Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture


Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneumothorax (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 polyurethane 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 guidance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.

Share and Cite:

S. Guenzani, P. Previtali, F. Piccioni, M. Allemano, S. Catania and M. Langer, "Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture," Open Journal of Anesthesiology, Vol. 3 No. 8, 2013, pp. 345-348. doi: 10.4236/ojanes.2013.38073.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Zaghal, M. Khalife, D. Mukherji, et al., “Update on Totally Implantable Venous Access Devices,” Surgical Oncology, Vol. 21, No. 3, 2012, pp. 207-215.
[2] B. Karapinar and A. Cura, “Complications of Central Venous Catheterization in Critically Ill Children,” Pediatrics International, Vol. 49, No. 5, 2007, pp. 593-599.
[3] C. C. Araujo, M. C. Lima and G. H. Falbo, “Percutaneous Subclavian Central Venous Catheterization in Children and Adolescents: Success, Complications and Related Factors,” Jornal de Pediatria, Vol. 83, No. 1, 2007, pp. 64-70.
[4] A. Citak, M. Karabocuoglu, R. Ucsel and N. Uzel, “Central Venous Catheters in Pediatric Patients—Subclavian Venous Approach as the First Choice,” Pediatrics International, Vol. 44, No. 1, 2002, pp. 83-86.
[5] J. Casado-Flores, J. Barja, R. Martino, A. Serrano and Valdivielso, “A Complications of Central Venous Catheterization in Critically Ill Children,” Pediatric Critical Care Medicine, Vol. 2, No. 1, 2001, pp. 57-62.
[6] J. Y. Lefrant, L. Muller, J. E. De La Coussaye, M. Prudhomme, J. Ripart, C. Gouzes, P. Peray, G. Saissi and J. J. Elrdjam, “Risk Factors of Failure and Immediate Complication of SCV Catheterization in Critically Ill Patients,” Intensive Care Medicine, Vol. 28, No. 8, 2002, pp. 1036-1041.
[7] J. Casado-Flores, A. Valdivielso-Serna, L. Perez-Jurado, J. Pozo-Roman, M. Monleon-Luque, J. Garcia-Perez, A. Ruiz-Beltran and M. A. Garcia-Teresa, “SCV Catheterization in Critically Ill Children: Analysis of 322 Cannulations,” Intensive Care Medicine, Vol. 17, No. 6, 1991, pp. 350-354.
[8] E. M. Johnson, D. A. Saltzman, G. Suh, R. A. Dahms and A. S. Leonard, “Complications and Risks of Central Venous Catheter Placement in Children,” Surgery, Vol. 124, No. 5, 1998, pp. 911-916.
[9] T. Pirotte and F. Veyckemans, “Ultrasound-Guided Subclavian Vein Cannulation in Infants and Children: A Novel Approach,” British Journal of Anaesthesia, Vol. 98, No. 4, 2007, pp. 509-514.
[10] O. Rhondali, R. Attof, S. Combet, D. Chassard and M. de Queiroz Siqueira, “Ultrasound-Guided SCV Cannulation in Infants: Supraclavicular Approach,” Pediatric Anesthesia, Vol. 21, No. 11, 2011, pp. 1136-1141.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.