Risk profile of subcutaneous port placement in small children
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Oct 2020 · 1 min read
In brief
In brief
Multi-institutional study of 500 children under 5 years demonstrates that subcutaneous port placement in patients weighing less than 10 kg carries no significantly higher complication risk than in larger children. Overall complication rate was 22%, with 16.3% requiring early removal, supporting port placement in small children when clinically indicated.
Written by the GCMD Library team from the article.
Abstract
Background/purpose
Long-term central venous access is a safe and common procedure in children. However, complications with devices are a reality. Smaller children are thought to have a higher rate of complication after port placement, and some surgeons avoid placing ports with an arbitrary weight cutoff out of concern for surgical site morbidity.
Methods
We performed a multi-institutional retrospective review of 500 patients less than 5 years of age undergoing port placement at three large volume children's hospitals from 2014 to 2018. Patients were divided by weight greater than or less than 10 kg at the time of insertion. Statistical analysis was performed to evaluate for differences in outcomes between the two groups.
Results
The majority of ports were placed for chemotherapy access (71.8%). Other indications included long-term infusions (18.8%) and difficult chronic IV access (9.4%). Of the 500 charts reviewed, 110 (22%) experienced some documented complication (28.9% <10 kg, 20.6% >10 kg, p = 0.096). There were no differences between the two groups in terms of the type or timing of complications. Overall, 16.3% of ports required removal prior to the end of therapy owing to a complication. Complication rate per day with the port in place was not different between the two groups (<10 kg: 0.68 complications/1000 port-days vs >10 kg 0.44 complications/1000 port-days, p = 0.068).
Conclusion
Weight less than 10 kg was not associated with a significantly higher incidence of any type of port complication in our cohort. This suggests that concern for complications should not exclude children less than 10 kg from port placement.
Type of study
Multi-institutional retrospective review.
Level of evidence
Level III.