Increased complication rates associated with Port-a-Cath placement in pediatric patients: location matters

J Pediatr Surg. 2013 Jun;48(6):1263-8. doi: 10.1016/j.jpedsurg.2013.03.020.

Abstract

Introduction: 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.

Keywords: Central line; Pediatrics; Port-a-Cath; Subcutaneous venous access device.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / etiology
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / instrumentation
  • Catheterization, Central Venous / methods
  • Child
  • Child, Preschool
  • Clavicle
  • Device Removal / statistics & numerical data
  • Female
  • Foreign-Body Migration / epidemiology
  • Foreign-Body Migration / etiology
  • Humans
  • Infant
  • Kaplan-Meier Estimate
  • Male
  • Proportional Hazards Models
  • Retrospective Studies
  • Thoracic Wall
  • Vascular Access Devices / adverse effects*