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Evaluation of implanted venous port-a-caths in children with medical complexity and neurologic impairment

  • Paymun PezeshkpourEmail author
  • Nicholas C. Armstrong
  • Sanjay Mahant
  • Prakash Muthusami
  • Joao G. Amaral
  • Dimitri A. Parra
  • Michael J. Temple
  • Bairbre L. Connolly
Original Article
  • 3 Downloads

Abstract

Background

Children with medical complexity and associated neurologic impairment frequently face difficulties with venous access. Intermittently they require urgent intravenous administration of fluids and medication.

Objective

To analyze the use of implanted port-a-caths in children with medical complexity who have neurologic impairment and difficult venous access.

Materials and methods

We performed a single-center observational study of port-a-caths placed by interventional radiologists in children with medical complexity with neurologic impairment. We analyzed peripheral intravenous access attempts, peripheral intravenous starts, peripheral intravenous complications, alternative temporary central venous access devices, port-a-cath insertions, catheter days, access days, port-a-cath-related complications, hospital admissions and emergency department visits. We compared the year pre port-a-cath to the year post port-a-cath.

Results

Twenty-one children with medical complexity with neurologic impairment (10 boys, 11 girls; median age 4.1 years; median weight 13.7 kg) underwent 26 port-a-cath insertions (median catheter days 787). In the year post port-a-cath compared to pre port-a-cath there was a highly significant reduction (P<0.001) in numbers of peripheral intravenous attempts, peripheral intravenous starts and skin punctures; and a significant reduction (P<0.05) in need for other devices, number of emergency department visits, emergency department visits resulting in hospital admissions, and total admissions. Adverse events were graded as mild (n=18), moderate (n=6) and severe (n=0).

Conclusion

Port-a-cath placement in children with medical complexity with neurologic impairment significantly reduced all peripheral intravenous attempts, peripheral intravenous starts, skin punctures, total number of emergency department visits, visits culminating in admission, and total number of inpatient admissions. Advantages must be considered against potential port-a-cath-related adverse events.

Keywords

Children Difficult venous access Interventional radiology Port-a-cath Reduced morbidity Technology dependence 

Notes

Compliance with ethical standards

Conflicts of interest

None

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Paymun Pezeshkpour
    • 1
    • 2
    Email author
  • Nicholas C. Armstrong
    • 1
    • 3
  • Sanjay Mahant
    • 4
  • Prakash Muthusami
    • 1
    • 2
  • Joao G. Amaral
    • 1
    • 2
  • Dimitri A. Parra
    • 1
    • 2
  • Michael J. Temple
    • 1
    • 2
  • Bairbre L. Connolly
    • 1
    • 2
  1. 1.Image Guided Therapy Centre, Diagnostic Imaging DepartmentThe Hospital for Sick ChildrenTorontoCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.University of LimerickLimerickIreland
  4. 4.Department of PediatricsThe Hospital for Sick ChildrenTorontoCanada

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