Management of stuck long-term port-a-cath

Background: Totally implanted venous access device (Port-A- Caths) is the stander access for chemotherapy treatment in children. Their removal after finishing the treatment is usually straight forward, but this however is not the case always and their removal can sometimes be challenging.
Methods: A retrospective review of 685 children’swho had Port-A- Cath’sinsertion and removals from October 2005 to 2014 were reviewed.
Result: 674(98%) of the Port-A- Cath’s lines were removed without difficulty. 76(11%) were removed because of sepsis or catheter malfunction, and 598 (89%) were removed after completion of chemotherapy. Removal of 11(1.6%) of these catheters was difficult. All required second neck incision and exploration of the internal jugular vein with proximal and distal control. In five out of eleven the catheter was removed safely after proper venotomy. One catheter broke during removal and the distal end with the calcification migrated and developed pulmonary embolus which was retrieve by interventional radiologist. Three other catheters require combined approach with the interventional radiologist to remove them. The remaining two Catheters could not remove completely and the remnant part was left inside.
Conclusions: Long-term silicon indwelling catheters which are used solely for chemotherapy administration can have pericatheter calcification. This makes their removal difficult and associated with complications. Removal of these catheters should not be taken lightly and should be done in center with supportive services including Interventional Radiology and Cardiac Surgery.