Purpose or Case Report: To analyze the use of implanted port-a-caths in Children with Medical Complexity (CMC), neurological impairment and difficult venous access.
Methods & Materials: REB approved retrospective single centre observational study of port-a-caths placed by Interventional Radiology (IR), in CMC with neurological impairment, to meet their general vascular access needs. Details of peripheral intravenous (PIV) attempts, PIV successful starts, PIV complications, alternative devices, port-a-cath insertions, dwell times, times accessed, and port-a-cath-related complications were analyzed. Information for the year pre-port-a-cath was compared to the year post-port-a-cath in 21 patients (10M; 11F). The Wilcoxon signed ranks test were performed by SPSS.
Results: 21 patients underwent 26 port-a-cath insertions (median age 3 years; median weight 12.7 kg). The median port-a-cath dwell time was 26.5 months, total number of port-a-cath dwell days was 31,632 and total number of days accessed was 1,066 (median 21/pt). There was a significant reduction (p<0.05) in number of PIV attempts, PIV starts, needle pokes, ED visits and admissions in year the post-port-a-cath compared to pre-port-a-cath. There was no severe adverse events, 6 moderate and 18 mild adverse events. Limitations of the study include its retrospective design, lack of scores for difficult IV access or scales for IV infiltration and extravasation.
Conclusions: Port-a-cath placement in CMC significantly reduced the number of PIV attempts, needle pokes and admission requirements with no major added complications. These results provide useful information for parents and health care providers considering port-a-cath placement in this population.