351 - Single-Incision Chest Port Placement in Pediatric Patients: A Retrospective Analysis

Purpose: Implantable central venous access (CVA) ports are essential to pediatric care, providing stable access for long term therapies including chemotherapy, antimicrobials, and parenteral nutrition, amongst others. Traditional techniques use two incisions: one for venous access and one for the port pocket. A single-incision, image-guided approach has been described that minimizes tissue dissection and procedural complexity, with improved cosmesis. This method has been reported in adults but published pediatric experiences are limited. Given children’s unique anatomic considerations and long-term CVA requirements, further evaluation is warranted. This study describes procedural metrics, adverse events (AEs), and outcomes of single-incision, image-guided port placement technique in a pediatric cohort.

Materials and Methods: Single-center retrospective review of 60 patients (28 M, median age 7.5 yrs [IQR 4.7 - 13.7] and weight 24.1 kg [IQR 17.2 - 50.8]) with single-incision port placement technique. Demographic, procedural, imaging and clinical data were reviewed. Technical success (TS) was defined as successful port placement with catheter tip at superior cavoatrial junction or superior right atrium. AE rates were expressed per catheter-days (CDs).

Results: TS rate was 98% (59/60). The primary indication was chemotherapy (92%). CVA was obtained via right internal jugular vein in 57 (95%). Median procedure time, fluoroscopic time, and dose area product were 60 min (IQR 60-72), 5.8 min (IQR 3.8-7.9), and 25.76 µGy.m^-2 (IQR 17.13-52.44), respectively.

In TS (n=59) procedures, cumulative CDs was 22,322 days (median CDs 266 days [range 31 – 1707]). AE rate was 27% (16/59) (0.072 per 100 CDs), with 4 early AEs (< 30 days post-procedure) and 12 late AEs. In 5 (8%) with central catheter–associated bloodstream infections (0.022 per 100 catheter-days), 2 required removal. There were 10 (17%) mechanical AEs (0.45 per 100 catheter-days), including 9 occlusions (successfully treated with fibrinolysis) and 1 migration (required catheter salvage procedure). In 1 patient with wound dehiscence, incision revision and primary closure at 44 days was performed. At study end, 76% (45/59) of ports were removed electively, 7% (4/59) demised secondary to underlying condition with port in-situ, and 17% (10/59) remained in use.

Conclusion: Single-incision chest port placement in children is feasible and safe, with high TS and low AE rate. This technique may benefit patients in whom avoidance neck incision is desirable, such as those with short neck anatomy, tracheostomy, or local cervical site infection.