MORBIDITY USING SUBCUTANEOUS PORTS AND EFFICACY OF VANCOMYCIN FLUSHING IN CANCER

An evaluation of totally implanted venous access systems inserted in 1 63 consecutive children with cancer is reported. From 1988 to 1994, 18 0 subcutaneous ports were inserted in children more than 1 year old. I nitial diagnosis was acute leukaemia (n=79), non-Hodgkin's lymphoma (n =33), and solid tumour (n=51). Median age was 85 months. Ah venous pro cedures were performed through the device. Chemotherapy was either mod erate (n=13) or intensive (n=119) or very intensive (n=48), including 16 patients undergoing marrow transplantation. Cumulative venous acces s totalled 55 770 patient days with a mean of 305 days/subcutaneous po rt. The cause of device removal was, end of treatment (n=111), death d ue to malignancy (n=20), catheter related infection (n=7), and occlusi on of the system (n=4). Mechanical complications occurred in 19 ports; 16 were due to clots, of which 14 were cleared with instillation of u rokinase. Documented infectious episodes occurred in 47 ports, recurre d once in 14, and twice in five cases. Among these infections, 47 were septicaemic; 31 due to Staphylococcus epidermidis. Twenty seven of in itial septic episodes were considered to be catheter related; the rate was 15%/subcutaneous port or 0.05/100 catheter days. Risk factors for the development of a first infection were age below 4 years and the t ime of use. Since February 1993, vancomycin (50 mu g/ml) has been give n and this has reduced the rate of S epidermidis infection from 26/83 subcutaneous port to 4/97. Life table analysis showed that the infecti on free interval for staphylococcus was significantly better after thi s technique was initiated (log rank test=0.02). Time saved was approxi mately 30minutes/patient/week compared with external catheters, or 45 hours/month for the cohort of children treated. Subcutaneous ports in paediatric cancer patients are reliable, safe, and durable and may off er an attractive alternative to external catheters for prolonged venou s access and intensive treatment.