The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single-center study in 200 children

Background: Totally implantable venous access devices (TIVAD) facilitate repeat intravenous therapy for children. Many children recover and the device may be removed. Although removal should be a simple procedure via a single incision, in our experience, this has not been the case. Methods: Two hundred consecutive cases of removal of TIVAD from September 2000 to January 2004 at Sophia Children's Hospital, Rotterdam, were reviewed. Results: Average patient age was 5.9 years. The commonest indication for placement was administration of chemotherapy (88%); commonest indication for removal was remission of disease (70%). The median duration in situ of the catheter was 29 months (range, 0.4-91 months). Complications with removal of the polyurethane catheter of the TIVAD were experienced in 16% of cases. To enable removal, a second incision was required in 28 patients, venotomy in 5; the catheter could not be removed in 3. For all complicated removals the catheter had been in situ for longer than 20 months. Conclusions: Long-term implantation of TIVAD with polyurethane catheter appears unsuitable owing to a high incidence of complication at time of removal.