The aim of this study was to compare peritoneal dialysis catheter insertion by the open method to the laparoscopic method. Twenty four laparoscopic and 10 open peritoneal dialysis catheter placements were performed in children between 2001 and 2008. Patient characteristics, operation related data, procedural complications and clinical outcome were compared. Although there were no cases of catheter obstruction, exit site infection or bleeding in the laparoscopic group, compared to the open method, there was no statistically significant difference between the two groups. Catheter removal rate due to complication was high in the open group and catheter survival rate was high in the laparoscopic group. We concluded that laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups with at least equivalent functional results compared to the open method. An advantage of laparoscopic catheter insertion is removal of the great omentum and easy fixation of the catheter to the abdominal wall.

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was 7.6±5.1 years old. The mean operation time was 67.4±21.3 minutes and C-arm fluoroscopy was used in 47(30.5%). The causes of Hickman catheter removal were termination of use in 82 (57.3%), catheter related bloodstream infection in 44(30.8%), mechanical malfunction in 11(7.7%), and accidents in 6(4.2%). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was 214.9±140.2 days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was 198.0±116.0 days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.

Chemoport is widely used in pediatric surgery field. But various complications can occur during the process of insertion or removal of chemoport. Surgeons must be familiar with the treatment of these complications. We had one catheter cuts off during chemoport removal, become a catheter embolism. Interventional radiologic removal was successful. Verifying the length of removed catheter and careful observation of the catheter tip during removal procedure is important to prevent the possibility of catheter embolus. Radiologic intervention was accessible to remove the retained catheter.

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29–42 weeks) and median birth weight was 3,105 gm (range, 1,040–3,720 gm). Median age at catheter insertion was 38.5 days (range, 1–236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time : 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3–72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.

Continuous Ambulatory Peritoneal Dialysis (CAPD) has now become an established form of renal replacement therapy in children. Despite of technical improvements, there are various complications in CAPD. We reviewed medical records of children who received CAPD at Seoul National University Children's Hospital in the period between May 1991 and June 2002. Ninety-three procedures of CAPD catheter insertion in 70 patients were included in this study. Complication rate was 64.5%, and CAPD catheter related peritonitis was most common. In conclusion, CAPD catheter related peritonitis develops in considerable number of pediatric patients. Although the peritonitis could be treated with empirical antibiotics therapy, further investigation to prevent complication is required.

Pseudoaneurysm of splenic artery may arise from a vascular erosion by the inflammatory processes around the splenic artery, particularly in acute pancreatitis and chronic pancreatitis, which may cause rupture of pseudoaneurysm and life threatening hemorrhage. Collective experience with this massive hemorrhage is attended by a high mortality rate even with prompt therapy, and conservative management is associated with an almost 100 per cent of mortality rate. Identification of the bleeding site at laparotomy may be exceedingly difficult, which makes the preoperative detection of bleeding source desirable. Peripancreatic vascular lesions can be identified by angiography, and in selected cases the risk of urgent operation to control massive hemorrhage may be obviated by embolization. The authors have recently experienced a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatic pseudocyst. We managed this child successfully with an urgent procedure of transcatheter arterial embolization and another elective surgery of pancreatic pseudocyst.

To evaluate the profitable central venous catheters (CVCs) in children, 320 CVCs placed in 255 neonate and children over a 10-year period were analyzed retrospectively. CVC was provided by one pediatric surgeon for a total of 6,116 patients days. The number of perioperative group including immediate TPN or chemo was 223, CVC just for TPN was 57 and chemotherapy 40. Local anesthesia was applied in 71 cases, and the others were under the general anesthesia. Subclavian vein catheterizations (SCVs) were 202 cases (82 infants and neonates), tunneled external jugular venotomy(EJV) 38, tunneled internal jugular venotomy(IJV) 2, facial venotomy (FV) 3, and umbilical venous catheterization (UVC) with vein transposition 74. In neonates, 72 UVCs were applied during laparotomy. SCV was increased with ages, 3 kg of minimal body weight. The average catheter-periods over-all were 19.1 days, of SCV 17 days, EJV 40, IJV 60 and UVC 14. Technical complications were; arterial puncture (6), puncture failure (5) and abnormal location(12) in SCV; insertion failure (3) in EJV; abnormal location in the portal vein (4) and the liver parenchyma (2) making cystic fluid accumulations in UVC. Twelve migrations (3.8%) out of position occurred; SCV(2), EJV (1) and UVC (9). For 4 cases (1.2 %) of catheter obstruction and 11 (3.4 %) of catheter infection (3 SCV, 2 EJV and 6 UVC), rescue procedures were applied with some achievements. There was one mortality (0.3 %) due to deep sedation in 1.06 kg baby for EJV. Cumulated surgeon's experience of the crafts, proper catheter selection and keeping the safety rouls would be the important factors for successful CVCs.

Percutaneous infraclavicular subclavian catheterization has been widely used for a total parenteral nutrition, hemodynamic monitoring and for venous access in difficult clinical situations. Many authors have claimed the infraclavicular cannulation of the subclavian vein in the tiniest infants can be performed with safety and ease, but there are always possibility of serious complications in this method. We present our experiences of peripheral venous cutdown with Broviac catheter. Author routinely introduced Broviac catheter into central vein via peripheral venous cutdown. There was no life threatening complications and no catheter related death. The complication rate was very low. The catheter related sepsis was documented in only two patient(4.7%). The average catheter longivity was 19.59 days. In view of the safety and low rate of complication, we think that peripheral venous cutdown with Broviac catheter should be the method of choice when central venous access is neccesary in infants. The infraclavicular subclavian catheterization should be reserved in infants with few accessable peripheral vein.