Infographic1 min read·Published Dec 2022Older

¿Por qué los portales subcutáneos se quedan atorados?

Infographic · Dec 2022 · 1 min read

In brief

Case-control study examining risk factors for difficult subcutaneous port removal in pediatric patients. Acute lymphoblastic leukemia diagnosis and prolonged placement duration (median 2.6 vs 0.8 years) were significantly associated with stuck ports requiring complex removal techniques.

Polyurethane ports placed for ALL treatment (2+ years) have significantly higher risk of becoming stuck during removal.
86% of stuck ports occurred in ALL patients vs 22% in controls; median placement duration 2.6 vs 0.8 years.
Subclavian access and polyurethane catheters (vs silicone) are associated with difficult port removals in children.
Preoperative planning for long-term ALL ports should include endovascular backup and extended OR time allocation.
Catheter surface roughness at removal correlates with difficulty (92.6% stuck ports vs 9.4% controls).

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with accompanying text boxes below describing outcomes. The left column shows balloon dilation, the middle shows Heller myotomy, and the right shows POEM procedure. Success rates are prominently displayed with percentage values.

Nueva infografía por Alex Halpern y Em Tombash

"¿Por qué los cateteres implantables quedan atascados? Un estudio de casos y controles" Jennifer Crook et.al.

Articulo completo: https://www.jpedsurg.org/article/S0022-3468(21)00537-6/fulltext

Autores: Jennifer L. Crook, Zhaohua Lu, Xiaoqing Wang, Nan Henderson, Kimberly E. Proctor, Vinod G. Maller, Hasmukh J. Prajapati, Robert E. Gold, Abdelhafeez H. Abdelhafeez, Lindsay J. Talbot, Ching-Hon Pui, Andrew M. Davidoff, James M. Hoffman, Andrew J. Murphy

Abstract

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.

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