Long-term complications in totally implantable venous access devices: randomized study comparing subclavian and internal jugular vein puncture.

BACKGROUND: This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. METHODS: A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008. Patients were randomly allocated to the subclavian or jugular vein group. The endpoint was complications that led to catheter revision or catheter removal. RESULTS: Six patients were excluded, 43 had the catheter implanted in the subclavian and 34 in the jugular vein. Subclavian catheters were used for up to 12.6 months, while jugular catheters were kept in place for up to 14.8 months (P = 0.38). No statistical differences were found between the groups concerning age, sex, leukocyte count, platelet count, type of admission (in or outpatient), or previous chemotherapy regimens. When analyzed individually, long-term complications did not present statistically significant differences either. Infection occurred in 20 and 11% (P = 0.44), while catheter embolism took place in 23 and 8% (P = 0.11) of patients with subclavian and jugular catheters, respectively. A statistical difference was seen in the total number of complications, which occurred in 48 and 23% (P = 0.02) of patients in the subclavian and in the jugular groups, respectively. CONCLUSIONS: Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein.

Rapunzel syndrome with a fatal outcome in a neglected child.

The "Rapunzel" syndrome (a trichobezoar with a long tail extending from the stomach to the small bowel) is an uncommon disease. It is related to severe complications but rarely associates to a fatal outcome. We report a case of a 5-year-old girl admitted at the emergency department in cardiorespiratory arrest whose autopsy disclosed an ileal perforation that is caused by a long bezoar extending from the stomach to the small bowel. The authors discuss a possible link between Rapunzel syndrome and child neglect.