. LIM placement was independently associated with increased total complication rate (p<0.001), migration rate (p<0.001), and operative exchange (p=0.017) compared to the SC group. The catheter survival time was decreased in the LIM vs. SC group (1021 ± 55 vs. 1396 ± 48 days, p=0.005). Additionally, LIM placement was independently associated with increased odds of catheter removal (p=0.006). MIM patients demonstrated fewer complications compared to the LIM group (17.4% vs. 44.6%, p=0.001) and were similar to the SC group (17.4% vs. 20.4%, p=0.835).
  
  
  CONCLUSIONS
  Lateral inframammary chest wall placement of PACs is independently associated with increased total complication rates, migration rates, and need for operative exchange. We recommend subclavicular or medial inframammary PAC placement in children.
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.forename: Emily L
authors.initials: EL
authors.lastname: Larimer
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Gwilliam
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.forename: J Ruben
authors.initials: JR
authors.lastname: Rodriguez
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002968:Clavicle; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D035441:Thoracic Wall; D062666:Vascular Access Devices / Q000009:adverse effects*
keywords: Central line; Pediatrics; Port-a-Cath; Subcutaneous venous access device