Purpose

We sought to identify clinical features associated with difficult subcutaneous port removals in children.

Methods

Ports placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were difficult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations.

Results

57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5–2.6] versus 0.8 years [IQR 0.5–1.4]; p < 0.001). On univariate analysis, procedural and device features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0001). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis.

Conclusion

Polyurethane central venous catheters placed for the two-year treatment of acute lymphoblastic leukemia may become difficult to remove. This constellation of factors warrants more extensive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time.

中文翻译：

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为什么皮下端口会卡住？病例对照研究

目的

我们试图确定与儿童难以去除皮下端口相关的临床特征。

方法

我们对 2014 年 4 月至 2017 年 9 月期间放置在我们机构的港口进行了前瞻性跟踪，以发现难以拆除的港口。进行了病例对照分析。将端口难以移除（卡住；病例）的患者与生物学性别和年龄匹配的对照以 1:3 的比例进行比较。逻辑回归确定了病例/对照状态与根据生物学性别和年龄调整为协变量的临床特征之间的关联。进行多变量分析以确定独立关联。

结果

分析了 57 个卡住端口（28 个极端 [10 个血管内介入] 和 29 个中度）和 171 个对照。卡住的端口与急性淋巴细胞白血病的诊断相关（86% 病例与 22.2% 对照；p  < 0.001）和更长的放置时间（中位数 2.6 年 [四分位距 (IQR) 2.5–2.6] 与 0.8 年 [IQR 0.5– 1.4]；p  < 0.001)。在单变量分析中，与卡住端口相关的程序和设备特征包括锁骨下通路（71.9% 病例与 48.5% 对照；p  = 0.0126）、聚氨酯与硅胶导管（96.5% 病例与 79.9% 对照；p  = 0.001）和拔除时导管外观粗糙（92.6% 病例与 9.4% 对照；p < 0.0001)。ALL 的诊断和线放置的持续时间与多变量分析中端口卡住有关。

结论

用于急性淋巴细胞白血病治疗两年的聚氨酯中心静脉导管可能难以移除。这一系列因素值得在术前更广泛地讨论风险、血管内备用的可用性以及更长的手术室时间的安排。