Why Do Subcutaneous Ports Get Stuck? A Case-Control Study.

Purpose: We sought to identify clinical features associated with difficult subcutaneous port removals in children. Methods: Ports placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were diffi-cult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations. Results: 57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5-2.6] versus 0.8 years [IQR 0.5-1.4]; p < 0.001). On univariate analysis, procedural and de-vice features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0 0 01). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis. Conclusion: Polyurethane central venous catheters placed for the two-year treatment of acute lym-phoblastic leukemia may become difficult to remove. This constellation of factors warrants more exten-sive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time. (c) 2021 Elsevier Inc. All rights reserved.