Pneumothorax complicating port-a-cath and Groshong catheter positioning in children : our experience before routine ultrasound-guided puncture

ABSTRACT Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneu- mothorax (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 polyure- thane 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 guid- ance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.