Complications of a Totally Implanted Vascular Access Device (Chemoport) in Children with Malignancy

Jung Ok Kim; Ji Hye Lee; Kun Soo Lee

doi:10.5045/kjh.2008.43.3.159

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Kim, Lee, and Lee: Complications of a Totally Implanted Vascular Access Device (Chemoport) in Children with Malignancy

Original Article

Korean J Hematol 2008;43(3):159-165.

Published online: 19 September 2008

DOI: https://doi.org/10.5045/kjh.2008.43.3.159

Complications of a Totally Implanted Vascular Access Device (Chemoport) in Children with Malignancy

Jung Ok Kim, M.D., Ji Hye Lee, M.D., Kun Soo Lee, M.D.

Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea

Correspondence to：Kun Soo Lee, M.D. Department of Pediatrics, Kyungpook National University Hospital 50, Samduck-dong 2-ga, Jung-gu, Daegu 700-721, Korea Tel: ＋82-53-420-5704, Fax: ＋82-53-425-6683 E-mail: kslee@knu.ac.kr

Received 22 November 2007 Revised 14 August 2008 Accepted 18 August 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Carefully using a totally implanted vascular access device and regular check-up of its condition in children who suffer with malignancy is very important. This study was performed to determine the complications related to using this device, according to the patient's age, gender and diagnosis, and the time from port insertion.

Methods:

We retrospectively studied 77 patients with malignancy (46 males and 31 females, age: 0.1∼18 years, mean age: 7.8 years) and they were treated with a totally implanted vascular access device (chemoport) from January 1996 to May 2007 in Kyungpook National University Hospital, Korea. We assessed the symptoms and radiologic findings, conducted blood tests and doppler USG; we found several complications and compared them according the patients’ age, gender and diagnosis.

Results:

Among the 77 cases with a totally implanted vascular access device (chemoport), 14 cases had complications related to the chemoport. Infections were detected in 8 cases. 6 of them had infections related to the chemoport after 4∼7 months from the port-insertion. After port removal and treatment with broad spectrum antibiotics, their symptoms such as fever and swelling were improved. Disconnection of the port was detected in 2 cases after 2 months and 22 months from port-insertion, respectively. These ports were successfully removed by cardiac catheterization. Rotation of the port was detected in one case after 9 months from port-insertion: the rotated port was removed. Obstruction with thrombus was detected in 3 cases, after 7∼16 months from port-insertion: this condition was treated with thrombolytic agents such urokinase and t-PA (tissue plasminogen activator), or surgical removal of the blood clot in the port site.

Conclusion:

To reduce the complications related to the totally implanted vascular access (device), such as infection, thrombosis and disconnection, we should carefully use this device and also regularly check its function and position. After completion of chemotherapy, removal of the port as soon as possible should be considered. If a complication is detected, then we should manage it immediately.

Keywords: Malignancy, Children, Complications, Totally implanted vascular access device (chemoport), Infection, Thrombosis, Disconnection

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Fig. 1

Number of patients with chemoport-related complications according to diagnosis.

Fig. 2

Number of patients with complications related to the chemoport according to interval from chemoport-insertion to complication develop.

Fig. 3

Cumulative number of patients with chemoport-related complications according to the interval from chemo-port-insertion to complication develop.

Fig. 4

Number of patients according to the type of complication.

Table 1.

Number of patients according to the diagnosis

Diagnosis	Number of patients
ALL	25 (32.5%)
AML	4 (5.2%)
Brain tumor	11 (14.3%)
Malignanat lymphoma	6 (7.8%)
Neuroblastoma	7 (9.1%)
Retinoblastoma	4 (5.2%)
Osteosarcoma	5 (6.5%)
Ewing sarcoma	3 (3.9%)
Germ cell tumor	4 (5.2%)
Other solid tumors	8 (10.4%)

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia.

Table 2.

Basic dates of the patients who had complications related to the chemoport, and management

Gender Age (yr)			Diagnosis	Tpye of the complication	Interval∗ (mo.)	Management
1	F	1.5	Ewing's sarcoma	Infection	4	Port removal and antibiotics medication
2	F	12.3	ALL	Infection	15	Port removal and antibiotics medication
3	M	14.3	ALL	Infection	7	Port removal and antibiotics medication
4	F	15.4	Ewing's sarcoma	Infection	11	Port removal and antibiotics medication
5	M	3	Medulloblastoma	Infection	7	Port removal and antibiotics medication
6	M	1.9	AML	Infection	4	Port removal and antibiotics medication
7	M	1.8	ALL	Infection	6	Port removal and antibiotics medication
8	F	1.1	Neuroblastoma	Infection	5	Port removal and antibiotics medication
9	M	5.1	ALL	Dysfunction d/t rotation of the port	9	Port removal
10	M	3.8	ALL	Obstruction of the port	7	Reposition of the port and removal of
11	M	5.9	ALL	Obstruction of the port	9	the blood clot Urokinase medication
12	F	6	Langerhans' cell histiocytosis	Thrombosis at theport site	16	tPA medication
13	F	2.6	Neuroblastoma	Disconnection of the port	22	Interventional port removal via cardiac catheterization
14	M	2.1	AML	Disconnection of the port	2	Interventional port removal via cardiac atheterization

∗Interval from chemoport-insertion to complication develop. Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; tPA, tissue plasminogen activator.

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