TITLE:
Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture
AUTHORS:
Silvia Guenzani, Paola Previtali, Federico Piccioni, Maria Chiara Allemano, Serena Catania, Martin Langer
KEYWORDS:
Pneumothorax; Central Venous Catheter; Groshong; Port-a-Cath; Children; Drainage
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.8,
October
14,
2013
ABSTRACT: Objective: To
study incidence and management of long term central venous catheter (CVC)
placement related pneumothorax
(PNX) in children. Aim: To construct
a baseline value before the introduction of systematic use of ultrasound
guidance, which requires specific training and equipment. Background: Anesthesia Service and Pediatric Oncology of the Italian National Cancer
Center; patients were
children (age ≤ 18
years) with solid tumors, needing long-term central venous catheters (Groshong or Port-a-Cath). Materials/Methods: Catheter placement was performed, mostly under general anesthesia,
utilizing a micropuncture 5-7 Fr needle and
fluoroscopy. In the study period ultrasound was used only in case of previously
failed attempts. Relevant data were collected retrospectively. Results: From August 2008 to December
2011, 452 catheters were implanted to our patients. The prevalent approach was
from subclavian vein (left 85.7%, right 9.7%);
in few cases internal jugular vein was chosen (right 2.4%, left 2.2%). Pneumothorax occurred
in 14 patients (3.1%; 95%CI 1.9-5.1). In 4/14
children the PNX was considered minimal and not treated. In 10 patients the PNX
was drained. In 7 cases a traditional, surgical thoracostomy was performed,
while in 3 children a 14-Ga polyurethane catheter (Arrow International®)
was inserted over a wire guide in the pleural space by anaesthetists. Conclusions: In
our centre rates of PNX are the same as those described in literature and are
expected to lower when ultrasound guidance of the puncture will be routinely applied. Percutaneous drainage of PNX
seems as effective as surgically placed thoracostomy catheter, but less
invasive.