title: Complicated vascular access port removals: incidence, antecedents and avoidance.
abstract: OBJECTIVE
  Port removal is usually a straightforward procedure delegated to trainees. However, some port removals are complicated by central venous catheter (CVC) fragmentation, a challenge for even experienced surgeons. This study aimed to determine the incidence of, and risk factors for, complicated port removal in children.
  
  
  METHODS
  A single-centre study assessed the outcome of removal for all paediatric ports inserted from 1996 to 2012. Data were recorded detailing patient, insertion, device and removal characteristics. Risk factors for complicated removals were scrutinised using Chi-square tests; p < 0.05 significant.
  
  
  RESULTS
  Of 628 ports inserted from 1996 to 2012, 443 were subsequently removed at the same centre. 8/443 (1.8%) removals were complicated by CVC fragmentation, a median of 3.3 (2.4-3.9) years after insertion. Of complicated cases, 8/8 underwent formal neck dissection, 3/8 intravascular dissection, and 1/8 endovascular retrieval. 2/8 cases have retained intravascular CVC fragments. Risk factors for complication were CVC caliber <6Fr (p < 0.001) and use duration >2 years (p < 0.001).
  
  
  CONCLUSIONS
  Greatest care and senior supervision should be ensured when removing ports with CVC caliber <6Fr and/or >2 years since insertion. However, complications also occur with larger CVCs or after shorter durations. Therefore, the key to avoiding complicated port removal may simply be: preparation, preparation, neck preparation.
authors.affiliation: Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Melbourne, VIC, 3052, Australia, warwick.teague@rch.org.au.
authors.forename: Warwick J
authors.initials: WJ
authors.lastname: Teague
authors.forename: Dina
authors.initials: D
authors.lastname: Fouad
authors.forename: Fraser D
authors.initials: FD
authors.lastname: Munro
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: McCabe
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000009:adverse effects*; D004210:Dissection; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome