Original article 183
ew Implantable Device for Long-Term Vascular Access in Children O. Reinberg', D. BecF ISer\"ice de Chirurgie Pediatrique and 2Ser,ice de Pediatrie, L'nite d'Onco-Hematologie, Centre Hospitalier L'ni\"ersitaire \'audois (CIIL'\"j, Lausanne, Suis e
\\'e report on our experience in the use of a ne\\' system of a totally implantabJe de\-ice for repeated \"ascular access in children, developed in 1989 by Pharmacia and named P.A.S. POIt® (Peripheral Access System POlt). The P.A.S. Port® is far smaIler than other systems and has been designed for peripherallocation in the arm. This a\-oids unsightly pectoral scars particularly in girls and allows insertion under locaJ anesthesia. It is an interesting alternati\-e to the POIt-a-Calh® for children older than 5 years of age. It is easilyaccepted by the patient as weIl as by the caring leam.
Key words \'ascular access - Catheterization - CentraJ venous - Implanl- Adolescent - ChiJd
Resume Nous rappOItons notre experience chez l'enfant d'un nouveau disposilif implantabJe miniaturise pour acces vasculaire, distribue par Pharmacia sous Je nom de PAS-Port®, introduit en Suisse en avriJ 1990. Outre sa tres petite taille, il offre l'avantage de pouvoir etre mis en pJace par une denudation au pli du coude en anesthesie locale ou loco-regionale, et se loge sur la face antero-interne de l'avant-bras. Le benefice esthetique par rapport au systeme Port-a-Cath® ou analogue est evidenl, et sa fiabilite est idenlique sinon meilleure. Il est mieux accepte par les pa-
JnlroducUon The inlroduction of a lotally implantable device for repeated vascular access has changed conditions for long-lerm lrealment in children, especiaIly in pedialric oncology (3, 4, 5, 6, 8). Since lhe inlroduction of the firsl Porta-Cath® in 1982, some inleresling progress has been made such as the introduction of chambers made of tilanium, 01' the use of a cream prm'iding a local aneslhesia at lhe sile of puncture (Emla Cream®). Recei\l'd "\o\emhcr 2\). 199 I Eur
J
Pcdialr Surg 2 (1092) 183-185 \\asson Edileur Paris
© Hippokrales \ erlag Slullgali
lients el par les infirmieres d'oncologie pedialrique qui preferenl sa manipulation a celle des systemes implantes dans la region pectorale_ Mots-cles Acces \'eineux - Calheters cenlraux - Syslemes impJantes - Enfants - Adolescents Zusammenfassung Wir berichten über un ere Erfahrung mil einem neuen implanlierbaren \ liniaturkammersystem, das für den zenlraJvenösen Zugang beim Kind verwendel wird. Dieses wurde im ApriJ 1990 in Europa unter dem )lamen PAS-POIt® eingefühlt und wird \"on der Firma Pharmacia \'ertrieben. Dank ihrer sehr geringen Dimension kann die Kammer unter Lokal- oder Lokoregionalanästhesie in die Ellenbeuge anteromedial implantiert werden. Der äslhetische \'orteil gegenüber dem Port-a-Cath-System ergibt sich aus dem Größenunterschied. Die Verläßlichkeit des neuen Systems ist gleich oder sogar besser als die des Port-a-CathSystems. Es wird vom Patienten sowie vom Pflegepersonal besser akzeptiert und letztere bevorzugen dessen Handhabung. Schlüsselwörter Zentralvenöser Zugang - Infusionskammer - Kinder - Adoleszente - Langzeiterfahrung
A new step has been achie\"ed wilh the development in 1989 by Pharmacia of the P.A.S. Port® (Peripheral Access System Port) (Fig. 1). The first model in Swilzerland wa implanted in an adult in January 1990, and \\'e implanted the first one in a child in April 1990. We report on our experience in lhe use of lhis ne\\' ystem, comparing 17 P.A.S. Port® implanled in children bet\\'een April 1990 and August 1991, \\ith 25 POIt-a-Cath® implanted by the same surgeon during lhe same period.
Downloaded by: University of British Columbia. Copyrighted material.
Summary
Eur J Pediatr urg 2 (1992)
O. Reinberg and D. Beck Septum (Silicone)
Table 2
Age, welght and helght of chlldren. Port·a·Ca h
ULTRA-LOCK Connectof (TItanlum) Suture Holes
Mean age Range (Years)
Houslng (Tltanlum)
Mean welgh Range (kg)
Outlet Tube
n
54 y. 07-17
13 y
8-18
20 kg 79-43
416 kg 25-67
105 cm
Mean helght Range (cm)
(Tltanlum)
Fig. 1
PAS. Port = 17
n = 25
151 cm 125- 74
70-164
PAS Port portal wlth connector
Table 3
nd,catlons
.\\ateria!s and methods
Port·a·Ca h = 25
n
The P.A.S. Port® is much smaller. and ha'> been deo igned for peripherallocation In lhe arm. This a\'oid,> unsightl.\· pectoral scar; PilliicularI\ In girls and allo\\'> in,>eriion under local ane,thesia (Table I). The form differs from the u;ual POli·a·Calh® as it must be easil~ held bet\\ een lhe thumb and the index lo be punctured The calheler is inlroduced into lhe lhorax through one of lhe left brachial \'eins if the patient is right·handed. Phleholomy is performed abo\'e lhe elbo\\. ,\fter se\eral allempl; \\ilh lhe perculaneou'> localor de\'ice (ath Finden. \\e reYelied lo the u'>ual method of fluoroscopy to position the calheler at the le\el of TI or '1'5. The chambe!"'> of lhe first P.A.S. I)Oli® \\'ere implanled anteriorly on the forearm according lo the in;tructions. Since the calheter nosse, the elbo\\, it \\'as mandatory to immobilize the arm during treatment. In the most recent palient . \\e implanted the pOlial aboye the elbo\\ lo allo\\ mO\'ements and a\'oid any risk of damage lo lhe catheler. This can be easily done as long as the portal is firmly fixed to the anterior aponeurosis to a\'oid "slipping away" if it has lo be punctured. The P.A.S. Port® i appreciated by the patients, as weil as by the nurses in the pediatric onco·hematology uni!.
Tumors
18 4 neuroblastoma 4 ALL 3 Wilms' tumor 2 hepatoblastoma 2 soft ISS e sarcoma 1 sacro-coccygeal teratoma 1 lymphoma (non-Hodgkln) 1 Hodgklll's dlsease
Hematology
PAS Por = 17
n
15 5 os eosarcoma 4 Hodgklils dlsease 2 lymphoma (nonHodgkln) 2 so t Issue sarcoma 2Wllms
o
4 1 Dlamond·Blackfan's anemla 1 Fanconl's anemla thrombocy openla a o-,mmune 1 thalassemla
Others
3 2 cyst,c f,brosls 1 persistent dlarrhea
2 2 cyst,c Ibrosls
Results We now have experienee of 3847 days of implantation of P.A.S. POli®, i. e. an ayerage of 226 days per system, compared to 8860 days of implantation of Port·a-Cath®, i. e. a mean duration of 354 days per system. The first implanted P.A.S. POli® were in the older ehildren, but as our experience inereased, we lowered the age of indicaLion for this system. Today our limiLing faetor is the diameter of one of the ba ilie or eephalie \'eins, wh ich must aeeommodate a eatheter of 1.9 mm of outside diameter. This i possible in a ehild of 6 to 7 years of age aeeording to his eon LituLion (Table 2). Henee, the indicaLions for in er· tion of one system or another ehanges lightly from one se ries to another series with the age of the ehildren (Table 3).
Table 1
Comparlson between the Port-a-Ca hand P A S -Port Systems
---
Port·a·Cath Velnous
Port-a-Cath "Low-Profile"
---
PAS Port
Portal speClfJcaCiOns (m mm)
Base Helght Sep um d ameter Ne ght :g)
25x25 13 11 26
25x25 10 95
:7
16 5x26 7
10 66 56
Catheter specd/cat/ons (m mm)
Outside diameter nSlde diameter Material
28 13 S, Icone
23
10 Silicone
19 10 Polyuret ane
All the Port-a-Cath® were inselied under general anesthesia. All but 12). He \\a,> lreated byan
Downloaded by: University of British Columbia. Copyrighted material.
184
Sem Implantable Det'iee Jor Long- Term \'ascular Aeeess in Chi/drell
---------
LJI) \\'e had 00 infeclious problem among the children wilh P.A.S. Port®. One potentially dangerous complication has been noted In one of the children in \\ hich the insertion of the P.A.S. POli® was difficulL there \\'a a partial rupture of the catheter atthe le\ cl of the middle shaft of the humeru .. i. e. out of a flexion zone Damage of the catheter during the diffieult inseliion is pos
ew Implantable Device for Long-Term Vascular Access in Children O. Reinberg', D. BecF ISer\"ice de Chirurgie Pediatrique and 2Ser,ice de Pediatrie, L'nite d'Onco-Hematologie, Centre Hospitalier L'ni\"ersitaire \'audois (CIIL'\"j, Lausanne, Suis e
\\'e report on our experience in the use of a ne\\' system of a totally implantabJe de\-ice for repeated \"ascular access in children, developed in 1989 by Pharmacia and named P.A.S. POIt® (Peripheral Access System POlt). The P.A.S. Port® is far smaIler than other systems and has been designed for peripherallocation in the arm. This a\-oids unsightly pectoral scars particularly in girls and allows insertion under locaJ anesthesia. It is an interesting alternati\-e to the POIt-a-Calh® for children older than 5 years of age. It is easilyaccepted by the patient as weIl as by the caring leam.
Key words \'ascular access - Catheterization - CentraJ venous - Implanl- Adolescent - ChiJd
Resume Nous rappOItons notre experience chez l'enfant d'un nouveau disposilif implantabJe miniaturise pour acces vasculaire, distribue par Pharmacia sous Je nom de PAS-Port®, introduit en Suisse en avriJ 1990. Outre sa tres petite taille, il offre l'avantage de pouvoir etre mis en pJace par une denudation au pli du coude en anesthesie locale ou loco-regionale, et se loge sur la face antero-interne de l'avant-bras. Le benefice esthetique par rapport au systeme Port-a-Cath® ou analogue est evidenl, et sa fiabilite est idenlique sinon meilleure. Il est mieux accepte par les pa-
JnlroducUon The inlroduction of a lotally implantable device for repeated vascular access has changed conditions for long-lerm lrealment in children, especiaIly in pedialric oncology (3, 4, 5, 6, 8). Since lhe inlroduction of the firsl Porta-Cath® in 1982, some inleresling progress has been made such as the introduction of chambers made of tilanium, 01' the use of a cream prm'iding a local aneslhesia at lhe sile of puncture (Emla Cream®). Recei\l'd "\o\emhcr 2\). 199 I Eur
J
Pcdialr Surg 2 (1092) 183-185 \\asson Edileur Paris
© Hippokrales \ erlag Slullgali
lients el par les infirmieres d'oncologie pedialrique qui preferenl sa manipulation a celle des systemes implantes dans la region pectorale_ Mots-cles Acces \'eineux - Calheters cenlraux - Syslemes impJantes - Enfants - Adolescents Zusammenfassung Wir berichten über un ere Erfahrung mil einem neuen implanlierbaren \ liniaturkammersystem, das für den zenlraJvenösen Zugang beim Kind verwendel wird. Dieses wurde im ApriJ 1990 in Europa unter dem )lamen PAS-POIt® eingefühlt und wird \"on der Firma Pharmacia \'ertrieben. Dank ihrer sehr geringen Dimension kann die Kammer unter Lokal- oder Lokoregionalanästhesie in die Ellenbeuge anteromedial implantiert werden. Der äslhetische \'orteil gegenüber dem Port-a-Cath-System ergibt sich aus dem Größenunterschied. Die Verläßlichkeit des neuen Systems ist gleich oder sogar besser als die des Port-a-CathSystems. Es wird vom Patienten sowie vom Pflegepersonal besser akzeptiert und letztere bevorzugen dessen Handhabung. Schlüsselwörter Zentralvenöser Zugang - Infusionskammer - Kinder - Adoleszente - Langzeiterfahrung
A new step has been achie\"ed wilh the development in 1989 by Pharmacia of the P.A.S. Port® (Peripheral Access System Port) (Fig. 1). The first model in Swilzerland wa implanted in an adult in January 1990, and \\'e implanted the first one in a child in April 1990. We report on our experience in lhe use of lhis ne\\' ystem, comparing 17 P.A.S. Port® implanled in children bet\\'een April 1990 and August 1991, \\ith 25 POIt-a-Cath® implanted by the same surgeon during lhe same period.
Downloaded by: University of British Columbia. Copyrighted material.
Summary
Eur J Pediatr urg 2 (1992)
O. Reinberg and D. Beck Septum (Silicone)
Table 2
Age, welght and helght of chlldren. Port·a·Ca h
ULTRA-LOCK Connectof (TItanlum) Suture Holes
Mean age Range (Years)
Houslng (Tltanlum)
Mean welgh Range (kg)
Outlet Tube
n
54 y. 07-17
13 y
8-18
20 kg 79-43
416 kg 25-67
105 cm
Mean helght Range (cm)
(Tltanlum)
Fig. 1
PAS. Port = 17
n = 25
151 cm 125- 74
70-164
PAS Port portal wlth connector
Table 3
nd,catlons
.\\ateria!s and methods
Port·a·Ca h = 25
n
The P.A.S. Port® is much smaller. and ha'> been deo igned for peripherallocation In lhe arm. This a\'oid,> unsightl.\· pectoral scar; PilliicularI\ In girls and allo\\'> in,>eriion under local ane,thesia (Table I). The form differs from the u;ual POli·a·Calh® as it must be easil~ held bet\\ een lhe thumb and the index lo be punctured The calheler is inlroduced into lhe lhorax through one of lhe left brachial \'eins if the patient is right·handed. Phleholomy is performed abo\'e lhe elbo\\. ,\fter se\eral allempl; \\ilh lhe perculaneou'> localor de\'ice (ath Finden. \\e reYelied lo the u'>ual method of fluoroscopy to position the calheler at the le\el of TI or '1'5. The chambe!"'> of lhe first P.A.S. I)Oli® \\'ere implanled anteriorly on the forearm according lo the in;tructions. Since the calheter nosse, the elbo\\, it \\'as mandatory to immobilize the arm during treatment. In the most recent palient . \\e implanted the pOlial aboye the elbo\\ lo allo\\ mO\'ements and a\'oid any risk of damage lo lhe catheler. This can be easily done as long as the portal is firmly fixed to the anterior aponeurosis to a\'oid "slipping away" if it has lo be punctured. The P.A.S. Port® i appreciated by the patients, as weil as by the nurses in the pediatric onco·hematology uni!.
Tumors
18 4 neuroblastoma 4 ALL 3 Wilms' tumor 2 hepatoblastoma 2 soft ISS e sarcoma 1 sacro-coccygeal teratoma 1 lymphoma (non-Hodgkln) 1 Hodgklll's dlsease
Hematology
PAS Por = 17
n
15 5 os eosarcoma 4 Hodgklils dlsease 2 lymphoma (nonHodgkln) 2 so t Issue sarcoma 2Wllms
o
4 1 Dlamond·Blackfan's anemla 1 Fanconl's anemla thrombocy openla a o-,mmune 1 thalassemla
Others
3 2 cyst,c f,brosls 1 persistent dlarrhea
2 2 cyst,c Ibrosls
Results We now have experienee of 3847 days of implantation of P.A.S. POli®, i. e. an ayerage of 226 days per system, compared to 8860 days of implantation of Port·a-Cath®, i. e. a mean duration of 354 days per system. The first implanted P.A.S. POli® were in the older ehildren, but as our experience inereased, we lowered the age of indicaLion for this system. Today our limiLing faetor is the diameter of one of the ba ilie or eephalie \'eins, wh ich must aeeommodate a eatheter of 1.9 mm of outside diameter. This i possible in a ehild of 6 to 7 years of age aeeording to his eon LituLion (Table 2). Henee, the indicaLions for in er· tion of one system or another ehanges lightly from one se ries to another series with the age of the ehildren (Table 3).
Table 1
Comparlson between the Port-a-Ca hand P A S -Port Systems
---
Port·a·Cath Velnous
Port-a-Cath "Low-Profile"
---
PAS Port
Portal speClfJcaCiOns (m mm)
Base Helght Sep um d ameter Ne ght :g)
25x25 13 11 26
25x25 10 95
:7
16 5x26 7
10 66 56
Catheter specd/cat/ons (m mm)
Outside diameter nSlde diameter Material
28 13 S, Icone
23
10 Silicone
19 10 Polyuret ane
All the Port-a-Cath® were inselied under general anesthesia. All but 12). He \\a,> lreated byan
Downloaded by: University of British Columbia. Copyrighted material.
184
Sem Implantable Det'iee Jor Long- Term \'ascular Aeeess in Chi/drell
---------
LJI) \\'e had 00 infeclious problem among the children wilh P.A.S. Port®. One potentially dangerous complication has been noted In one of the children in \\ hich the insertion of the P.A.S. POli® was difficulL there \\'a a partial rupture of the catheter atthe le\ cl of the middle shaft of the humeru .. i. e. out of a flexion zone Damage of the catheter during the diffieult inseliion is pos
