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Sueyoshi S, Ono T, Chitose SI, Fukahori M, Kurita T, Umeno H. The risk of pocket infection or bloodstream infection following central venous port placement for the patients with Cetuximab therapy. J Oncol Pharm Pract 2024:10781552231225933. [PMID: 38258296 DOI: 10.1177/10781552231225933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Cetuximab is a molecular targeted drug that targets epithelial growth factor receptors. The skin toxicity of cetuximab arising from epithelial growth factor inhibition is well known. Some patients with cetuximab therapy decided to make central venous port during the long-term intravenous treatments. Therefore, the author hypothesized that cetuximab administration might increase the risk of central venous port-related infection due to damage to skin barrier function. The main aim of the present study was to investigate the relationship between cetuximab administration and central venous port-related infection. METHODS A total of 83 patients had a central venous port placed from 2016 through 2021. We analyzed, retrospectively, the relationship between cetuximab therapy and the incidence of central venous port-related infection involving central line-associated bloodstream infection and pocket infection. Additionally, the risk factors of central venous port-related infection were examined in the population undergoing cetuximab therapy. RESULTS In total populations (83 cases), central line-associated bloodstream infection happened in five patients (6%) and pocket infection happened in six patients (7%) after central venous port placement. In the cetuximab therapy group (45 cases), there were four patients with central line-associated bloodstream infection (9%) and six with pocket infection (13%). The pocket infection happened more frequently in the cetuximab group than the other group with significant differences. Additionally, in the cetuximab group, the patients who had an interval of less than seven days between central venous port placement and cetuximab dosing, or central venous port placement preceded by cetuximab dosing had more pocket infection with significant differences. CONCLUSION Skin complications after the central venous port placement were related to cetuximab administration and the timing of cetuximab therapy.
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Affiliation(s)
- Shintaro Sueyoshi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Mioko Fukahori
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takashi Kurita
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohito Umeno
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Augustin AM, Kertels O, Wiegering V, Thurner A, Kickuth R. Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients. Pediatr Radiol 2022; 52:1550-1558. [PMID: 35368211 PMCID: PMC9271099 DOI: 10.1007/s00247-022-05321-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. OBJECTIVE To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. MATERIALS AND METHODS Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. RESULTS Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. CONCLUSION Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080, Würzburg, Germany.
| | - Olivia Kertels
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| | - Verena Wiegering
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
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Risk factors assessment for radiographically guided port implantations with forearm access. PLoS One 2021; 16:e0259127. [PMID: 34699565 PMCID: PMC8547706 DOI: 10.1371/journal.pone.0259127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Port implantations at the forearm are associated with an increased risk of relevant vein thrombosis. Therefore, with this study we sought to identify the responsible risk factors to improve technical quality of the method. Methods This is a retrospective analysis of 313 patients with port implantation at the forearm in 2019. Then, exploratory statistics were conducted comprising Cox-Regression and Kaplan-Meier-Analyses. Results Mean age was 60 ± 14 years. 232 (74%) of the patients were female. No early infection was observed. 29 late infections and 57 cases of thrombosis occurred. In only 9% of the patients with thrombosis hospital admission was necessary for treatment. Median interval to the diagnosis of thrombosis was 23 days; inter-quartile-range: 16–75. Mean interval to elective port explantation was 227 ± 128 days. There was no effect of occurrence of thrombosis of the interventionalist, the assistance nor of several technical aspects. However, there was a significantly lower risk of thrombosis for primary implanted port system compared to replacement ports, Hazard-ratio: 0.34 [Confidence interval: 0.172, 0.674], p = 0.002. Age was a significant risk factor for late infections, Hazard-ratio: 3.35 [Confidence interval:1.84, 6.07], p < 0.0001. Conclusion The main risk factor for adverse outcome after radiographically guided port implantation at the forearm is the type of the implanted port system. The reason for that might not be the material itself but the experience of a team with a certain port system. Age is a risk factor for late complications.
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Early Results of Totally Implantable Central Venous Access Port Insertion Through a Supraclavicular Approach. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost 2020; 18:2253-2273. [PMID: 32479699 DOI: 10.1111/jth.14930] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP-associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. METHODS Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. RESULTS In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24-3.28), and 0.08 (95 CI: 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95% CI: 2.94-4.76). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. CONCLUSIONS Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.
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Affiliation(s)
- Meng Jiang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, Wuhan, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Successful percutaneous transvenous retrieval of intravascular fractured port catheter: a single center experience. J Cardiothorac Surg 2020; 15:101. [PMID: 32423421 PMCID: PMC7236484 DOI: 10.1186/s13019-020-01131-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fractured catheter as a foreign body in situ is a rare complication after port catheter placement. We report a single center's experience on percutaneous transvenous retrieval of intravascular fractured port catheter and treatment techniques. METHODS Patients undergoing percutaneous transvenous retrieval of intravascular fractured port catheter from Jan 2010 to Dec 2018 were retrospectively collected. A total of 10 patients (8 females and 2 males) were enrolled in this study. Procedures were performed within 1 day after diagnosis. Two methods of retrieval were considered, direct retrieval by gooseneck snare and guide wire as media to retrieve were used in the procedure. RESULTS All the fractured catheters in 10 patients were successfully retrieval by 2 methods, direct retrieval by gooseneck snare(n = 6) and guide wire as media of retrieval(n = 4). The time interval between port catheter implantation and discovery of catheter fracture was 36.50 ± 42.99(ranged 1 to 146) days. The operation time was 24.10 ± 8.32(ranged 10 to 36) minutes. No immediate procedure related or 1 month follow-up complications occurred in all the 10 patients. CONCLUSION Percutaneous transvenous retrieval of intravascular fractured port catheter is a simple and safe procedure, which maybe recommended as the first choice for patients with fractured port catheter in situ.
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Kariya S, Nakatani M, Ono Y, Maruyama T, Ueno Y, Komemushi A, Tanigawa N. Assessment of the Antithrombogenicity of a Poly-2-Methoxyethylacrylate-Coated Central Venous Port-Catheter System. Cardiovasc Intervent Radiol 2020; 43:775-780. [PMID: 32055927 DOI: 10.1007/s00270-020-02408-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the antithrombogenic effects of poly-2-methoxyethylacrylate (PMEA) coating applied to the internal surfaces of the port-catheter system to prevent thrombotic occlusion. MATERIALS AND METHODS PMEA coating was applied to the inner surfaces of the entire system, including the chamber, catheter, and connecting stem. PMEA-coated and uncoated port-catheter systems were each filled with fresh human blood for 1 or 3 h and then flushed with saline. Volumes of residual thrombi in the system and protein in the catheter were then compared. RESULTS Saline flushing of the PMEA-coated port-catheter system expelled all visually recognizable thrombi, leaving no unremovable adhesions. In contrast, the uncoated port showed thrombi adherent to the inner surfaces and incomplete expulsion with flushing. Mean (± standard deviation) residual thrombus mass was significantly lower in PMEA-coated port-catheter systems (20.5 ± 6.2 mg) than in uncoated systems (230.3 ± 92.5 mg; p < 0.01). Mean residual protein was likewise significantly lower in PMEA-coated systems (20.5 ± 6.2 mg) than in uncoated systems (230.3 ± 92.5 mg; p < 0.01). CONCLUSIONS PMEA coating on a central venous port-catheter system decreased accumulation and facilitated flushing of thrombi from the system by flushing, as compared with the uncoated system. PMEA-coated central venous port-catheter systems appear relatively antithrombotic compared to uncoated systems.
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Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
| | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
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Li G, Zhang Y, Ma H, Zheng J. Arm port vs chest port: a systematic review and meta-analysis. Cancer Manag Res 2019; 11:6099-6112. [PMID: 31308748 PMCID: PMC6613605 DOI: 10.2147/cmar.s205988] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background Two prevailing, totally implantable venous access ports are routinely utilized in oncology: chest port or arm port. This systematic review with meta-analysis was conducted to compare safety and efficiency of the two techniques. Methods We performed evidence acquisition intensively from PubMed, Embase, and Cochrane Library. Available comparative studies that evaluated both techniques were identified. The outcomes of interest included total complication events, procedure-related infections, thrombosis, intra-operative complications, mechanical complications, conversion rate, early port removal, and operating time. Results Thirteen comparative studies including 3,896 patients (2,176 for chest ports, and 1,720 for arm ports) were identified. The present study showed that arm port was associated with higher procedure conversion rate (2.51% in chest port group and 8.32% in arm port group; odd ratios [OR] 0.27, 95% confidence interval [CI] 0.15-0.46; p<0.001), but lower incidence of intra-operative complications (1.38% in chest port group and 0.41% in arm port group; OR 2.38, 95% CI 1.07-5.29; p=0.03). There were no between-group differences with respect to total complication events, procedure-related infections, thrombosis, mechanical complications, early port removal, and operating time. Subgroup analysis of patients under 60 years revealed that no significant difference was detected in intra-operative events (1.19% in chest port group and 0.02% in arm port group, OR 2.59, 95% CI 0.74-9.08; p<0.14), indicating that age may be a risk factor for intra-operative events. Sensitivity analysis did not change conclusions of all endpoints of interest. Conclusion Arm port is associated with higher procedure conversion rate, but lower incidence of intra-operative complications, and age may be a risk factor for intra-operative events.
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Affiliation(s)
- Guanhua Li
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, People's Republic of China
| | - Yu Zhang
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, People's Republic of China
| | - Hongmin Ma
- Department of Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, People's Republic of China
| | - Junmeng Zheng
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, People's Republic of China
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Alfonso Alvarez-Rodríguez J, García-Suárez M, Fernández-García D, Méndez-Martínez C, Gómez-Salgado J. Analysis of peripheral central venous access ports at the forearm: An observational study. Eur J Cancer Care (Engl) 2018; 27:e12929. [PMID: 30298954 DOI: 10.1111/ecc.12929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 01/16/2018] [Accepted: 08/22/2018] [Indexed: 01/27/2023]
Abstract
The aim of this study was to analyse the characteristics of central venous catheters with brachial-implanted reservoirs and the complications associated with their use over a 4-years period. This observational study was carried out in an onco-haematological day hospital in Spain. Information was collected about 125 catheters inserted in patients requiring intravenous chemotherapy. There were more catheters implanted in women than men and the mean age was 58.6 years. Seventy of the implanted catheters were made of polyurethane and 55 of silicone. Left laterality prevailed with a mean catheter dwell-time of 347.1 days. A total of 164 complications were registered, 124 of them came from blood draws, where the most frequent complication was "inability to withdraw, ability to infuse". Forty complications were associated with the administration of treatments. Furthermore, there were 21 catheter removals, caused by several other complications different from those mentioned before. Statistically significant differences were found when associating types of catheters, laterality, blood draws and administration of treatments. Results showed how silicone ports would be more appropriate for patients who carry these types or ports than polyurethane because they reduce the number of complications causes by thrombosis.
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Affiliation(s)
| | | | | | | | - Juan Gómez-Salgado
- Department of Nursing, Faculty of Nursing, Universidad de Huelva, Huelva, Spain.,Espíritu Santo University, Guayaquil,Ecuador
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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Tippit D, Siegel E, Ochoa D, Pennisi A, Hill E, Merrill A, Rowe M, Henry-Tillman R, Ananthula A, Makhoul I. Upper-Extremity Deep Vein Thrombosis in Patients With Breast Cancer With Chest Versus Arm Central Venous Port Catheters. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223418771909. [PMID: 29881287 PMCID: PMC5987887 DOI: 10.1177/1178223418771909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/29/2018] [Indexed: 12/31/2022]
Abstract
Most of the patients undergoing treatment for cancer require placement of a
totally implantable venous access device to facilitate safe delivery of
chemotherapy. However, implantable ports also increase the risk of deep vein
thrombosis and related complications in this high-risk population. The objective
of this study was to assess the incidence of upper-extremity deep vein
thrombosis (UEDVT) in patients with breast cancer to determine whether the risk
of UEDVT was higher with chest versus arm ports, as well as to determine the
importance of previously reported risk factors predisposing to UEDVT in the
setting of active cancer. We retrospectively reviewed the medical records of 297
women with breast cancer who had ports placed in our institution between the
dates of December 1, 2010, and December 31, 2016. The primary outcome was the
development of radiologically confirmed UEDVT ipsilateral to the implanted port.
Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1
documented case of associated pulmonary embolism. Fourteen (9.5%) of 147
subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150
subjects with chest ports (P = .0056). Thus, implantation of
arm ports as opposed to chest ports may be associated with a higher rate of
UEDVT in patients with breast cancer.
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Affiliation(s)
- Danielle Tippit
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric Siegel
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniella Ochoa
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Angela Pennisi
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Erica Hill
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amelia Merrill
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark Rowe
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronda Henry-Tillman
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aneesha Ananthula
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Issam Makhoul
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Burbridge B, Plewes C, Stoneham G, Szkup P, Otani R, Babyn P, Bryce R. Randomized Clinical Trial Evaluating Complications and Complication-Related Removal of Arm-Situated Power-Injectable and Non-Power-Injectable Totally Implanted Venous Access Devices among Cancer Patients. J Vasc Interv Radiol 2018; 29:648-656.e3. [PMID: 29499999 DOI: 10.1016/j.jvir.2017.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 11/16/2017] [Accepted: 11/26/2017] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To evaluate the hypothesis that power-injectable (PI) totally implanted venous access devices (TIVADs) situated in the arm are associated with more frequent complications and complication-related removal than non-power-injectable (NPI) arm TIVADs among adult cancer patients. MATERIALS AND METHODS In this single-center trial, 211 adult chemotherapy patients were randomized to receive either a PI or a NPI arm TIVAD. Follow-up involved a standardized telephone interview 1 week after insertion, followed by a chest X-ray, arm X-ray, and Doppler ultrasound at 3 months and 12 months. Online complication reporting was also provided by patients and care providers for a minimum of 1 year. The primary end point was removal for port-related complications; the secondary end point was the occurrence of any port-related complication. RESULTS Forty-two complications occurred (19.9% of patients), precipitating the removal of 6 PI ports and 7 standard ports. Time-to-removal did not differ between TIVAD types (hazard ratio 0.75, 95% confidence interval [CI] 0.25-2.24; P = .61). Complications were related to thrombosis, infection, or mechanical issues, with no statistical difference between groups for overall occurrence (23.1% vs 17.0%, odds ratio 1.47, 95% CI 0.74-2.92; P = .27); however, by type of complication, thrombosis occurred more frequently among PI TIVAD patients (15.2% vs 6.1%, odds ratio 2.79, 95% CI 1.04-7.44; P = .03). CONCLUSIONS There was no difference in port-related complication occurrence or complication-related removal when using the arm PI port compared with the NPI port among cancer patients.
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Affiliation(s)
- Brent Burbridge
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8.
| | - Chris Plewes
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Grant Stoneham
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
| | - Peter Szkup
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
| | - Rob Otani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
| | - Paul Babyn
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
| | - Rhonda Bryce
- Clinical Research Support Unit, College of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
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Ramamurthi A, Chick JFB, Srinivasa RN, Hage AN, Grove JJ, Gemmete JJ, Johnson TD, Srinivasa RN. Chest Radiograph Measurement Technique Facilitates Accurate Bedside Peripherally Inserted Central Catheter Placement in Children. Cardiovasc Intervent Radiol 2017; 41:443-448. [PMID: 29238870 DOI: 10.1007/s00270-017-1857-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the chest radiograph measurement technique for placing bedside peripherally inserted central catheters (PICCs). MATERIALS AND METHODS Two hundred and thirty-two consecutive pediatric patients, mean age of 56.3 months (range: 0-203 months), underwent PICC placement from January 2015 to May 2017 (28 months) with a total of 232 PICCs placed. Measurements were taken from the cavoatrial junction to clavicle, clavicle to medial margin of mid-humeral head, and medial margin of mid-humeral head to mid-humerus. The difference between total radiographic measured length and actual PICC length was then calculated, and the percent difference (from actual cut length) was recorded. An equivalence test was performed using the two, one-sided test method. RESULTS Mean ± standard deviation cavoatrial junction to clavicle length was 5.29 ± 2.20 cm (range: 2.1-12.6 cm). Mean clavicle to shoulder length was 8.20 ± 3.59 cm (range: 3.23-19.06 cm). Mean shoulder to mid-humerus length was 7.88 ± 3.87 cm (range: 2.01-16.8 cm). Mean total radiographic measured length was 21.37 ± 9.19 cm (range: 7.42-43.6 cm). Mean actual cut PICC length was 20.64 ± 8.72 cm (range: 8.5-44 cm). The mean difference between predicted, or total radiographic measured length, and actual cut PICC length was 0.73 ± 2.51 (range: - 5.42-8.60 cm). The mean percent difference was 4.07 ± 12.65% (range: - 23.84-47.80%). An equivalence test rejected the null hypothesis of the true percent difference greater/less than ± 6.67% with a p value of 0.002. CONCLUSION The chest radiograph measurement technique is an accurate method to determine catheter length for PICC placement at bedside in the pediatric population.
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Affiliation(s)
- Aishu Ramamurthi
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.,Department of Biology, Duke University, Durham, NC, 27705, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Rajiv N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jason J Grove
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Timothy D Johnson
- Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arobr, MI, 48109, USA
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Wildgruber M, Lueg C, Borgmeyer S, Karimov I, Braun U, Kiechle M, Meier R, Koehler M, Ettl J, Berger H. Polyurethane versus silicone catheters for central venous port devices implanted at the forearm. Eur J Cancer 2016; 59:113-124. [DOI: 10.1016/j.ejca.2016.02.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 12/27/2022]
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Almasi-Sperling V, Hieber S, Lermann J, Strahl O, Beckmann MW, Lang W, Sagban TA. Femoral Placement of Totally Implantable Venous Access Ports in Patients with Bilateral Breast Cancer. Geburtshilfe Frauenheilkd 2016; 76:53-58. [PMID: 26855441 DOI: 10.1055/s-0035-1558173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Aim of this study was to determine the rate of complications following femoral placement of totally implantable venous access ports (f-TIVAP) in women with bilateral breast cancer, with a special focus on long-term function, deep vein thrombosis (DVT), and port infection. Methods: 73 patients with bilateral breast cancer treated between October 2000 and January 2013 with placement of an f-TIVAP using a transfemoral approach were retrospectively reviewed. All patients were followed up, and all complications of f-TIVAP were recorded. Results: The median age was 62.5 years (range: 35-86 years). Four patients received f-TIVAP under local anesthesia, and 69 underwent placement under general anesthesia. Mean follow-up was 33.7 months (SD 25.9; range: 0.2-93.5 months). Complications over the entire period of observation included infections in 21 %, DVT in 19 % and catheter occlusion in 12 %. Patients receiving chemotherapy who developed leukopenia were more likely to experience DVT at the access site (p = 0.037). There was a trend towards a higher infection rate when the device was used more often (p = 0.084). Conclusion: Although the rates of complications in the longer term, especially device infections and DVTs, appeared to be relatively high, TIVAP implantation using femoral vein access is recommended in patients with bilateral breast cancer not suitable for cephalic vein cut-down.
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Affiliation(s)
- V Almasi-Sperling
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - S Hieber
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - J Lermann
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - O Strahl
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - W Lang
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - T A Sagban
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
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Wei WC, Wu CY, Wu CF, Fu JY, Su TW, Yu SY, Kao TC, Ko PJ. The Treatment Results of a Standard Algorithm for Choosing the Best Entry Vessel for Intravenous Port Implantation. Medicine (Baltimore) 2015; 94:e1381. [PMID: 26287429 PMCID: PMC4616437 DOI: 10.1097/md.0000000000001381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vascular cutdown and echo guide puncture methods have its own limitations under certain conditions. There was no available algorithm for choosing entry vessel. A standard algorithm was introduced to help choose the entry vessel location according to our clinical experience and review of the literature. The goal of this study is to analyze the treatment results of the standard algorithm used to choose the entry vessel for intravenous port implantation.During the period between March 2012 and March 2013, 507 patients who received intravenous port implantation due to advanced chemotherapy were included into this study. Choice of entry vessel was according to standard algorithm. All clinical characteristic factors were collected and complication rate and incidence were further analyzed.Compared with our clinical experience in 2006, procedure-related complication rate declined from 1.09% to 0.4%, whereas the late complication rate decreased from 19.97% to 3.55%. No more pneumothorax, hematoma, catheter kinking, fractures, and pocket erosion were identified after using the standard algorithm. In alive oncology patients, 98% implanted port could serve a functional vascular access to fit therapeutic needs.This standard algorithm for choosing the best entry vessel is a simple guideline that is easy to follow. The algorithm has excellent efficiency and can minimize complication rates and incidence.
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Affiliation(s)
- Wen-Cheng Wei
- From the Department of Surgery, Division of Thoracic and Cardiovascular Surgery (W-CW, C-YW, C-FW, T-WS, S-YY, T-CK, P-JK); and Department of Internal Medicine, Division of Chest and Critical Care, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan (J-YF)
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Abstract
AbstractPurpose: Various venous access devices are available, including peripheral venous lines, peripherally inserted central catheters lines, and subcutaneous port catheters. The latter provides medium-to long-term venous access and includes medical devices that can be inserted either on the chest (chest ports) or in the arm (arm ports). We report the techniques, dedicated indications, and main complications of arm port insertion using the ultrasonography (US) guidance method.Methods: Tips and tricks of percutaneous real-time US-guided vein access technique in the arm are reviewed, and a brief literature review is reported.Results: Technical feasibility is almost 99%. US guidance allows depiction of anatomic variants, reduces the number of failed attempts, and increases the technical access rate compared with venography-guided access. Comparison of arm ports to chest ports reveals a higher global complication rate. We also report typical (mechanical) complications and dedicated indications, including contraindications to chest port insertion and selected patients for whom chest ports are not possible (eg, those with breast, head, and neck cancer; obesity; cosmesis; and requiring upright position).Conclusions: Arm port insertion under US guidance is safe and effective, and has dedicated indications.
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Zhou J, Qian S, He W, Han G, Li H, Luo R. Implanting totally implantable venous access port via the internal jugular vein guided by ultrasonography is feasible and safe in patients with breast cancer. World J Surg Oncol 2014; 12:378. [PMID: 25487539 PMCID: PMC4265500 DOI: 10.1186/1477-7819-12-378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022] Open
Abstract
Background Because of long-term use for chemotherapy and fluid administration in cancer patients, a totally implantable venous access port (TIVAP) has been advised as a feasible catheter. The purpose of this study was to evaluate the effectiveness and safety of ultrasound (US)-guided internal jugular vein (IJV) puncture for TIVAP implantation in patients with breast cancer. Methods We reviewed the medical records of 492 patients who underwent US-guided IJV puncture for TIVAP implantation at our oncology department between 2010 and 2013. Indications, surgical complications, and early and long-term complications were analyzed. Results All TIVAPs were implanted successfully. Indications for TIVAP were chemotherapy alone (88 patients), chemoradiotherapy (387 patients), surgery (12 patients), and parenteral nutrition (5 patients). Complications were observed in 65 (13.21%) patients. The median duration of the TIVAP was 359 days (range, 28 to 712 days) without damage to the port or catheter, or leakage of drugs outside of the port system. Conclusions A TIVAP can be employed for chemotherapy and parenteral nutrition on the implantation day. Using a US-guided IJV puncture to completely implant a TIVAP is feasible and safe in patients with breast cancer.
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Affiliation(s)
| | | | | | | | - Hongsheng Li
- Cancer Center, Nanfang Hospital, Southern Medical University, No, 1838, Northern Guangzhou Road, 510515 Guangzhou, Guangdong, China.
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Useful Equation for Proper Estimate of Left Side Peripherally Inserted Central Venous Catheter Length in Relation to the Height. J Vasc Access 2014; 16:42-6. [DOI: 10.5301/jva.5000309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose Direct measurement of venous length is easy to cause contamination during bedside insertion of peripherally inserted central venous catheter (PICC). It is necessary to provide an equation for proper estimate of catheter length in case of bedside insertion of PICC in relation to patient height. Methods For 165 PICC cases through left arm vein in 151 adult patients (male: female = 72:79), the cubital crease to carina length (CCL) was calculated as follows: CCL = (distance from cubital crease to puncture point) + (length of PICC inside body) – (distance from carina to catheter tip on post-procedural chest radiograph). We analyzed the relationship between CCL and height with regression analysis and suggest a new equation of CCL based on height. Results The mean CCL through the left arm vein was 47.1 ± 2.6 cm in male and 44.0 ± 2.9 cm in female. CCL was significantly correlated with patient height. Equation of CCL (cm) based on height was as follows: CCL = height* 0.19 + 14. Conclusions The equation of our study would provide a new equation for proper estimation of catheter length in case of bedside insertion of left arm PICC in relation to height and be helpful for optimal positioning of catheter tip of PICC.
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Short-term and long-term outcome of radiological-guided insertion of central venous access port devices implanted at the forearm: a retrospective monocenter analysis in 1704 patients. Eur Radiol 2014; 25:606-16. [PMID: 25239184 DOI: 10.1007/s00330-014-3417-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/06/2014] [Accepted: 08/27/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objectives are to analyze the technical success rate as well as the short-term and long-term complications of totally implantable venous access ports (TIVAPs) at the forearm. METHODS Retrospective analysis of 1,704 consecutively implanted TIVAPs was performed. Primary endpoints were defined as technical success rate, clinical outcome, device service interval, and rates of major complications. Minor complications not requiring port explantation were defined as secondary endpoints. RESULTS The technical success rate was 99.2 % with no major complications. During follow-up, a total of 643,200 catheter-days were documented, the mean device service interval was 380.6 days/patient. A total of 243 complications (14.4 %) in 226 patients were observed (0.4/1000 catheter-days), in 140 patients (8.3 %) the port device had to be explanted. Disconnection between the port device and the catheter (1.6 %) was more frequent than fracture (0.8 %) and leakage (0.6 %) of the catheter, which occurred more frequently when the catheter was inserted via the cephalic versus the brachial vein. CONCLUSION TIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications.
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21
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Long-term Outcome of Peripherally Implanted Venous Access Ports in the Forearm in Female Cancer Patients. Cardiovasc Intervent Radiol 2014; 38:657-64. [DOI: 10.1007/s00270-014-0975-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 07/06/2014] [Indexed: 12/20/2022]
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Femoral placement of totally implantable venous power ports as an alternative implantation site for patients with central vein occlusions. Support Care Cancer 2013; 22:383-7. [PMID: 24061782 DOI: 10.1007/s00520-013-1984-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the indication, technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) in a femoral position in patients with contraindications to implantation in a standard position. METHODS Retrospectively, we screened our interventional radiology department database between 12/2,009 and 3/2,013 to identify 1,729 patients with a port implantation. In 8/1,729 (0.47 %) patients (1 male, 7 female, mean age 55.5 ± 9.6 years) the TIVPP was implanted via the common femoral vein with the port placed in the anterior thigh. All devices were high-pressure injectable, implanted under local anaesthesia with sonographic as well as fluoroscopic guidance, and were tunnelled subcutaneously. Indication, technical success and complications were retrospectively analysed according to the Society of Interventional Radiology (SIR) criteria. RESULTS Indications were planned chemotherapy for breast (n = 6) and oesophagus cancer (n = 1) as well as need for long-term central venous access for intravenous therapy (n = 1) with a contraindication to or failed implantation in a standard position owing to central vein occlusions. Technical success was 100 %. A number of five devices were placed in the right, three in the left thigh. Altogether 1,979 catheter days were analysed. One device was explanted owing to infection after 84 days (late complication, 0.05/100 catheter days). No early complication was observed. CONCLUSIONS Our data suggest that if implantation of a TIVPP is not favourable in a standard chest, upper arm or forearm position, femoral placement of the device may alternatively be used safely and with high technical success.
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Garajová I, Nepoti G, Paragona M, Brandi G, Biasco G. Port-a-Cath-related complications in 252 patients with solid tissue tumours and the first report of heparin-induced delayed hypersensitivity after Port-a-Cath heparinisation. Eur J Cancer Care (Engl) 2012; 22:125-32. [PMID: 22966988 DOI: 10.1111/ecc.12008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of the subcutaneous Port-a-Catheters (Port-a-Caths) provides an important mean of venous access for oncological patients. The aim of our retrospective consecutive single-centre study was to investigate Port-a-Cath-related complications in 252 cancer patients. Overall period of Port-a-Caths maintenance was 25 months. The strategy of our centre is to keep Port-a-Caths in situ up to the end of follow-up in adjuvant cancer patients. A total of 22 complications were recorded (8.73%). Interventional complications occurred in four patients. The main complications during Port-a-Cath use included thrombosis (4 patients, 1.58%), infections (4 patients, 1.58%), persistent pain or discomfort (3 patients, 1.19%) and dislocations (2 patients, 0.79%). Median time to the occurrence of any type of complications was 4.5 months. Eleven Port-a-Caths were removed due to complications (4.36%). Similar rate of Port-a-Cath-related thrombosis/infection was seen in adjuvant and advanced cancer patients (no statistical significance). Continuous infusion of anticancer therapy via a Port-a-Cath system is a relatively safe procedure, although major complications might occur. We are first to describe heparin-induced delayed hypersensitivity after heparinisation of Port-a-Cath. This fact should influence the preference to keep the Port-a-Cath after completion of adjuvant anticancer treatment.
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Affiliation(s)
- I Garajová
- L & A Seràgnoli Department of Hematology and Oncological Sciences, University of Bologna, Bologna, Italy.
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Akahane A, Sone M, Ehara S, Kato K, Suzuki M, Tanaka R, Suwabe A, Itabashi T, Masahiro K. Central venous port-related infection in patients with malignant tumors: an observational study. Ups J Med Sci 2012; 117:300-8. [PMID: 22376242 PMCID: PMC3410290 DOI: 10.3109/03009734.2012.664178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated the characteristics of central venous port (CVP)-related infection with microbiological assessments in patients with malignant tumors. MATERIALS AND METHODS In a prospective setting, patients with CVP for the treatment of malignant tumors were enrolled in this study. The incidence of CVP-related infection during three months was determined. Microbiological surveillance from skin swab was performed before and after CVP placement. RESULTS Fifty-nine patients were enrolled in this study, and 60 CVPs were implanted. Thirty-six (61%) patients had head and neck malignancies. Access route was subclavian vein in 43 (71.7%) CVPs and forearm vein in 17 (28.3%). CVP-related infection was observed in three (5.1%) patients: port-pocket infection in one and probable CVP-related infection in two patients, respectively. No definitive CVP-related bloodstream infection was observed. Before the placement of CVP, colonization at the insertion site was observed in ten subclavian CVP patients, while no colonization was observed in the forearm CVP patients. At 1 and 4 weeks, detection rates of colonization were also higher in subclavian CVP patients. No definitive relationship was demonstrated between skin colonization and clinical development of CVP-related infection. CONCLUSION The rate of CVP-related infection in this prospective evaluation in patients with malignant tumors was comparable to previous studies. Colonization of the skin was more prominent in the subclavian site than in the forearm site. Although skin colonization was not proven to be a risk factor of infection, these results may draw attention to the adequate maintenance of CVP. ( TRIAL REGISTRATION UMIN000003664).
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Affiliation(s)
- Akio Akahane
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
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Goltz JP, Petritsch B, Kirchner J, Hahn D, Kickuth R. Percutaneous image-guided implantation of totally implantable venous access ports in the forearm or the chest? A patients’ point of view. Support Care Cancer 2012; 21:505-10. [DOI: 10.1007/s00520-012-1544-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
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Goltz JP, Noack C, Petritsch B, Kirchner J, Hahn D, Kickuth R. Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devices approved for high-pressure injections. Br J Radiol 2012; 85:e966-72. [PMID: 22674705 DOI: 10.1259/bjr/33224341] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To evaluate the technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) approved for high-pressure injections, and to analyse their value for arterial phase CT scans. METHODS Retrospectively, we identified 204 patients who underwent TIVPP implantation in the forearm (n=152) or chest (n=52) between November 2009 and May 2011. Implantation via an upper arm (forearm port, FP) or subclavian vein (chest port, CP) was performed under sonographic and fluoroscopic guidance. Complications were evaluated following the standards of the Society of Interventional Radiology. Power injections via TIVPPs were analysed, focusing on adequate functioning and catheter's tip location after injection. Feasibility of automatic bolus triggering, peak injection pressure and arterial phase aortic enhancement were evaluated and compared with 50 patients who had had power injections via classic peripheral cannulas. RESULTS Technical success was 100%. Procedure-related complications were not observed. Catheter-related thrombosis was diagnosed in 15 of 152 FPs (9.9%, 0.02/100 catheter days) and in 1 of 52 CPs (1.9%, 0.002/100 catheter days) (p<0.05). Infectious complications were diagnosed in 9 of 152 FPs (5.9%, 0.014/100 catheter days) and in 2 of 52 CPs (3.8%, 0.003/100 catheter days) (p>0.05). Arterial bolus triggering succeeded in all attempts; the mean injection pressure was 213.8 psi. Aortic enhancement did not significantly differ between injections via cannulas and TIVPPs (p>0.05). CONCLUSIONS TIVPPs can be implanted with high technical success rates, and are associated with low rates of complications if implanted with sonographic and fluoroscopic guidance. Power injections via TIVPPs are safe and result in satisfying arterial contrast. Conventional ports should be replaced by TIVPPs.
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Affiliation(s)
- J P Goltz
- Julius Maximilian University of Würzburg, Institute of Radiology, Würzburg, Germany.
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Goltz JP, Petritsch B, Thurner A, Hahn D, Kickuth R. Complications after percutaneous placement of totally implantable venous access ports in the forearm. Clin Radiol 2012; 67:1101-7. [PMID: 22583951 DOI: 10.1016/j.crad.2012.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/24/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
This article focuses on radiological imaging of complications after interventional percutaneous insertion of totally implantable venous access ports (TIVAPs) which were placed in the forearm. Thus far most reviews have dealt with pectorally-placed TIVAPs. Compared with the pectoral approach, implantation in the forearm has been associated with certain complications owing to a longer route of the port catheter within a smaller vein, and owing to the route across the elbow joint, resulting in higher rates of catheter-associated thrombosis and possible mechanical complications. The purpose of this review is to describe the complications after implantation of TIVAPs in the forearm, and to make radiologists familiar with the key findings of the complications during radiological imaging, including colour-coded and compression Duplex ultrasound, computed tomography, and digital subtraction venography.
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Affiliation(s)
- J P Goltz
- Institute of Radiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
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Common and uncommon complications of totally implantable central venous ports: a pictorial essay. J Vasc Access 2012; 13:345-50. [PMID: 22307469 DOI: 10.5301/jva.5000055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study is to present the characteristic radiologic features of common and uncommon complications in totally implantable central venous ports. MATERIAL AND METHODS The authors reviewed 138 implantations of central venous ports in oncologic patients during an 18-month period and present the characteristic imaging features of the complications detected. RESULTS All chest ports were placed via the internal jugular vein using both fluoroscopic and ultrasound guidance. The technical success rate was 99.3% (137/138). All catheter or port-related complications were retrospectively assessed. Sixteen complications were detected during the follow-up period, and catheter removal was required in 10 patients. CONCLUSIONS Image-guided central venous port catheter implantation is a very safe procedure with a low rate of complications. The typical imaging features of common and uncommon complications are very helpful in establishing the correct diagnosis and thus tailoring the appropriate therapy.
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Marcy PY, Figl A, Amoretti N, Thariat J. Further data about upper extremity ports. Cardiovasc Intervent Radiol 2011; 34:657-8; author reply 659-60. [PMID: 20811891 DOI: 10.1007/s00270-010-9963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Identification of Risk Factors for Catheter-Related Thrombosis in Patients with Totally Implantable Venous Access Ports in the Forearm. J Vasc Access 2011; 13:79-85. [DOI: 10.5301/jva.5000003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose To identify risk factors for the development of catheter-related thrombosis (CRT) in patients with totally implant-able venous access ports (TIVAP) in the forearm, and to analyze the effect of prophylaxis and treatment. Methods We retrospectively identified 200 patients (94 men, 106 women, mean age 57.7 +/-14 y) with TIVAP implantation in the forearm between 3/2010 and 11/2010. Type, number of punctures and sonographically defined diameter of the accessed vein were analyzed. Chemotherapy administered prior to the implantation procedure and history of thrombo-embolic events were assessed. Thrombo-embolic prophylaxis (TEP) following port implantation and treatment as well as course of CRT were analyzed. Results Twenty-one patients (10.5%) were diagnosed with CRT. Accessed vessels and mean diameter were basilic (n=150, 3.7 mm), brachial (n=39, 3.5 mm) and cephalic (n=11, 3.5 mm) vein. Neither type nor vessel diameter had effect on CRT development (P>.05). Implantation in the left forearm resulted in a significantly higher rate of CRT (P=.04). Ninety-five patients (47.5%) received chemotherapy and 30 patients (15.0%) had a history of thrombosis prior to implantation; both had no effect on development of CRT. Low molecular weight heparin (LMWH) was prescribed in 94/200 patients (47.0%) and had no effect on development of CRT (P>.05). Therapeutic anticoagulation with LMWH resulted in clinical improvement in 12/21 patients (57.4%). Conclusions TIVAPs of the forearm may be associated with a certain rate of early and late CRT. The simplest vein to puncture should be selected for vascular access. Thrombo-embolic prophylaxis appears to be rather ineffective for prevention of CRT.
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Reply to Letter: Further Data About Upper Extremity Ports. Cardiovasc Intervent Radiol 2011. [DOI: 10.1007/s00270-010-9972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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