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Sosnowska-Sienkiewicz P, Moryciński S, Januszkiewicz-Lewandowska D, Michalik K, Madziar K, Kukfisz A, Zielińska D, Mańkowski P. Totally implantable venous ports in infants and children: a single-center retrospective study of indications and safety. Front Oncol 2024; 14:1351630. [PMID: 38690159 PMCID: PMC11058838 DOI: 10.3389/fonc.2024.1351630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Totally Implantable Venous Access Devices (TIVADs) contribute significantly to the treatment progress and comfort of patients requiring long-term therapy. However, the procedure for implanting TIVADs, as well as its very presence, may be associated with complications. Aim This study evaluates the indications, safety, and complication rates of venous port implantations in pediatric patients. It also explores factors influencing the occurrence of early and late complications post-implantation. Materials and methods The study included 383 pediatric patients treated at the Department of Pediatric Surgery, Traumatology, and Urology in Poznan between 2013 and 2020 who underwent 474 implantations of intravenous ports. Venous access was achieved using the Seldinger technique. Statistical analysis was performed using Statistica 13 with TIBCO and PQStat 1.8.2.156 with PQStat. Results Venous ports were used in 345 oncology patients requiring chemotherapy (90% of the total group) and in 38 children (10%) with non-oncology indications. There were 36 early complications (7.6%) and 18 late complications (3.8%), excluding infectious complications. The most common early, non-infectious complications included pneumothorax (15 patients; 3%) and port pocket hematoma (12 patients; 2.5%). The most common late, non-infectious complications observed were venous catheter obstruction (8 children; 1.7%) and port system leakage (5 children; 1%). Infectious complications occurred in 129 cases (27.2%). Children with a diagnosis of non-Hodgkin's lymphoma, acute myeloid leukemia, and acute lymphoblastic leukemia had a significantly higher incidence of port infections. Venous ports equipped with a polyurethane catheter, compared to systems with a silicone catheter, functioned significantly shorter. Conclusions The Seldinger method of port implantation is quick, minimally invasive, and safe. The type of port, including the material of the port's venous catheter, and the underlying disease have an impact on the durability of implantable intravenous systems. The experience of the surgeon is related to the frequency of complications associated with the procedure.
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Affiliation(s)
| | - Sebastian Moryciński
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Karolina Michalik
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznan, Poland
| | - Klaudyna Madziar
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Agata Kukfisz
- Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Daria Zielińska
- Provincial Hospital for Neurological and Mental Illness, Lubiaz, Poland
| | - Przemysław Mańkowski
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznan, Poland
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Mull HJ, Foster MV, Higgins MCSS, Sturgeon DJ, Hederstedt K, Bart N, Lamkin RP, Sullivan BA, Ayeni C, Branch-Elliman W, Malloy PC. Development and Validation of an Electronic Adverse Event Model for Patient Safety Surveillance in Interventional Radiology. J Am Coll Radiol 2023:S1546-1440(23)01041-4. [PMID: 38157954 DOI: 10.1016/j.jacr.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Comprehensive adverse event (AE) surveillance programs in interventional radiology (IR) are rare. Our aim was to develop and validate a retrospective electronic surveillance model to identify outpatient IR procedures that are likely to have an AE, to support patient safety and quality improvement. METHODS We identified outpatient IR procedures performed in the period from October 2017 to September 2019 from the Veterans Health Administration (n = 135,283) and applied electronic triggers based on posyprocedure care to flag cases with a potential AE. From the trigger-flagged cases, we randomly sampled n = 1,500 for chart review to identify AEs. We also randomly sampled n = 600 from the unflagged cases. Chart-reviewed cases were merged with patient, procedure, and facility factors to estimate a mixed-effects logistic regression model designed to predict whether an AE occurred. Using model fit and criterion validity, we determined the best predicted probability threshold to identify cases with a likely AE. We reviewed a random sample of 200 cases above the threshold and 100 cases from below the threshold from October 2019 to March 2020 (n = 20,849) for model validation. RESULTS In our development sample of mostly trigger-flagged cases, 444 of 2,096 cases (21.8%) had an AE. The optimal predicted probability threshold for a likely AE from our surveillance model was >50%, with positive predictive value of 68.9%, sensitivity of 38.3%, and specificity of 95.3%. In validation, chart-reviewed cases with AE probability >50% had a positive predictive value of 63% (n = 203). For the period from October 2017 to March 2020, the model identified approximately 70 IR cases per month that were likely to have an AE. CONCLUSIONS This electronic trigger-based approach to AE surveillance could be used for patient-safety reporting and quality review.
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Affiliation(s)
- Hillary J Mull
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Marva V Foster
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; VA Boston Healthcare System, Department of Quality Management, Boston, Massachusetts
| | | | - Daniel J Sturgeon
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Kierstin Hederstedt
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Nina Bart
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Rebecca P Lamkin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Brian A Sullivan
- Duke University School of Medicine, Department of Gastroenterology, Durham, North Carolina; Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Christopher Ayeni
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Westyn Branch-Elliman
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Patrick C Malloy
- Director of the VHA National Radiology Program, VA New York Harbor Healthcare System, New York, New York
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Suzuki T, Michimoto K, Hasumi J, Kisaki S, Hasegawa Y, Fujimori A, Yoshimatsu L, Ashida H, Ojiri H. Silver-Mixed Port Reduces Venous Access Port Related Infection Rate Compared to Non-Silver-mixed Port: A Single-center Retrospective Analysis. Cardiovasc Intervent Radiol 2023; 46:1696-1702. [PMID: 37902854 PMCID: PMC10695883 DOI: 10.1007/s00270-023-03583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Totally implantable venous access ports (TIVAPs) are increasingly used as safe and convenient central venous access devices. However, several TIVAP-related complications occur, with port/catheter infection being most common. Silver-mixed ports have recently been introduced in anticipation of reducing TIVAP infection. This study aimed to investigate the efficacy of this device in reducing port infection by examining groups with and without silver-mixed devices. MATERIALS AND METHODS From April 2017 to July 2022, silver-mixed ports (S group) and non-silver-mixed port group (NS group) were reviewed at our institution. The incidence of TIVAP-related infections, patient characteristics, and bacteriological data were evaluated. Univariate and multivariate analyses were used to evaluate risk factors for TIVAP-related infection. RESULTS A total of 607 patients (S group, n = 203; NS group, n = 404) were enrolled. The rates of TIVAP-related infection were 3.0% (n = 6) and 7.7% (n = 31) in the S and NS groups, respectively. The incidence of total infection per 1000 catheter-days were 0.114 and 0.214 the S and NS groups, respectively. In the entire group, the rates of infection were 6.1% (n = 37) and the incidence of total infection per 1000 catheter-days was 0.187. Univariate and multivariate analyses revealed a significantly lower TIVAP-related infection rate in S group than NS group (p = 0.0216, odds ratio = 2.88 confidence interval: 1.17-7.08). No gram-negative rods were detected in the S group as port infection. CONCLUSION Silver-mixed port may be feasible in preventing port infection. LEVEL OF EVIDENCE Level 3, Local non-random sample.
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Affiliation(s)
- Takayuki Suzuki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Kenkichi Michimoto
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Yasuaki Hasegawa
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Ayako Fujimori
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Lynn Yoshimatsu
- Department of Radiology, The Jikei University Daisan Hospital, 4-11-1, Izumihonchou, Komae-shi, Tokyo, 201-8601, Japan
| | - Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
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Freire MP, Assis DB, Carlesse F, Belizario JDC, Germano PCP, Virolli JM, Turdo AC, Rodrigues BQ, Maciel ALP, Goncalves P, Boszczowski I, Abdala E, Levin AS. A surveillance program for long-term central venous access-associated infections in outpatient chemotherapy services. Infect Control Hosp Epidemiol 2023; 44:1555-1561. [PMID: 37039458 DOI: 10.1017/ice.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE In this study, we described the first results of a surveillance system for infections associated with long-term central venous catheters (LT-CVC) in patients under outpatient chemotherapy. DESIGN This was a multicentric, prospective study. SETTING Outpatient chemotherapy services. PARTICIPANTS The study included 8 referral cancer centers in the State of São Paulo. INTERVENTION These services were invited to participate in a newly created surveillance program for patients under chemotherapy. Several meetings were convened to share previous experiences on LT-CVC infection surveillance and to define the surveillance method. Once the program was implemented, all bloodstream infection (LT-CVC BSIs), tunnel infection, and exit-site infections associated with LT-CVC were reported. Data from January to May 2021 were analyzed. The median monthly number of chemotherapy sessions per clinic was 925 (IQR, 270-5,855). We used Poisson regression to analyze the association of rates with the characteristics of the services. RESULTS In total, 107 LT-CVC infections were reported, of which 95% were BSIs, mostly associated with totally implantable devices (76%). Infections occurred a median of 4 days after the last catheter manipulation and 116 after the LT-CVC insertion. Also, 102 microorganisms were isolated from LT-CVC BSIs; the most common pathogen was Staphylococcus epidermidis, at 22%. Moreover, 44 infections (44%) fulfilled the criteria for CVC-related LT-CVC BSI and 27 infections (27%) met the criteria for mucosal barrier injury. The 1-year cumulative LT-CVC BSI rate was 1.94 per 1,000 CVC days of use. The rates were higher in public hospitals (IRR, 6.00; P < .001) and in hospitals that already had in place surveillance for LT-CVC infections (IRR, 2.01; P < .01). CONCLUSION Our study describes an applicable surveillance method for infections in cancer outpatients using LT-CVC.
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Affiliation(s)
- Maristela P Freire
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
- Infection Control Service, Cancer Institute of São Paulo State, São Paulo, Brazil
| | - Denise Brandão Assis
- Division of Hospital Infections, Center for Epidemiologic Surveillance "Prof. Alexandre Vranjac," Center for Disease Control, São Paulo State Health Department, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Icaro Boszczowski
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Edson Abdala
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
- Infection Control Service, Cancer Institute of São Paulo State, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
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Risk Factors of Catheter-Related Infection in Unplanned Extubation of Totally Implantable Venous-Accessportsin Tumor Patients. Emerg Med Int 2022; 2022:4235316. [PMID: 36204335 PMCID: PMC9532140 DOI: 10.1155/2022/4235316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Totally implantable intravenous ports (TIVAPs) are mostly used for long-term intravenous infusion therapy in cancer patients and can be left in the body for long periods of time for easy management, making them a simple and safe infusion device. Although the risks associated with long-term retention of fully implantable IV ports are less than those associated with other intravenous catheters, various complications may still occur at the time of implantation or during long-term use. Purpose To provide a scientific basis for clinical reduction of implantable intravenous port-associated infection complications by studying the risk factors for catheter-associated infection complications in patients applying implantable intravenous ports. Methods A retrospective study was conducted on oncology patients treated with TIVAP at our hospital between January 2017 and November 2021, with a review of patients who were unplanned for extubation. Their demographic data, underlying disease status, and surgery-related data were counted to summarize and analyze the complications and related influencing factors of implantation and postimplantation. Results A total of 70 individuals with a mean age of 56.49 ± 12.19 years were included in the study. Among them, 39 were male and 64 had the highest percentage of epithelial tumors, followed by tumors of the lymphopoiesis system and mesenchymal tumors with 4 and 2 cases, respectively. Forty-eight of these patients did not have their ports removed as planned due to the occurrence of catheter-related hematogenous infections. In univariate analysis, BMI and neutropenia were risk factors for catheter-associated infections. In the multivariate analysis, BMI (OR = 1.38, 95% CI: 1.07–1.78, p=0.013) was an independent risk factor for catheter-associated infections. Conclusions The overall complication rate of fully implanted intravenous ports was high, but most complications improved with symptomatic management, and no deaths due to port complications were identified. Infection was the most common complication, with catheter-associated bloodstream infection being the most common cause of unplanned port extraction. Patients with a higher BMI were at high risk of developing implantable IV port-associated infections, which may be an independent risk factor for implantable IV port-associated infections.
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Reply to Dr. Toro’s letter to editor “Port catheter tip positioning is essential”. Langenbecks Arch Surg 2022; 407:1313-1314. [DOI: 10.1007/s00423-022-02519-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
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Toro A, Magazu' S, Fiorino L, Di Carlo I. Port catheter tip positioning is essential. Langenbecks Arch Surg 2022; 407:1311-1312. [PMID: 35364725 DOI: 10.1007/s00423-022-02506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Adriana Toro
- General Surgery, Augusta Hospital, Syracuse, Italy
| | - Sarita Magazu'
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, General Surgery, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Leonardo Fiorino
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, General Surgery, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, General Surgery, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy.
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Scheunemann S, Daenenfaust L, Langenbach MR. Use of plastic adhesive skin drapes in cancer patients undergoing totally implantable vascular access port (TIVAP) placement-a randomized controlled pilot study. Langenbecks Arch Surg 2022; 407:1257-1262. [PMID: 35257222 DOI: 10.1007/s00423-022-02489-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE A totally implantable vascular access port (TIVAP) is commonly required in cancer patients. Possible adverse events after TIVAP implantation include surgical site infection (SSI) and port-related bacteremia. This study examined whether adhesive surgical drapes can reduce the risk of SSI. METHODS A total of 100 mostly cancer patients were randomized into two groups before undergoing TIVAP implantation by surgical cut-down. In one group, an adhesive, non-impregnated drape was applied to the skin prior to incision, while the control group underwent surgery without a drape. Swabs were taken from the surgical site and sent for microbiologic testing. SSI rates were compared between groups. RESULTS No SSI occurred within 30 days after surgery. In each group, two patients died. There were 5 complications (port thrombosis, port dislocation, two cases of pneumothorax, skin allergy), all in the intervention group (p = 0.056). Using the incision drape prolonged procedure time by + 5 min (95% CI - 1 to + 10, p = 0.125). Microbiologic swab testing failed to detect any effect of the incision drape. CONCLUSIONS Plastic adhesive skin drapes may be unnecessary in cancer patients who undergo surgical implantation of a TIVAP.
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Affiliation(s)
- Sönke Scheunemann
- Department for General and Abdominal Surgery, Evangelical Hospital, Evangelisches Krankenhaus Lippstadt gGmbH, Wiedenbrücker Str.33, 59555, Lippstadt, Germany.,University of Witten/Herdecke, Witten, Germany
| | - Lars Daenenfaust
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Mike Ralf Langenbach
- Department for General and Abdominal Surgery, Evangelical Hospital, Evangelisches Krankenhaus Lippstadt gGmbH, Wiedenbrücker Str.33, 59555, Lippstadt, Germany. .,University of Witten/Herdecke, Witten, Germany.
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