Intravenous literature: Bass, J., and Halton, J.M. (2009) Skin erosion over totally implanted vascular access devices in children. Seminars in Pediatric Surgery. 18(2), p.84-6.
Erosion of the skin over a totally implanted vascular access device (TIVAD) is a rare event that may lead to life-threatening sequelae. From 1994 to 2007, we reviewed the medical records and central line database of 960 central line insertions for the complication of skin erosion over the TIVAD. Outcome measures included age, gender, and nutritional status, number of days until complication, insertion site, and attending surgeon. A total of 540 of the 960 central lines were TIVAD. Skin erosion occurred in 9 patients for an incidence of 1.67%. Average age at insertion was 51 months (range 25-116.5 months). The average catheter duration use in days was 335 with a range of 39-1575 days. Malnutrition defined as BMI <5% or a decrease in BMI percentiles occurred in 2 and 4 patients, respectively, and contributed to the thinning of the subcutaneous fat. Skin erosion over TIVAD is a rare complication. Most cases can be prevented by inserting the device in a subfacial location in the very young child or in the child with expected weight loss. Furthermore, the device should be placed at a fair distance from the skin incision to prevent early skin erosion through the wound.