Xu Hongxiang,Dong Rui,Zhang Jun.Expert Consensus on Clinical Practice of Totally Implantable Venous Access Ports in Children (Edition 2026)[J].Journal of Clinical Pediatric Surgery,2026,(06):512-519.[doi:10.3760/cma.j.cn101785-20260408-00162]
儿童完全植入式静脉输液港临床实践专家共识(2026版)
- Title:
- Expert Consensus on Clinical Practice of Totally Implantable Venous Access Ports in Children (Edition 2026)
- 关键词:
- 完全置入式静脉输液港; 静脉输液; 儿童; 临床实践指导方针; 专家共识
- Keywords:
- Totally Implantable Venous Access Port; Intravenous Infusion; Child; Practice Guideline; Expert Consensus
- 摘要:
- 随着医疗技术发展及儿童疾病谱变迁,完全植入式静脉输液港(totally implantable venous access port,TIVAP)在儿童患者中的应用日益广泛。为进一步规范儿童静脉输液港的临床实践,由重庆医科大学附属儿童医院与复旦大学附属儿科医院牵头,组织全国25位儿童静脉输液港领域的专家,围绕其适应证与禁忌证、植入流程、应用与维护、并发症管理及装置移除等全过程,制定了《儿童完全植入式静脉输液港临床实践专家共识(2026版)》,供临床参考。
- Abstract:
- With advances in medical technology and the changing pediatric disease spectrum,totally implantable venous access ports (TIVAPs) have been widely used in children.To further standardize the clinical practice of totally implantable venous access ports (TIVAPs) in children, the Children’s Hospital of Chongqing Medical University and Children’s Hospital of Fudan University took the lead in organizing 25 national specialists engaged in pediatric TIVAP management. Focusing on the full-cycle clinical procedures including indications and contraindications,implantation protocols, clinical application and maintenance,complication management, and device removal,the experts jointly formulated the Expert Consensus on Clinical Practice of Totally Implantable Venous Access Ports in Children (2026 Edition) for clinical reference.
参考文献/References:
[1] Niederhuber JE,Ensminger W,Gyves JW,et al.Totally implanted venous and arterial access system to replace external cathe-ters in cancer treatment[J].Surgery,1982,92(4):706-712.
[2] Mcgovern B,Solenberger R,Reed K.A totally implantable venous access system for long-term chemotherapy in children[J].J Pediatr Surg,1985,20(6):725-727.DOI:10.1016/S0022-3468(85)80033-6.
[3] Ullman AJ,Bernstein SJ,Brown E,et al.The Michigan appropriateness guide for intravenous catheters in pediatrics:min-iMAGIC[J].Pediatrics,2020,145(S3):S269-S284.DOI:10.1542/peds.2019-3474I.
[4] Ullman AJ,Chopra V,Brown E,et al.Developing appropriateness criteria for pediatric vascular access[J].Pediatrics,2020,145(S3):S233-S242.DOI:10.1542/peds.2019-3474G.
[5] Neville JJ,Aye HM,Hall NJ.Tunnelled external versus implanted port central venous catheters in paediatric oncology:a sys-tematic review and meta-analysis[J].Arch Dis Child,2023,108(12):975-981.DOI:10.1136/archdischild-2023-325789.
[6] Rognoni C,Mussa B,Tarricone R.Totally implanted ports and peripherally inserted central catheters for chemotherapy:a sys-tematic review and meta-analysis of clinical outcomes and economic evaluations[J].Expert Rev Med Devices,2026,23(3):335-347.DOI:10.1080/17434440.2026.2625370.
[7] 新生儿脐静脉置管临床研究协作组,孔祥永,封志纯,等.静脉输液港用于新生儿脐静脉置管的临床多中心研究[J].中国小儿急救医学,2019,26(7):552-554.DOI:10.3760/cma.j.issn.1673-4912.2019.07.016. Clinical Research Collaborative Group on Umbilical Venous Catheterization in Newborns,Kong XY,Feng ZC,et al.Clinical multicenter study of vascular access pump system for neonatal umbilical vein catheterization[J].Chin Pediatr Emerg Med,2019,26(7):552-554.DOI:10.3760/cma.j.issn.1673-4912.2019.07.016.
[8] Christison-Lagay ER,Brown EG,Bruny J,et al.Central venous catheter consideration in pediatric oncology:a systematic review and meta-analysis from the American Pediatric Surgical Association Cancer Committee[J].J Pediatr Surg,2024,59(8):1427-1443.DOI:10.1016/j.jpedsurg.2024.03.047.
[9] Augustin AM,Kertels O,Wiegering V,et al.Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients[J].Pediatr Radiol,2022,52(8):1550-1558.DOI:10.1007/s00247-022-05321-x.
[10] Han LL,Zhang J,Deng XB,et al.Totally implantable venous access ports:a prospective randomized study comparing subcla-vian and internal jugular vein punctures in children[J].J Pediatr Surg,2021,56(2):317-323.DOI:10.1016/j.jpedsurg.2020.04.021.
[11] Hamzah KA,Kurmasha YH,Shweliya MA,et al.Internal vs.external jugular vein access for pediatric totally implantable ve-nous ports:a systematic review and meta-analysis[J].Pediatr Surg Int,2025,41(1):180.DOI:10.1007/s00383-025-06089-5.
[12] 国家肿瘤质控中心乳腺癌专家委员会.肿瘤患者上臂植入式静脉给药装置全程管理中国专家共识(2024版)[J].中华肿瘤杂志,2024,46(6):517-525.DOI:10.3760/cma.j.cn112152-20231217-00364. Breast Cancer Expert Committee of National Caner Quality Control Center.Expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients (2024 edition)[J].Chin J Oncol,2024,46(6):517-525.DOI:10.3760/cma.j.cn112152-20231217-00364.
[13] Lian BX,Lee YY,Lee RZ,et al.Femoral venous access port in an adolescent with complete superior Vena Cava obstruction:a case report[J].Cureus,2025,17(4):e83169.DOI:10.7759/cureus.83169.
[14] Onan HB,Piskin FC,Sozutok S,et al.An alternative central venous access route for pediatric patients with chronic critical illness:the transhepatic approach[J].Indian J Pediatr,2024,91(3):254-259.DOI:10.1007/s12098-022-04219-8.
[15] Johnston AJ,Simpson MJ,McCormack V,et al.Association of Anaesthetists guidelines:safe vascular access 2025[J].Anaes-thesia,2025,80(11):1381-1396.DOI:10.1111/anae.16727.
[16] Yun JN,Baek G,Indorf A,et al.Incidence of port site complications in relation to timing of bevacizumab infusion[J].J Oncol Pharm Pract,2025,31(4):528-533.DOI:10.1177/10781552241245037.
[17] Erdoes G,Goobie SM,Haas T,et al.Perioperative considerations in the paediatric patient with congenital and acquired coag-ulopathy[J].BJA Open,2024,12:100310.DOI:10.1016/j.bjao.2024.100310.
[18] Papastefan ST,Zeineddin S,Blakely ML,et al.Association of prophylactic antibiotics with early infectious complications in children with cancer undergoing central venous access device placement[J].Ann Surg,2024,280(6):1021-1028.DOI:10.1097/SLA.0000000000006140.
[19] Xie YL,Liu L,Jiao JQ,et al.Health education and nursing needs of breast cancer patients with totally implantable venous access ports at different stages[J].Altern Ther Health Med,2023,29(2):22-28.
[20] Leibowitz A,Oren-Grinberg A,Matyal R.Ultrasound guidance for central venous access:current evidence and clinical rec-ommendations[J].J Intensive Care Med,2020,35(3):303-321.DOI:10.1177/0885066619868164.
[21] Gullo G,Rotzinger DC,Frossard P,et al.Value of projectional imaging relative to cross-sectional imaging to assess catheter tip position in the superior vena cava:evaluation of reader variability[J].Br J Radiol,2025,98(1166):237-245.DOI:10.1093/bjr/tqae218.
[22] 黎明,刘赞,黄召,等.腔内心电图定位技术在儿童输液港植入术中的应用[J].临床小儿外科杂志,2024,23(7):672-676.DOI:10.3760/cma.j.cn101785-202311045-012. Li M,Liu Z,Huang Z,et al.Application of intracavity electrocardiography positioning technology in children’s totally implant-able venous access ports implantation[J].J Clin Ped Sur,2024,23(7):672-676.DOI:10.3760/cma.j.cn101785-202311045-012.
[23] Yang SJ,Kong XR,Liu LF,et al.Application of transesophageal echocardiography for localization in totally implantable ve-nous access port implantation through subclavian approach in children[J].Clin Cardiol,2021,44(1):129-135.DOI:10.1002/clc.23518.
[24] Deng XB,Peng L,Zhang J,et al.Dual ultrasound-guided totally implantable venous access ports via the right internal jugular vein in pediatric patients with cancer:a preliminary experience in a single institution[J].World J Pediatr Surg,2023,6(3):e000509.DOI:10.1136/wjps-2022-000509.
[25] Zhang YJ,Ou CP,Bai XH,et al.Efficacy and safety of the combination of propofol and S(+)-ketamine for procedural sedation in pediatric patients undergoing totally implantable venous access port implantation:a prospective randomized controlled study[J].Front Pediatr,2022,10:974917.DOI:10.3389/fped.2022.974917.
[26] Wang YQ,Gao MY,Bai GN.Assessment of the feasibility and safety of totally implantable venous access port to collect blood samples in pediatric patients with acute lymphoblastic leukemia[J].Pak J Med Sci,2025,41(6):1644-1650.DOI:10.12669/pjms.41.6.11978.
[27] 张阳阳,张洪新,张娜,等.完全植入式静脉输液港因并发症拔管风险预测模型的建立及验证[J].中华护理杂志,2024,59(20):2455-2462.DOI:10.3761/j.issn.0254-1769.2024.20.004. Zhang YY,Zhang HX,Zhang N,et al.Construction and validation of a risk prediction model for extubation due to complica-tions of totally implantable access port[J].Chin J Nurs,2024,59(20):2455-2462.DOI:10.3761/j.issn.0254-1769.2024.20.004.
[28] 中华人民共和国国家卫生和计划生育委员会.静脉治疗护理技术操作规范:WS/T 433-2013[S].北京:中国标准出版社,2014. National Health and Family Planning Commission of the People’s Republic of China.Nursing practice standards for intrave-nous therapy:WS/T 433-2013[S].Beijing:Standards Press of China,2014.
[29] Rosenbluth G,Tsang L,Vittinghoff E,et al.Impact of decreased heparin dose for flush-lock of implanted venous access ports in pediatric oncology patients[J].Pediatr Blood Cancer,2014,61(5):855-858.DOI:10.1002/pbc.24949.
[30] Semerci R,Bing?l H,Bay büyükkapu S,et al.Comparison of heparin and saline for prevention of central venous catheter oc-clusion in pediatric oncology:a systematic review and meta-analysis[J].Semin Oncol Nurs,2023,39(4):151426.DOI:10.1016/j.soncn.2023.151426.
[31] de Souza S,Takashima MD,Hyun A,et al.Complications in central venous access devices in paediatric cancer care:a global cross-sectional survey[J/OL].Eur J Haematol:2025.https://doi.org/10.1111/ejh.70041.DOI:10.1111/ejh.70041.
[32] Eghbali A,Shirani A,Obeidinia M,et al.Impact of TauroLockTM-HEP500 versus unfractionated heparin for prevention of catheter complications in children with malignancy:a prospective,randomized,controlled study[J].Eur J Med Res,2025,30(1):1137.DOI:10.1186/s40001-025-03413-6.
[33] Hsieh HC,Hung SC,Huang SY,et al.A prospective,randomized study assessing different modalities for flushing totally im-planted vascular access device in children with malignancy[J].J Chin Med Assoc,2022,85(1):114-119.DOI:10.1097/JCMA.0000000000000601.
[34] Viana Taveira MR,Lima LS,de Araújo CC,et al.Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port:a cohort study[J].Pediatr Blood Cancer,2017,64(2):336-342.DOI:10.1002/pbc.26225.
[35] 王丹,张娜,邵静波,等.血液肿瘤患儿中心静脉导管相关血流感染的危险因素分析[J].中国感染与化疗杂志,2022,22(1):1-7.DOI:10.16718/j.1009-7708.2022.01.001. Wang D,Zhang N,Shao JB,et al.Risk factors for central venous catheter-related bloodstream infection in children with hema-tological malignancy[J].Chin J Infect Chemother,2022,22(1):1-7.DOI:10.16718/j.1009-7708.2022.01.001.
[36] Saavedra-Lozano J,Slocker-Barrio M,Fresán-Ruiz E,et al.Consensus document of the Spanish Society of Paediatric Infec-tious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP) for the diagnosis and treatment of central venous catheter-related infections in paediatric care[J].An Pediatr (Engl Ed),2024,100(6):448-464.DOI:10.1016/j.anpede.2024.05.012.
[37] Cherkashin M,Alexandrov S,Nikolaev A,et al.Venous thromboembolism in children with totally implanted venous access devices.Systematic review[C]//ECR 2023.Vienna:European Society of Radiology,2023:C-21299.DOI:10.26044/ecr2023/C-21299.
[38] Monagle P,Azzam M,Bercovitz R,et al.American society of hematology/international society on thrombosis and haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients[J].Blood Adv,2025,9(10):2587-2636.DOI:10.1182/bloodadvances.2024015328.
[39] Koretsune Y,Sugawara S,Sone M,et al.Inversion of central venous ports in children under six years old:a retrospective analysis of 154 oncology patients[J].Cureus,2024,16(6):e63106.DOI:10.7759/cureus.63106.
[40] Annetta MG,Pinelli F,Ortiz Miluy G,et al.The SaRePo protocol:a seven-step strategy to minimize complications potentially related to the removal of totally implanted central venous access devices[J].J Vasc Access,2026,27(1):5-11.DOI:10.1177/11297298251333863.
相似文献/References:
[1]黄一敏,徐伟珏,吴一波,等.小儿完全植入式静脉输液港导管相关性血流感染的诊治——附4例报道[J].临床小儿外科杂志,2020,19(10):939.[doi:10.3969/j.issn.1671-6353.2020.10.015]
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备注/Memo
收稿日期:2026-4-8。
基金项目:国家自然科学基金资助项目(82573719);重庆市科卫联合基金资助项目(2021MSXM298)注册编号:国际实践指南注册与透明化平台(PREPARE—2026CN1258)
通讯作者:章均,Email:junzhang@hospital.cqmu.edu.cn;董瑞,Email:rdong@fudan.edu.cn