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Is there a Real Advantage in Utilizing Central Venous Ports in Oncology Surgery? An Analysis of the Cost-Effectiveness Ratio. TUMORI JOURNAL 2018. [DOI: 10.1177/030089160108700438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Madabhavi I, Patel A, Sarkar M, Anand A, Panchal H, Parikh S. A Study of Use of "PORT" Catheter in Patients with Cancer: A Single-Center Experience. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917691031. [PMID: 28469510 PMCID: PMC5395272 DOI: 10.1177/1179554917691031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/06/2017] [Indexed: 11/15/2022]
Abstract
Background: Effective and reliable venous access is one of the cornerstones of modern medical therapy in oncology. Materials and methods: This is a prospective observational study, which collected data of patients who require “PORT” catheter insertion for any cancer, at a tertiary care oncology hospital in Ahmadabad, Gujarat, India, during a 2-year period. Aims and objectives: The main objective of this study was to study the various complications and outcomes related to “PORT” catheters. Results: “PORT” catheter was inserted in 100 patients and was most commonly used in solid malignancies (n = 86, 86%), followed by hematologic malignancies (n = 14, 14%). Among the solid malignancies, breast cancer (38, 38%) was the most common underlying disease, whereas among the hematologic malignancies, acute lymphoblastic leukemia (6, 6%) was the most common underlying disease for “PORT” catheter insertion. Chemotherapy was started on the first day of “PORT” catheter in 74% of patients in the “PORT” study group. The various complications developed in the “PORT” study group in the descending order are as follows: 4 patients (4%) developed early infection (⩽30 days after “PORT” placement), 4 (4%) late infection (⩾30 days after “PORT” placement), 4 (4%) bloodstream infection, 2 (2%) local skin infection at the “PORT” insertion site, 2 (2%) dislodgment of the “PORT” catheter, 2 (2%) fracture of the “PORT” catheter, and 1 recurrent pleural effusion. One patient (1%) developed thrombosis as the complication of “PORT” catheter insertion. Conclusions: The most disturbing aspect of treatment for a patient with cancer is multiple painful venipunctures made for administration of cytotoxic agents, antibiotics, blood products, and nutritional supplements. The focus of this prospective observational research is to study the various underlying diseases for which “PORT” catheter is needed in different solid and hematologic malignancies and the various complications and outcomes in pediatric and adult patients with cancer.
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Affiliation(s)
- Irappa Madabhavi
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Apurva Patel
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, India
| | - Asha Anand
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Harsha Panchal
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Sonia Parikh
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
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Central venous access port devices - a pictorial review of common complications from the interventional radiology perspective. J Vasc Access 2012; 13:9-15. [PMID: 21725953 DOI: 10.5301/jva.2011.8439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 11/20/2022] Open
Abstract
Portacaths are tunnelled and totally implanted central venous access port devices (CVAPD). They are commonly used for intravenous antibiotic delivery in patients with cystic fibrosis. More recently, they are being used in oncology to deliver chemotherapy and apheresis. It is therefore important to be aware of portacath associated complications and their imaging features. This pictorial review illustrates and discusses common complications associated with Portacath devices.
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Girard R, Traullé C, DeSantis N, Espinouse D, Gardes S, Coiffier B. Groshong or implanted catheter infections in ambulatory haematological patients. J Infect Public Health 2010; 3:134-41. [DOI: 10.1016/j.jiph.2010.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 09/16/2009] [Accepted: 05/20/2010] [Indexed: 10/19/2022] Open
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Ng F, Mastoroudes H, Paul E, Davies N, Tibballs J, Hochhauser D, Mayer A, Begent R, Meyer T. A comparison of Hickman line- and Port-a-Cath-associated complications in patients with solid tumours undergoing chemotherapy. Clin Oncol (R Coll Radiol) 2007; 19:551-6. [PMID: 17517500 DOI: 10.1016/j.clon.2007.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 03/05/2007] [Accepted: 04/15/2007] [Indexed: 11/19/2022]
Abstract
AIMS To compare the complication rates of Hickman lines and Port-a-Caths in patients undergoing infusional chemotherapy for solid tumours. MATERIALS AND METHODS A single institution retrospective analysis comparing complication rates for 30 Hickman lines and 33 Port-a-Caths inserted for chemotherapy in adults with solid tumours was carried out. RESULTS Patients were well matched in terms of primary site and chemotherapy regimen. In both cases, over 85% were inserted radiologically under local anaesthetic. The total time in situ for Hickman lines and Port-a-Caths was 3539 days (median 83, range 6-585) and 5783 days (median 158, range 20-456), respectively. The complication rate for Hickman lines was 5.09/1000 catheter days, almost five times that for Port-a-Caths, with 1.04/1000 catheter days, a relative risk of 4.9 (confidence interval: 1.9-15.1, P=0.0003). Most (73%) complications occurred within 4 weeks of insertion. However, some arose much later: the range of time to complication was 1-304 days for Hickman lines and 1-132 days for Port-a-Caths. Infection was the most common complication, accounting for nine of 18 Hickman line complications and five of six Port-a-Cath complications, giving an overall infection rate of 2.54/1000 catheter days and 0.86/1000 catheter days, respectively. Additionally, Hickman lines had a 26% leakage rate or displacement rate, which did not occur at all in the Port-a-Cath group. Complications required the removal of 16 Hickman lines and five Port-a-Caths. The rate of removal was five times higher for Hickman lines (Hickman lines=4.52/1000 catheter days, Port-a-Caths=0.86/1000 catheter days, P=0.0027). Overall, the cost of Port-a-Caths was less than that of Hickman lines. CONCLUSION In this study, Port-a-Caths were shown to be both safer and cheaper than Hickman lines for patients requiring infusional chemotherapy.
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Affiliation(s)
- F Ng
- Academic Department of Oncology, Royal Free and University College Medical School, Rowland Hill Street, London, UK
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Vardy J, Engelhardt K, Cox K, Jacquet J, McDade A, Boyer M, Beale P, Stockler M, Loneragan R, Dennien B, Waugh R, Clarke SJ. Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature. Br J Cancer 2004; 91:1045-9. [PMID: 15316563 PMCID: PMC2747721 DOI: 10.1038/sj.bjc.6602082] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Central venous access port devices (CVAPD) are necessary for delivery of prolonged infusional chemotherapy or in patients with poor peripheral venous access. Previous studies of Hickman catheters report complication rates in about 45% of patients. Our aim was to assess the early and late complication rate, and duration that the CVAPD remained functional, following insertion by interventional radiologists in patients with solid tumours. A prospective study was undertaken in 110 consecutive patients who had insertion of 111 subclavian CVAPD. The median age of patients was 57 years (range 17–83), 64 were females; 68 patients (61%) had gastrointestinal tumours and 25 (23%) had breast cancer. CVAPD were successfully implanted in all but one patient. There were four (4%) immediate major complications: thrombosis 2 and pneumothorax 2. Nine patients (8%) had bruising or pain. Four devices (4%) became infected. In total, 100 CVAPD (90%) were either removed as planned at the end of treatment (n=23) after a median 203 days, or remained in situ for a median of 237 days (7–1133). Premature removal occurred in eight patients due to infection (n=4), thrombosis (n=3) or faulty device (n=1). Four patients were lost to follow-up. Radiological insertion of CVAPD is safe and convenient with low rates of complications.
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Affiliation(s)
- J Vardy
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - K Engelhardt
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - K Cox
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
| | - J Jacquet
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - A McDade
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - M Boyer
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - P Beale
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - M Stockler
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - R Loneragan
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - B Dennien
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
| | - R Waugh
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
| | - S J Clarke
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050 NSW, Australia
- Concord Repatriation General Hospital, Hospital Rd, Concord, 2139 NSW, Australia
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050 NSW, Australia. E-mail:
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Boussen H, Mtaallah M, Dhiab T, Khalfallah S, Jerbi G, Hechiche M, Mezlini A, Rahal K, Ben Ayed F. [Evaluation of implantable sites in medical oncology in Tunisia. Prospective study of 205 cases]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:509-13. [PMID: 11471498 DOI: 10.1016/s0750-7658(01)00413-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the insertion and use of implantable central venous accesses in medical oncology at the Institute Salah Azaïz. METHODS From January 1992 to June 2000, 205 patients including 179 adults (118F/61M) and 26 children aged 7 months to 72 years (mean 37 years) required the insertion of an implantable port (IP). Tumoral pathology was dominated by metastatic breast carcinoma (93/179), digestive cancer (42/179) and paediatric cancer (26 cases). RESULTS Excluding 3 initial failures, we inserted 205 IP for 202 patients. The supraclavicular anatomic way (Yoffa) was used in 156/205 cases and the subclavicular (Aubaniac) for the resting 32 cases with a jugular conversion in 17 cases. Initial complications were represented by 6 arterial puncture (2.9%), 3 pneumothorax (1.5%) and 1 catheter migration in the right pulmonary artery. Median life duration of the material was 210 days (3 to 1460 days) for adults and 185 days (3 to 1460 ays) for children. Mean life duration for the 205 IP was 240 days +/- 239 (3 to 1460 days) with a total of 49,200 IP-days. We explanted 17 IP for infection (8 cases), cutaneous ulceration (8 cases) and actinomycin extravasation (1 case). We observed 6 cases (2.9%) of subclavian and jugular thrombosis treated by anticoagulants and conservation management of the port. Presently, 58 patients are alive with IP in place. CONCLUSION Implantable ports represent a useful option in medical oncology for patients treated with prolonged chemotherapy and adjuvant treatments such as antibiotics, transfusion. This method allows a good comfort for the patients and also the treating team but requires a prealable training for the nursing team.
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Affiliation(s)
- H Boussen
- Service de carcinologie médicale, Institut Salah Azaïz, boulevard du 9 avril, Bab Saadoun, Tunis, Tunisie.
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Whitman ED. Vascular Access for Cancer. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Biffi R, de Braud F, Orsi F, Pozzi S, Mauri S, Goldhirsch A, Nolè F, Andreoni B. Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol 1998; 9:767-73. [PMID: 9739444 DOI: 10.1023/a:1008392423469] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A few data are available from analyses of the complications and costs of central venous access ports for chemotherapy. This prospective study deals with the complications and global costs of central venous ports connected to a Groshong catheter for deliverance of long-term chemotherapy. PATIENTS AND METHODS Patients with a variety of solid neoplastic diseases requiring chemotherapy who were undergoing placement of implantable ports over a 30-month period (1 October 1994 to 31 March 1997) have been prospectively studied. Follow-up continued until the device was removed or the study was closed (30 September 1997); patients with uneventful implant experience and subsequent follow-ups of less than 180 days were not considered for this study. A single port, constructed of titanium and silicone rubber (Dome Port, Bard Inc., Salt Lake City, USA), was used, connected to an 8 F silastic Groshong catheter tubing (Bard Inc., Salt Lake City, USA). Two-hundred ninety-six devices were placed in the operating room under fluoroscopic control even in the patients treated and monitored in a day-hospital setting: 37 of them were in an angiographic suite. A central venous access form was filled in by the operator after the procedure and all ports were followed prospectively for device-related and overall complications. The average purchase cost of the device was obtained from the hospital charges, based on the costs applied during the 30-month period of the study. Insertion and maintenance costs were estimated by obtaining the charges for an average TIAP implant and its subsequent use; the costs of complication management were assessed analytically. The total cost of each device was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any. The cost of removing the TIAP was also included in the economic analysis when required by the treatment of the complication. RESULTS Three hundred thirty-three devices, for a total of 79,178 days in situ, were placed in 328 patients. Five patients received second devices after removal of the first. In all cases the follow-up was appropriate (median 237 days, range 180-732). Early complications included 10 pneumothoraxes (3.4%; six tube-thoracostomies were applied, 1.8%) and six revisions for port and/or catheter malfunction (overall early complications = 16, 4.48%). Late complications comprised five instances of catheter rupture and embolization (1.5%, 0.063 episodes/1000 days of use), five of venous thrombosis (1.5%, 0.063 episodes/1000 days of use), one of pocket infection (0.3%, 0.012 episodes/1000 days of use), and eight of port-related bacteremia (2.4%, 0.101 episodes/1000 days of use). The infections were caused by coagulase-negative Staphylococcus aureus (five cases), Bacillus subtilis (one case), Streptococcus lactaceae (one case) and an unknown agent (one case); port removal was necessary in six of eight cases. The total cost per patient treated for a six-month period, consisting of the costs of purchase and implantation, treatment of early and late complications, and of maintenance of the device, is US$1,970. CONCLUSIONS This study represents the largest published series of patients with totally implantable access ports connected to a Groshong catheter. We have shown that US$2,000 are sufficient to cover six months of chemotherapy in one patient using the most expensive commercially available implantable port. According to the present study, totally implantable access ports connected to a Groshong catheter are associated with high purchase and insertion costs, a low complication rate and low maintenance costs. These data support their increasing use in current oncologic medical practice.
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Affiliation(s)
- R Biffi
- Division of General Surgery, European Institute of Oncology, Milano, Italy.
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Affiliation(s)
- E D Whitman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Whitman ED, Boatman AM. Comparison of diagnostic specimens and methods to evaluate infected venous access ports. Am J Surg 1995; 170:665-9; discussion 669-70. [PMID: 7492023 DOI: 10.1016/s0002-9610(99)80038-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Implanted venous access port infection can be difficult to diagnose and treat. If device removal is necessary, confirming port infection is problematic. MATERIALS AND METHODS Culture specimens from three sites, catheter tip (Tip), port pocket, and the material within the reservoir (Inside), were sent from ports removed for potential infection. The results of these cultures were compared to preremoval peripheral and central blood cultures. RESULTS Forty-five ports were removed for suspected infection. Confirmed port infection was defined as positive culture(s) from one or more experimental specimen(s). In 29 evaluable cases, the Inside specimens were completely predictive. Tip specimens were less accurate, even with a lower diagnostic threshold. In 7 of 19 confirmed infections, only the Inside culture was diagnostic. CONCLUSION The most predictive culture specimen in a potentially infected port is the thrombotic material inside the reservoir.
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Affiliation(s)
- E D Whitman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
OBJECTIVE To provide an overview of the patient selection criteria for a vascular access device (VAD) and its maintenance care. CONCLUSIONS The availability of different types of devices had led to confusion on the part of many health care professionals as to which device is the best for their purpose. Selecting the appropriate VAD is an interdisciplinary decision based on patient characteristics, type of therapy, support system availability, and cost. Numerous controversial issues surround the care of VADs, and research results have not yet resolved these practice issues. Although various procedures are used throughout the country, it can be reasonably concluded that the fundamental requirement for successful maintenance of a VAD is strict adherence to established care protocols. IMPLICATIONS FOR NURSING PRACTICE Assessment of the need for a VAD is an ongoing process. Nurses are in a perfect position to assess the factors that precede device selection, including the frequency of access, type of intravenous therapy, and the condition of the patient's peripheral veins. The vast array of devices demands specialized knowledge in selecting the appropriate VAD, providing correct care, and evaluating the device once inserted or implanted.
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Affiliation(s)
- M N Winslow
- University of Alabama and Hospital at Birmingham, USA
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