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Guerreiro H, Schröder H, Huber G, Busch F, Sellenschloh K, Adam G, Ittrich H, Busch JD. Quantification of mechanical properties in long-term in vivo used silicone catheter lines according to DIN 10555-3. Clin Biomech (Bristol, Avon) 2023; 107:106015. [PMID: 37321163 DOI: 10.1016/j.clinbiomech.2023.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Totally implantable central venous access port devices are crucial for intravenous application of chemotherapeutics and long-term therapy for chronic disease. Common complications include thrombosis and device fracture related to altered material properties through exposure in situ. This study exhibits whether uniaxial tensile properties (DIN 10555-3) of in vivo used catheters prove inferior to unused catheters. MATERIAL AND METHODS 5 unused, originally packed silicone catheters were cut into 6 segments of 50 mm: 3 segments each were cleaned via cleaning solution (n = 15) while 3 segments were left unattended (n = 15). Distal segments (50 mm) of long-term in vivo used silicone catheters were cleaned before testing (n = 33). Overall mechanical behavior was tested in a custom-made self-centering, torsion free carrier. Maximum force stress at failure, strain at failure and Young's modulus were determined and statistically analyzed. FINDINGS Unused catheters showed no significant difference in testing. in vivo used catheters exhibited 20% lower maximal force than unused catheters (p < 0.001), strain at break (p 〈0,001), and 7% higher elastic modulus (p = 0.004; power: 0.845). Due to a constant cross section area, stress at failure was proportional to maximum force (p < 0.001). Relation between determined parameters and dwell times was non-significant. INTERPRETATION In vivo long-term used silicone catheters showed significantly lower ultimate strength than unused ones. It is likely that in situ altering changes the mechanical properties of catheters and may potentially lead to failure.
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Affiliation(s)
- H Guerreiro
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - H Schröder
- Institute of Biomechanics TUHH Hamburg University of Technology, Hamburg, Germany
| | - G Huber
- Institute of Biomechanics TUHH Hamburg University of Technology, Hamburg, Germany
| | - F Busch
- Division of Neonatology, Department of Pediatrics Bern University Hospital, University of Bern, Switzerland
| | - K Sellenschloh
- Institute of Biomechanics TUHH Hamburg University of Technology, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J D Busch
- Department of Diagnostic, Interventional Radiology and Pediatrics Bern University Hospital, University of Bern, Switzerland
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Donev L, Stepanovski A, Filipova E, Lleshi A, Kartalov A, Stepanovska AA. Malposition of subcutaneous central venous port system in a toddler with acute lymphoblastic leukemia: A case report. Int J Surg Case Rep 2023; 106:108075. [PMID: 37084558 PMCID: PMC10140788 DOI: 10.1016/j.ijscr.2023.108075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Central venous port systems are essential for reliable and long-term venous access in children, mainly for cancer therapy, parenteral nutrition, administration of medications, blood transfusion, etc. However, complications either periprocedural, early, or delayed can be expected and may affect the venous port function, with occasional revision and even port removal. CASE PRESENTATION A central venous port device was implanted in a 2.5-year-old boy for chemotherapy administration in the treatment of acute lymphoblastic leukemia. After a month he presented again to our clinic due to a venous port device dysfunction, and inability to aspirate blood or infuse medications. A reoperation was done that revealed a port chamber in-place rotation. The chamber was repositioned in the pouch and suture-fixated. No port-related problems occurred in the follow-up period. CLINICAL DISCUSSION AND CONCLUSION Central venous port chamber rotation is among the rarest complications, which usually makes the port unusable. It should be quickly recognized, to avoid further damage, such as extravasation of the chemotherapeutic agent or mechanical chamber impairment. A reoperation is almost always needed with subsequent placement of the port in the correct position. This paper also emphasizes the key concepts of complication in implantable venous ports in children.
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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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Yoon SY, Jeon GS, Jung S. Image-guided placement of totally implanted vascular access device: retrospective analysis of the clinical outcomes and associated risk factors. BMJ Support Palliat Care 2021:bmjspcare-2021-002917. [PMID: 33927012 DOI: 10.1136/bmjspcare-2021-002917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 04/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine risk factors for catheter survival and complications after image-guided implantation of a totally implanted vascular access device (TIVAD). METHODS A total of 2883 TIVADs (2735 patients, 63.5±13 years old, 1060 men, 1675 women) implanted under guidance by ultrasound and fluoroscopy in our institution from January 2010 to December 2019 were evaluated retrospectively. We used the log rank test and logistic regression to analyse risk factors associated with catheter survival and complications. RESULTS Female patients (n=1778; 61.7%; mean catheter survival days: 780.6 days) and those with a haematological malignancy (n=277; 10.1%; mean catheter survival days: 1019 days) had significantly better catheter survival than male patients (n=1105; 38.3%; mean catheter survival days: 645.9 days) and those with a solid organ malignancy (n=2447; 89.5%; mean catheter survival days: 701 days) (p<0.001 and p=0.003). Patients with haematological malignancies and benign vascular inflammatory disease (n=11; 0.4%) were vulnerable to infection (n=96; 3.3%) (p<0.001 and p=0.004). Thrombotic malfunction (n=38; 1.3%) was significantly more common in females than males (p=0.005). Non-thrombotic malfunction (n=16; 0.6%) showed a significant association with left positioning of the TIVAD (n=410; 14.2%) (p=0.043). Wound dehiscence (n=3; 0.1%) was significantly more frequent in punctured veins other (n=23; 0.8%) than the internal jugular vein (p<0.001). CONCLUSIONS Increased attention should be paid to patients with an underlying haematological malignancy, underlying vascular inflammatory disease, female patients, older patients, those accessed via a vein other than the IJV, those with left positioning of the TIVAD system or those with a prolonged TIVAD maintenance.
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Affiliation(s)
- So Yeon Yoon
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Gyeong Sik Jeon
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Sanghoon Jung
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
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Yeniguen M, Braun T, Vlazak A, Umscheid T, Juenemann M, Gerriets T, Tschernatsch M. A rare cause of stroke: fail-implanted venous port catheter system - a case report. BMC Neurol 2021; 21:158. [PMID: 33853541 PMCID: PMC8045173 DOI: 10.1186/s12883-021-02191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background We present the case of a 75-year-old female with acute embolic cerebral infarction caused by a fail-implanted venous port catheter system in the left subclavian artery. Case presentation A 75-year-old woman presented to our emergency room after acute onset of a right-sided hemiparesis and dysarthria. Within 2 days after admission, she developed a left-sided hemiparesis, ataxia with concordant gait disturbance and incoordination of the left upper limb. DWI-MRI showed acute multiple infarcts in both cerebral and cerebellar hemispheres. Laboratory examination, 24-h Holter electrocardiography and transthoracic echocardiography provided no pathological findings. Further examination revealed an arterially fail-implanted port catheter, placed in the left subclavian artery with its tip overlying the ascending aorta, as the source of cerebral embolism. Conclusion This is the first case report of thromboembolic, cerebral infarction due to a misplaced venous port catheter in the subclavian artery, emphasizing the imperative need for a thorough diagnostic workup, when embolism is suspected but cannot be proven at first glance.
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Affiliation(s)
- Mesut Yeniguen
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169, Friedberg, Germany
| | - Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169, Friedberg, Germany.
| | - Alexander Vlazak
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany
| | - Thomas Umscheid
- HELIOS Klinik für Gefäßmedizin, Emser Straße 29-31, 65307, Bad Schwalbach, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany
| | - Tibo Gerriets
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169, Friedberg, Germany
| | - Marlene Tschernatsch
- Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany
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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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Zhou C, Lu L, Yang L, Xi W, Ma T, Yang C, Wu J, Shangguan C, Zhu Z, Zhang J. Modified surface measurement method to determine catheter tip position of totally implantable venous access port through right subclavian vein. J Vasc Surg Venous Lymphat Disord 2020; 9:409-415. [PMID: 32726669 DOI: 10.1016/j.jvsv.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Optimal catheter tip position of a totally implantable venous access port (TIVAP) is important to maintain its function and to avoid severe complications. In this study, we aimed to assess the reliability of a modified surface measurement method to determine optimal tip position of a TIVAP catheter inserted through the right subclavian vein. METHODS Clinical and radiologic information of 105 patients who underwent TIVAP implantation through the right subclavian vein was collected retrospectively. The length of the implanted catheter was determined by a modified surface measurement method, as follows. The distance from the puncture point (point A) to the middle point of the sternal notch (point B), then from the middle point of the sternal notch (point B) to the middle point of Louis angle (point C) was added up. The equation for the catheter length is given by catheter length (cm) = AB + BC + 3. Postprocedure plain chest radiography (CXR) and enhanced chest computed tomography (CT) were used to check the catheter tip position and to calculate optimal position rate. Distance from the carina to the catheter tip and the length of the vertebral body unit were measured on both CXR and CT. Distances from carina to caval-atrial junction (CAJ) and from catheter tip to CAJ were measured on CT. RESULTS Mean length of the implanted catheter of all patients was 17.0 ± 0.7 cm (male vs female, 17.3 ± 0.5 cm vs 16.7 ± 0.7 cm; P < .001). On CXR, a catheter tip located within 2.4 vertebral body units below the carina was identified as the optimal position, and the optimal position rate was 97.1% (102/105 cases). On CT, two definitions of optimal position were used: within 2 cm above or below the CAJ and within 2 cm above or at the CAJ; the optimal position rate was 92.4% (97/105 cases) and 78.1% (82/105 cases), respectively. Median follow-up time was 9.4 months. During the follow-up, no severe cardiac complication was recorded. CONCLUSIONS The modified surface measurement had high reliability in determining the optimal catheter length to accurately place the tip in the superior vena cava near the CAJ.
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Affiliation(s)
- Chenfei Zhou
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Lu
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Yang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqi Xi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Ma
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Yang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junwei Wu
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengfang Shangguan
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenggang Zhu
- Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Okazaki M, Oyama K, Kinoshita J, Miyashita T, Tajima H, Takamura H, Ninomiya I, Fushida S, Ohta T. Incidence of and risk factors for totally implantable vascular access device complications in patients with gastric cancer: A retrospective analysis. Mol Clin Oncol 2019; 11:343-348. [PMID: 31475061 PMCID: PMC6713938 DOI: 10.3892/mco.2019.1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/27/2019] [Indexed: 01/17/2023] Open
Abstract
Totally implantable vascular access devices (TIVADs) are often used to administer chemotherapy by prolonged intravenous infusion. The objective of the present study was to investigate the incidence of long-term complications and identify risk factors associated with TIVAD placement in patients with gastric cancer. A total of 121 patients with gastric cancer who had undergone 150 TIVAD placement procedures for chemotherapy or supportive care were enrolled in the present retrospective cohort study. A number of risk factors were analyzed, including age, sex, hypertension, diabetes mellitus, history of thrombosis, body mass index, disease stage, and site and purpose of TIVAD. In total, 40 TIVADs (26.7%) developed long-term complications, of which 27 (18.0%) were infections, seven (4.7%) were catheter-related deep vein thrombosis (CR-DVT), and six (4.0%) were obstructions. Chemotherapy was associated with an increased rate of infectious adverse events (odds ratio 2.925; 95% CI, 1.104-7.750; P=0.031) according to the multivariate analysis. CR-DVT occurred more frequently in upper arm ports than in chest wall ports; however, this difference was not statistically significant (7.5 vs. 0.0%; P=0.084) according to the univariable analysis. All CR-DVTs developed in the upper arm sites. Chemotherapy and the upper arm site were associated with long-term complications in patients with TIVAD. However, further studies are needed to confirm the findings of the present study and to determine the reasons for the high incidence of long-term complications in these patients.
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Affiliation(s)
- Mitsuyoshi Okazaki
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Katsunobu Oyama
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Jun Kinoshita
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Tomoharu Miyashita
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Hidehiro Tajima
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroyuki Takamura
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Itasu Ninomiya
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Sachio Fushida
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Tetsuo Ohta
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
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Local Anesthesia for Port Catheter Placement in Oncology Patients: An Alternative to Landmark Technique Using Ultrasound-Guided Superficial Cervical Plexus Block-A Prospective Randomized Study. JOURNAL OF ONCOLOGY 2019; 2019:2585748. [PMID: 31467534 PMCID: PMC6699304 DOI: 10.1155/2019/2585748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Background/Objectives Most patients that require port operation have experienced severe pain due to multiple surgeries in the past. Therefore, these patients have fear of pain before the procedure. This study aims to compare superficial cervical plexus block (SCPB) with local infiltration anesthesia in terms of comfort. Methods 100 cancer-diagnosed patients were divided into two groups. The first group, the landmark technique with local infiltration anesthesia, was used for intravenous entry (Group LM, n = 50). The second group, USG, was used for venous entry with SCPB as anesthesia (Group US, n = 50). The type of local anesthesia, port placement technique, duration of the procedure, number of procedures, complications, visual analog scale (VAS) score, and surgeon's satisfaction with the procedure were recorded. Results It was established that an average of 1.7 and 1.1 attempts was conducted in Groups LM and US, respectively (P = 0.010). VAS scores were found to be 4.04 in Group LM and 2.62 in GroupUS (P = 0.001). Surgeon satisfaction was 1.96 in GroupLM and 2.38 in GroupUS (P = 0.014). The mean duration of the procedure was 22.10 minutes in GroupLM and 43.50 minutes in GroupUS (P = 0.001). Complication rates were observed in 1 patient in GroupLM and 9 patient in GroupUS (P = 0.040). Conclusions In the patient group with a high level of pain and anxiety port catheter placement using USG and SCPB, supported by routine sedation, provides better comfort for both patient and surgeon.
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Retrospective outcome analysis of rates and types of complications after 8654 minimally invasive radiological port implantations via the subclavian vein without ultrasound guidance. Radiol Med 2019; 124:926-933. [DOI: 10.1007/s11547-019-01048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
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Bademler S, Üçüncü M, Yıldırım İ, Karanlık H. Risk factors for complications in cancer patients with totally implantable access ports: A retrospective study and review of the literature. J Int Med Res 2018; 47:702-709. [PMID: 30442047 PMCID: PMC6381497 DOI: 10.1177/0300060518808167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To analyze the risk factors for complications associated with the use of totally implantable access ports (TIAPs) in cancer patients. METHODS Data for 2,713 cancer patients who received a TIAP between January 2010 and September 2016 at a single center were analyzed retrospectively. RESULTS The average age of the patients was 54.2 ± 9.92 years, and 1,247 (47.5%) were women. The right subclavian vein was the preferred insertion site. Seventy-seven patients developed early complications and 50 developed late complications. The incidence of complications increased as the number of punctures increased. Percutaneous intervention increased the risk of complications during port insertion, but age, sex, body mass index, and the use of physiological saline solution instead of heparin for washing after port insertion did not increase the risk. The use of ultrasonography during insertion reduced the risk of complications. CONCLUSIONS Various factors may affect the function of TIAPs in cancer patients both during insertion and follow-up. Age, sex, body mass index, and the use of physiological saline solution for washing did not affect the incidence of complications, but the use of ultrasonography during insertion did affect the complication rate.
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Affiliation(s)
- Süleyman Bademler
- 1 Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhammed Üçüncü
- 2 Institute of Health Science, Istanbul Gelisim University, Istanbul, Turkey
| | - İlknur Yıldırım
- 3 Department of Anesthesiology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Hasan Karanlık
- 4 Department of General Surgery, Institute of Oncology, Istanbul University, Istanbul, Turkey
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LeVasseur N, Stober C, Daigle K, Robinson A, McDiarmid S, Mazzarello S, Hutton B, Joy A, Fergusson D, Hilton J, McInnes M, Clemons M. Optimizing vascular access for patients receiving intravenous systemic therapy for early-stage breast cancer-a survey of oncology nurses and physicians. Curr Oncol 2018; 25:e298-e304. [PMID: 30111975 PMCID: PMC6092058 DOI: 10.3747/co.25.3903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema. Results Survey responses were received from 25 physicians and 57 oncology nurses. Administration of trastuzumab or an anthracycline was associated with a higher likelihood of a cvad being recommended. Other factors associated with recommendation of a cvad included prior difficult IV access and a recommendation from the chemotherapy nurse. Although the complication rates perceived to be associated with the use of piccs and ports remained high, respondents felt that cvads might improve patient quality of life. Risk factors perceived to be associated with the risk of lymphedema were axillary lymph node dissection, radiation to the axilla, and line-associated infection. Factors known to be unrelated to lymphedema risk (specifically, blood draws and blood pressure measurement) continue to be perceived as posing a higher risk. Conclusions Despite widespread use of chemotherapy for patients with breast cancer, the type of venous access used for treatment varies significantly, as do perceptions about the risks of cvad use and the risk for lymphedema development. Further prospective studies are needed to identify best-practice strategies.
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Affiliation(s)
- N. LeVasseur
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - C. Stober
- The Ottawa Hospital Research Institute, Ottawa
| | - K. Daigle
- Department of Nursing, The Ottawa Hospital, Ottawa
| | - A. Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston; and
| | - S. McDiarmid
- Department of Nursing, The Ottawa Hospital, Ottawa
| | | | - B. Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A. Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - D. Fergusson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - J. Hilton
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
| | - M. McInnes
- Department of Radiology, The Ottawa Hospital, Ottawa, ON
| | - M. Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
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13
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Hendriksz CJ, Harmatz P, Giugliani R, Roberts J, Arul GS. Risks of long-term port use in enzyme replacement therapy for lysosomal storage disorders. Mol Genet Metab Rep 2018; 15:71-73. [PMID: 29845015 PMCID: PMC5966583 DOI: 10.1016/j.ymgmr.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 11/21/2022] Open
Abstract
Totally implantable vascular access devices (TIVADs) are commonly used in conjunction with enzyme replacement therapy (ERT) for lysosomal storage disorders (LSDs). This case series describes potential complications associated with long-term TIVAD use, such as compromise of skin integrity, infection, or port failures. Best practices and skilled specialists are essential for minimizing complications from long-term TIVAD use for ERT.
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Affiliation(s)
- Christian J. Hendriksz
- Salford Royal Foundation NHS Trust, Manchester, UK
- University of Pretoria, Department of Paediatrics and Child Health, Steve Biko Academic Unit, Pretoria, South Africa
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Roberto Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS and INAGEMP, Porto Alegre, Brazil
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14
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Makary MS, Lionberg A, Khayat M, Lustberg MB, AlTaani J, Pan XJ, Layman RR, Raman SV, Layman RM, Dowell JD. Advanced stage breast cancer is associated with catheter-tip thrombus formation following implantable central venous port placement. Phlebology 2018; 34:107-114. [PMID: 29771187 DOI: 10.1177/0268355518774442] [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: 01/23/2023]
Abstract
PURPOSE Catheter-tip associated thrombosis is not uncommon in patients with implantable central venous ports; however, the prevalence and clinical impact of this complication on patient management is unclear. This study aims to identify risk factors for thrombus formation in a large population receiving serial echocardiograms (echo) following port placement. METHODS A total of 396 female breast cancer patients underwent internal jugular vein chest port placement between 2007 and 2013 and received echo studies every third month. Catheter tip position was measured from chest radiography and catheter associated thrombus was identified by echo. RESULTS Sixteen out of 396 patients (4%) had catheter-tip thrombus. No patients were symptomatic or prophylactically anticoagulated. Patients with thrombus were significantly younger than those without (46.4 years versus 53.4 years, respectively, p = 0.02) and had higher stage breast cancer with 75% versus 44.7% having stage III or IV cancer ( p = 0.017). Thrombus was identified after a median of 91 days. No significant difference was identified in anatomic ( p = 0.1) or measured ( p = 0.15) tip position, port laterality ( p = 0.86), or number of port lumens ( p = 0.65). CONCLUSIONS In this large cohort, younger patients and those with more advanced stage breast cancer were more associated with catheter-tip-related thrombus after port placement.
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Affiliation(s)
- Mina S Makary
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Lionberg
- 2 Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Mamdouh Khayat
- 3 Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Maryam B Lustberg
- 4 Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jamal AlTaani
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xueliang J Pan
- 5 Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard R Layman
- 6 Division of Diagnostic Imaging, Department of Imaging Physics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Subha V Raman
- 7 Division of Cardiovascular Medicine, Department of Internal Medicine, Richard R. Ross Heart Hospital and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel M Layman
- 8 Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Joshua D Dowell
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,9 Northwest Radiology, St. Vincent Health, Indianapolis, IN, USA
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15
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Jonczyk M, Gebauer B, Rotzinger R, Schnapauff D, Hamm B, Collettini F. Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience. In Vivo 2018; 32:179-184. [PMID: 29275317 PMCID: PMC5892650 DOI: 10.21873/invivo.11222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Totally implantable central venous port systems provide a safe and effective, long-term means of access for administration of hyperosmolar, local irritant medication, such as chemotherapy, antibiotics and parenteral nutrition. AIM To evaluate the combination of access site and level of experience on fluoroscopy times (FT) and dose area products (DAP) during implantation of port catheters in a large patient population. MATERIALS AND METHODS A total of 1,870 patients (992 women, 878 men; age: 61±13.14 years) were reviewed investigating two groups of junior (≤50 implantations) and senior (>50) radiologists. RESULTS Senior radiologists required less FT/DAP (0.24 s/57.3 μGy m2 versus 0.43 s/68.2 μGy m2, respectively; p<0.001). Right jugular vein access required the least FT/DAP (0.25 s/56.15 μGy m2) and right-sided implantation lower FT/DAP (right: 0.26 s/56.4 μGy m2, left: 0.40 s/85.10 μGy m2, p<0.001). CONCLUSION Due to DAP/FT reductions, the right jugular vein seems to be the most favorable implantation side for port systems. For further dose reduction, residents should be well-trained.
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Affiliation(s)
- Martin Jonczyk
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Roman Rotzinger
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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16
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McLoughlin M, Stepien KM, McNelly B, Thompson L, Gorton J, Hendriksz CJ. The use of port-a-caths in adult patients with Lysosomal Storage Disorders receiving Enzyme Replacement Therapy-one centre experience. Mol Genet Metab Rep 2017; 13:111-114. [PMID: 29071212 PMCID: PMC5651539 DOI: 10.1016/j.ymgmr.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022] Open
Abstract
Port-a-cath is a widely used device in patients with long-term venous access demand such as frequent or continuous administration of medications such as Enzyme Replacement Therapy (ERT), chemotherapy delivery, blood transfusions, blood products, and fluids. Patients with Lysosomal Storage Diseases (LSDs) often require recurrent courses of ERT. We reviewed our experience of using port-a-caths in patients with LSDs with the focus on challenges and complications associated with these catheters. Among 245 adult patients who were treated with ERT, twenty patients (8.2%) had a port-a-cath inserted due to poor venous access. Six patients were using their first port whereas five other patients had their port-a-caths replaced at least once. The remaining six patients had inactive port-a-caths. The majority of patients with active port-a-caths never missed more than one consecutive infusion, although one patient missed 2 consecutive infusions whilst on holiday. We identified significant gaps in patients' and their families' understanding of the management of port-a-caths and risks associated with them. It resulted in producing a leaflet and designing an educational program for our LSD patients.
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Affiliation(s)
- Mairead McLoughlin
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Karolina M Stepien
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Briony McNelly
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Lorraine Thompson
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Janet Gorton
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Christian J Hendriksz
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom.,Paediatrics and Child Health, University of Pretoria, Steve Biko Academic Unit, Pretoria, South Africa
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17
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Keulers AR, Kiesow L, Mahnken AH. Port Implantation in Patients with Severe Thrombocytopenia is Safe with Interventional Radiology. Cardiovasc Intervent Radiol 2017; 41:80-86. [DOI: 10.1007/s00270-017-1794-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/05/2017] [Indexed: 01/03/2023]
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18
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Busch JD, Vens M, Mahler C, Herrmann J, Adam G, Ittrich H. Complication Rates Observed in Silicone and Polyurethane Catheters of Totally Implanted Central Venous Access Devices Implanted in the Upper Arm. J Vasc Interv Radiol 2017; 28:1177-1183. [PMID: 28549710 DOI: 10.1016/j.jvir.2017.04.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/16/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To present frequency and types of complications related to silicone (SI) versus polyurethane (PUR) catheters of totally implanted venous access devices (TIVADs) placed in the upper arm. MATERIAL AND METHODS A cohort of 2,491 consecutive patients with TIVADs implanted between 2006 and 2015 was retrospectively analyzed. Complications were classified according to SIR guidelines. Pearson χ2 test was used for categorical variables, and Student t test was used for continuous variables. Nominal P values were reported, and 2-sided P values < .05 were considered significant. RESULTS Of 2,270 patients meeting the inclusion criteria, 538 had an SI catheter, and 1,732 had a PUR catheter. Total dwell time was 584,853 catheter days. Mean total complication rate was 12.25% (SI, 14.87%; PUR, 11.43%; P = .040). Subanalysis revealed significant differences for material failures (eg, catheter fracture [SI, 3.35%; PUR, 0.06%; P < .001] and thrombotic catheter occlusion/venous thromboses [SI, 2.79%/0.74%; PUR, 1.33%/3.17%; P < .001]) but nonsignificant differences for infections (eg, local infection and catheter-related sepsis [SI, 4.64%; PUR, 4.68%; P = 1]) or other nonthrombotic dysfunctions (eg, catheter detachment, line migration, wound dehiscence [SI, 3.35%; PUR, 2.19%; P = .179]). CONCLUSIONS The reported data suggest different risk profiles in SI catheters compared with PUR catheters, with more material failures and thrombotic catheter occlusions in SI catheters and more venous thromboses in PUR catheters.
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Affiliation(s)
- Jasmin D Busch
- Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
| | - Maren Vens
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Catherine Mahler
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Jochen Herrmann
- Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
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19
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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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20
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Choosing the appropriate side for subcutaneous port catheter placement in patients with mastectomy: ipsilateral or contralateral? Radiol Med 2017; 122:472-478. [DOI: 10.1007/s11547-017-0736-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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21
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Implantable Central Venous Access Ports Placed in Mastectomy Incision Sites: A Safe and Viable Option. Am Surg 2016. [DOI: 10.1177/000313481608201205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Abstract
As part of the vascular access procedures, venous ports, commonly referred to as catheters, are placed under the skin to enable safe and easy vascular access for administration of repeated drug treatments. 122 patients who had received a venous port catheter insertion procedure in the general surgery department between January 1012 and January 2014 were involved in this study. Patients were divided into two groups: those who had undergone a fluoroscopy (group 1) and those who had not undergone a fluoroscopy (group 2). Complications that emerged during and after the port catheter insertion procedure and successful insertion rates were recorded in the database. Data of these patients were presented in a prospective manner. There were 92 to 30 patients in groups 1 and 2, respectively. In group 1, the mean age was approximately 56.8, total catheter stay time was 20,631 days, and mean time of port use was 224.2 days. In group 2, the mean age was approximately 61.2, total catheter stay time was 13,575 days, and mean time of port use was 452.5 days. Successful insertion rate was 100% and 90% in groups 1 and 2, respectively (P < 0.05). The proper insertion of the port catheter accompanied by monitoring methods can decrease procedure-related complications. Statistical comparisons between the two groups in terms of malposition and successful insertion rates also support this view (P < 0.05). The findings support the view that in cancer patients, a venous port catheter insertion accompanied by a fluoroscopy can be safely performed by general surgeons.
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23
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Li Y, Cai Y, Gan X, Ye X, Ling J, Kang L, Ye J, Zhang X, Zhang J, Cai Y, Hu H, Huang M, Deng Y. Application and comparison of different implanted ports in malignant tumor patients. World J Surg Oncol 2016; 14:251. [PMID: 27664131 PMCID: PMC5035459 DOI: 10.1186/s12957-016-1002-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/08/2016] [Indexed: 01/27/2023] Open
Abstract
Background The current study aims to compare the application and convenience of the upper arm port with the other two methods of implanted ports in the jugular vein and the subclavian vein in patients with gastrointestinal cancers. Methods Currently, the standard of practice is placement of central venous access via an internal jugular vein approach. Perioperative time, postoperative complications, and postoperative comfort level in patients receiving an implanted venous port in the upper arm were retrospectively compared to those in the jugular vein and the subclavian vein from April 2013 to November 2014. Results Three hundred thirty-four patients are recruited for this analysis, consisting of 107 in the upper arm vein group, 70 in the jugular vein group, and 167 in the subclavian vein group. The occurrence of catheter misplacement in the upper arm vein is higher than that in the other two groups (13.1 vs. 2.9 vs. 5.4 %, respectively, P = 0.02), while the other complications in the perioperative period were not significantly different. The occurrence of transfusion obstacle of the upper arm vein group is significantly lower than that of the jugular and subclavian groups (0.9 vs. 7.1 vs. 7.2 %, P = 0.01). The occurrence of thrombus is also lower than that of other two groups (0.9 vs. 4.3 vs. 3.6 %, P = 0.03). Regarding the postoperative comfort, the influences of appearance (0 vs. 7.1 vs. 2.9 %, P = 0.006) and sleep (0.9 vs. 4.2 vs. 10.7 %, P = 0.003) are significantly better than those of the jugular and subclavian vein groups. Conclusions Compared to the jugular and the subclavian vein groups, the implanted venous port in the upper arm vein has fewer complications and more convenience and comfort, and might be a superior novel choice for patients requiring long-term chemotherapy or parenteral nutrition.
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Affiliation(s)
- Yanhong Li
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Yonghua Cai
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Xiaoqin Gan
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Xinmei Ye
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Jiayu Ling
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Liang Kang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Junwen Ye
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Xingwei Zhang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Jianwei Zhang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Yue Cai
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Huabin Hu
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Meijin Huang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
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24
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Burak Çildağ M, Faruk Kutsi Köseoğlu Ö. Esophageal perforation during cuffed tunneled catheter introduction: First case in literature. Hemodial Int 2016; 20:E1-E3. [PMID: 27061122 DOI: 10.1111/hdi.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The percutaneous catheterization of central veins is increasingly used in nephrological practice as a temporary or permanent vascular access. Some mechanical complications may occur during insertion of catheter such as misplaced catheter. In this report, we present a case that was misplaced the catheter in esophagus and to analyze the reason of catheter malposition during percutaneous tunneled hemodialysis catheter insertion.
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Affiliation(s)
- Mehmet Burak Çildağ
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydin, 00900, Turkey.
| | - Ömer Faruk Kutsi Köseoğlu
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydin, 00900, Turkey
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25
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Kassir R, Blanc P, Gugenheim J, Amor IB, Debs T, Tiffet O. Sleeve Gastrectomy: Exposure of the Left Pillar. Am Surg 2016. [DOI: 10.1177/000313481608200205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Radwan Kassir
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
| | - Pierre Blanc
- Department of Digestive Surgery Clinique Chirurgicale Mutualiste de Saint-Etienne France
| | - Jean Gugenheim
- Department of Bariatric Surgery Archet 2 Hospital University Hospital of Nice Nice, France
| | - Imed Ben Amor
- Department of Bariatric Surgery Archet 2 Hospital University Hospital of Nice Nice, France
| | - Tarek Debs
- Department of Bariatric Surgery Archet 2 Hospital University Hospital of Nice Nice, France
| | - Olivier Tiffet
- Department of General Surgery CHU Hospital Jean Monnet University Saint Etienne, France
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26
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Fosh B, Canepa M, Eaton M. Long-term venous access insertion: 'the learning curve'. ANZ J Surg 2015; 86:1038-1041. [PMID: 26510720 DOI: 10.1111/ans.13338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The central venous access port device (CVAPD) provides reliable vascular access and is used for delivery of fluids and for obtaining blood samples. However, it can carry some intra- and post-operative complications such as thrombosis, pneumothorax, catheter fracture and port malposition. This article describes one surgeon's experience over a 16-year period and strategies to avoid complications. METHODS The data were prospectively collected from 1996 to 2012 (16-year period). Collected data included age and gender of the patient, pathology, type of port used, anaesthetic type, side and site of insertion, and complications. RESULTS A total of 958 devices were implanted. The average age of the patient was 57.8 years. Sixty-eight complications were recorded with an average complication rate of 7.1%. This rate decreased from 23% between 1996 and 1997 to 3.6% from 2010 to 2013. Venous thrombosis was the main source of complications with an incidence of 2.5%. This complication occurred in seven of the first 86 patients (8.1%, 1996-1998) and decreased to 1.9% between 2000 and 2013. Twenty infections (2%), five pneumothoraces secondary to insertion (0.5%), one port malposition (0.1%) and three fractures of the catheter (0.3%) occurred over the 16 years. CONCLUSION The surgeon's complications of CVAPD insertion requiring removal or revision of the port were considerably reduced as the surgeon's experience increases. It is suggested that all surgeons whose practice includes CVAPD insertion will have an initial learning curve, and strategies described in this paper may help decrease the number of complications.
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Affiliation(s)
- Beverley Fosh
- Department of Breast and Endocrine Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Maximiliano Canepa
- Department of Breast and Endocrine Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Michael Eaton
- Department of Breast and Endocrine Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
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Ultrasound-Guided Radiological Placement of Central Venous Port via the Subclavian Vein: A Retrospective Analysis of 500 Cases at a Single Institute. Cardiovasc Intervent Radiol 2015; 33:989-94. [PMID: 20390274 DOI: 10.1007/s00270-010-9841-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 03/12/2010] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the technical success rate and adverse events (AEs) associated with ultrasound (US)-guided radiological placement (RP) of a central venous port (CVP) via the subclavian vein (SCV). Between April 2006 and May 2007, a total of 500 US-guided RPs of a CVP via the SCV were scheduled in 486 cancer patients (mean age +/- SD, 54.1 +/- 18.1 years) at our institute. Referring to the interventional radiology report database and patients' records, technical success rate and AEs relevant to CVP placement were evaluated retrospectively. The technical success rate was 98.6% (493/500). AEs occurred in 26 cases (5.2%) during follow-up (range, 1-1080 days; mean +/- SD, 304.0 +/- 292.1 days). AEs within 24 h postprocedure occurred in five patients: pneumothorax (n = 2), arterial puncture (n = 1), hematoma formation at the pocket site (n = 2), and catheter tip migration into the internal mammary vein (n = 1). There were seven early AEs: hematoma formation at the pocket site (n = 2), fibrin sheath formation around the indwelling catheter (n = 2), and catheter-related infections (n = 3). There were 13 delayed AEs: catheter-related infections (n = 7), catheter detachments (n = 3), catheter occlusion (n = 1), symptomatic thrombus in the SCV (n = 1), and catheter migration (n = 1). No major AEs, such as procedure-related death, air embolism, or events requiring surgical intervention, were observed. In conclusion, US-guided RP of a CVP via the SCV is highly appropriate, based on its high technical success rate and the limited number of AEs.
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Is there any effect of first-day usage of a totally implantable venous access device on complications? Int J Clin Oncol 2015; 20:1057-62. [DOI: 10.1007/s10147-015-0830-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
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A retrospective statistical analysis of the late complications associated with central venous port placements. Jpn J Radiol 2014; 33:21-5. [DOI: 10.1007/s11604-014-0375-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Massmann A, Jagoda P, Kranzhoefer N, Buecker A. Local Low-Dose Thrombolysis for Safe and Effective Treatment of Venous Port-Catheter Thrombosis. Ann Surg Oncol 2014; 22:1593-7. [DOI: 10.1245/s10434-014-4129-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Indexed: 12/21/2022]
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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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Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction. Cardiovasc Intervent Radiol 2014; 38:642-50. [DOI: 10.1007/s00270-014-0968-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
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Oh JS, Choi BG, Chun HJ, Lee HG. Mechanical thrombolysis of thrombosed central venous port. Cardiovasc Intervent Radiol 2014; 37:1358-62. [PMID: 25085243 DOI: 10.1007/s00270-014-0956-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the effectiveness of a mechanical thrombolysis for thrombosed central venous port (CVP). METHODS A total of 38 patients (22 women and 16 men, median age of 55 years) were referred to our interventional unit for thrombosed implanted CVPs. The period between CVP implantation and the initial suspicion of mechanical complication varied from 2 to 35 months (mean 11.5 months) and the interval since last use of the CVP averaged 47 days (range 28-324 days). Our mechanical thrombolysis technique was performed to fragment thrombus in the port chamber by whirling the floppy tip of 0.018-inch hair-wire. Only 19-gauge noncoring needle and 0.018-inch hire-wire were used without cut-down. After removing the hair-wire and placing a second needle, the fragmented thrombi was slowly aspirated with a negative pressure and the remnant thrombus was flushed out by pushing a saline fluid. The degree of fragmentation of thrombus was evaluated with posttreatment angiography; incomplete lysis was defined as more than 50 % of thrombus remaining, significant lysis was 10-50 % of initial thrombosis remaining, and near-complete lysis was less than 10 % thrombus remaining. RESULTS We observed near-complete lysis in 22 patients (58 %), significant lysis in 14 patients (37 %), and incomplete lysis in two patients (5 %). The technical success rate was 82 % (31 of 38 patients). There were no major or minor complications in the recovery room during a 30-min observation period or late complications at outpatient follow-up. CONCLUSION A mechanical thrombolysis technique can be used to dissolve thrombus effectively from thrombosed implanted CVP on an outpatient basis.
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Affiliation(s)
- Jung Suk Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, 137-040, Korea,
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Administration of chemotherapy via the median cubital vein without implantable central venous access ports: port-free chemotherapy for metastatic colorectal cancer patients. Int J Clin Oncol 2014; 20:332-7. [DOI: 10.1007/s10147-014-0703-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
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Sharp NE, Knott EM, Thomas P, Rivard DC, St Peter SD. Burden of complications from needle penetration of plastic ports in children. J Pediatr Surg 2014; 49:763-5. [PMID: 24851765 DOI: 10.1016/j.jpedsurg.2014.02.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/13/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complications of totally implanted venous access ports are well documented. A concerning mechanical complication we have encountered is posterior penetration of plastic ports with the access needle. The purpose of this study is to investigate the burden of posterior penetrations. METHODS We performed a retrospective review of all ports placed between November 2007 and December 2011 at a single institution. RESULTS There were 247 children who received a port. 117 children (47%) received a port with a plastic posterior wall, 95 children (38%) received a port with a metal posterior wall, and 35 children (14%) had ports that were unable to be identified as plastic or metal. Posterior port penetrations occurred 8 times (3.2% overall, 6.8% of plastic ports). All perforations occurred in plastic ports of a single brand and product code. Average time from port insertion to penetration was 11.2±21.3 months (range 0.3 to 63.4 months). Other complications included catheter malfunction (14), infection (9), pain (2), inability to draw/aspirate (4), leak (3), port migration (2), and malfunctioning not otherwise specified (15). CONCLUSIONS There is an unacceptably high risk of needle penetration of the posterior wall of plastic ports. We recommend utilizing ports with metal backing to avoid this complication.
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Is Ultrasound-guided Central Venous Port Placement Effective to Avoid Pinch-off Syndrome? J Vasc Access 2014; 15:311-6. [DOI: 10.5301/jva.5000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 11/20/2022] Open
Abstract
Purpose Ultrasound (US)-guided internal jugular vein access has been the standard practice of central venous port (CVP) placement. The subclavian vein (SCV) access has also been preferred, but has potential risk of pinch-off syndrome (POS). The purpose of this study was to examine the effect of US-guided SCV access to avoid POS in patients with CVP. Methods Included in this study were patients who had undergone CVP placement via the SCV. We mainly assessed the computed tomography (CT) findings from two different placement techniques of a CVP via the SCV: (i) venipuncture point described by the ratio between the distance from the venipuncture point to the sternoclavicular joint and the clavicular length; and (ii) presence of direct attachment of the catheter to the clavicle. Secondary outcome was POS rate associated with two different placement techniques of CVP via the SCV. Results A total of 237 patients were included in this study between August 2007 and January 2011. A total of 100 patients (42.2%) underwent CVP placement using the landmark technique while 137 patients (57.8%) underwent CVP placement by US guidance. CT revealed that the US-guided technique tended to be lateral SCV approach compared with the landmark technique (p<0.001). A total of four patients (1.7%) experienced POS, all of them in the landmark group. Conclusion Our results showed that the US-guided technique determines a more lateral SCV approach, with a reduced POS risk than the landmark venipuncture technique.
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Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications. Eur J Radiol 2013; 82:e691-6. [DOI: 10.1016/j.ejrad.2013.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 11/24/2022]
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Effect of port-care frequency on venous port catheter-related complications in cancer patients. Int J Clin Oncol 2013; 19:761-6. [DOI: 10.1007/s10147-013-0609-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 08/02/2013] [Indexed: 12/30/2022]
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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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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, 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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Phase 2 study of modified irinotecan and bolus 5-fluorouracil/l-leucovorin in Japanese metastatic colorectal cancer patients. Adv Ther 2012; 29:287-96. [PMID: 22351434 DOI: 10.1007/s12325-012-0002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Using the recommended doses obtained from our previous phase 1 trial of a modified Saltz chemotherapy regimen for metastatic colorectal cancer (weekly irinotecan and bolus 5-fluorouracil/l-leucovorin for 3 weeks every 28 days), we performed the present phase 2 trial to evaluate efficacy and toxicity. METHODS A total of 29 patients with metastatic colorectal cancer were included. Our modified Saltz regimen was administered. The primary endpoint was overall response rate. RESULTS Of the 29 patients, 11 had previous chemotherapy. A partial response occurred in 11 patients, stable disease in 16 patients, and progressive disease in two patients. Disease control rate was 93.1%. Response rates with and without previous treatment were 18.2% and 50%, respectively. Median progression-free survival was 17.3 months. The main hematologic toxicities were leukopenia (22.6%) and neutropenia (45.2%). No treatment-related deaths occurred. CONCLUSION Our modified Saltz regimen exhibited sufficient efficacy, feasibility, and manageable toxicity as a therapeutic option for selected colorectal cancer patients.
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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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Walser EM. Venous Access Ports: Indications, Implantation Technique, Follow-Up, and Complications. Cardiovasc Intervent Radiol 2011; 35:751-64. [DOI: 10.1007/s00270-011-0271-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 07/19/2011] [Indexed: 11/29/2022]
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Central venous port implantations via the cephalic vein applying an intravasal electrographic control of the catheter tip position: a single-center experience of 316 cases. World J Urol 2011; 30:399-404. [PMID: 21874511 DOI: 10.1007/s00345-011-0752-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 08/16/2011] [Indexed: 01/23/2023] Open
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Narducci F, Jean-Laurent M, Boulanger L, El Bédoui S, Mallet Y, Houpeau JL, Hamdani A, Penel N, Fournier C. Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. Eur J Surg Oncol 2011; 37:913-8. [PMID: 21831566 DOI: 10.1016/j.ejso.2011.06.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/25/2011] [Accepted: 06/28/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Totally Implantable Venous Access Port Systems (TIVAPS) are widely used in oncology, but complications are frequent, sometimes necessitating device removal and consequently delays in chemotherapy. The aim of this study was to investigate possible risk factors for morbidity. METHODS A total of 815 consecutive cancer patients (median age: 56.2 years [0.8-85.2]; 522 female) were enrolled in this observational, single-centre study between May 2nd 2006 and April 30th 2007. TIVAPS implantation involved principally cephalic or external jugular vein access. Patients were followed up for one year unless the device was removed earlier. RESULTS The overall morbidity rate was 16.1% (131/815). Complications necessitated device removal in 55 patients a mean of 3.7 months [0.2-12.0] after implantation. These comprised TIVAPS-related infection (19), port expulsion (14), catheter migration (6), venous thrombosis (5), mechanical problems (3), skin disorders (2), pain (2), drug extravasation (2) infection unrelated to TIVAPS (1) and inflammation (1). No patient died during the study. The factor most strongly predictive of complications was the interval between insertion and first use of the TIVAPS, ranging from 0 to 135 days (median: 8.0 days). The morbidity rate was 24.4% when this interval was 0-3 days, 17.1% when it was 4-7 days and 12.1% when it exceeded 7 days (p < 0.01; Chi(2) test). The median interval was 6 days (0-53) and 8 days (0-135), respectively, in patients with and without complications (p < 0.001). CONCLUSION To reduce complications, an interval of at least 8 days between placement of the TIVAPS and its first use may be advisable.
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Affiliation(s)
- F Narducci
- Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France.
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Evaluation of Radiologically Implanted Central Venous Port Systems Explanted Due to Complications. J Vasc Access 2011; 12:306-12. [DOI: 10.5301/jva.2011.7739] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2011] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study was to evaluate explantations of central venous port systems that were implanted by interventional radiologists in cases where complications demanded the removal of the port device. Methods In this retrospective single-center study, explantation rates of central venous port catheter systems (CVPS) associated with complications were investigated over a 10-year period. All CVPS were implanted and explanted in our radiology department's interventional suite. Port catheter dysfunctions were divided into early and late complications, as well as into nonthrombotic and thrombotic events. Indications for implantation and explantation as well as clinical demographics were considered. Results One hundred and ninety-three CVPS were removed from 182 patients, due to complications. The total indwelling time of all CVPS was 55,132 catheter-days (mean 285.7; range 1–2,704). The most common diagnoses were gastrointestinal cancers 77 (39.9%) and hematological malignancies 32 (16.6%). Bloodstream infections 134 (69.4%) were the most common indication for the explantation procedure. These were followed by catheter-related thrombosis 28 (14.5%), nonthrombotic CVPS dysfunction 18 (9.3%), port pocket infections 9 (4.7%), and others 4 (2.1%). The highest percentages of explantations related to bloodstream infections were observed in patients with malabsorption (81.8%) and hematological malignancies (81.3%). Conclusion Bloodstream infections were the most common cause for port explantation, followed by catheter-related thrombosis. Complication-related explantations were mainly for late-onset complications. Prevention and management strategies should be applied regarding care and usage of port systems to reduce the rate of complication-related explantations.
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Teichgräber UKM, Nagel SN, Kausche S, Enzweiler C. Clinical benefit of power-injectable port systems: a prospective observational study. Eur J Radiol 2011; 81:528-33. [PMID: 21392913 DOI: 10.1016/j.ejrad.2011.01.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 01/01/2011] [Accepted: 01/03/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To prospectively evaluate the clinical benefit of a central venous port system, which is approved for contrast media injection during contrast enhanced computed tomography. MATERIALS AND METHODS At a university teaching hospital, 98 patients (59 female, 39 male; median age 61.7 years; range 23-83) had a power-injectable central venous port catheter system implanted. All implantations were performed under ultrasonographic and fluoroscopic guidance by interventional radiologists. Procedure related immediate (up to 24 h after implantation), early (<30 days after implantation) and late complications were documented. The frequency of port system use for contrast enhanced computed tomography scans was also considered. Any port capsule migration was assessed indirectly by determining the catheter tip position. The intended follow-up period was 180 days. RESULTS An overall complication rate of 0.69 for 1,000 catheter days in 78 evaluated ports was recorded (12 ports affected, 15.4%). During the observational period, 40 of 104 contrast enhanced computed tomography scans were performed utilizing the port for contrast media administration (38.5%). 30 catheter tip retractions of more than 3 cm were observed in 82 patients (36.6%). Overall, tip dislocations were statistically more frequent in the female subgroup. CONCLUSION The complication rate found in this study is comparable to those, which have been published for standard port systems. The utilization of the device for contrast media injection during contrast enhanced computed tomography scans should be increased. Finally, the port capsule has to be carefully positioned and fixed to prevent migration.
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Affiliation(s)
- Ulf K M Teichgräber
- Department of Radiology, Charité Medical School, Humboldt University and Free University, Charitéplatz 1, D-10117 Berlin, Germany.
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Teichgräber UK, Pfitzmann R, Hofmann HAF. Central venous port systems as an integral part of chemotherapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:147-53; quiz 154. [PMID: 21442071 DOI: 10.3238/arztebl.2011.0147] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 04/08/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Port systems are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access. They are used mainly for cancer patients. METHODS This article is based on a selective literature review, the guidelines of the German Society for Nutrition Medicine and of the European Society for Clinical Nutrition and Metabolism, and the recommendations of the German Society for Pediatric Oncology and Hematology. RESULTS In modern oncology, central venous port systems are increasingly replacing short-term and permanently tunneled central venous catheters. They are indicated for patients who need long-term intravenous treatment involving, e.g., the repeated administration of chemotherapeutic drugs, parenteral nutrition, transfusions, infusions, injections, and/or blood sample collection. Port systems can markedly alleviate the burden of intravenous therapy and thereby improve these patients' quality of life. The planning, preparation, and performance of port system implantation require meticulous attention to detail. The rate of implantation-associated complications is less than 2% in experienced hands; overall complication rates have been reported from 4.3% to as high as 46%. The proper postoperative use and care of the port system are of decisive importance to the outcome. Reported infection rates during port system use range from 0.8% to 7.5% in current clinical studies. CONCLUSION The treatment, follow-up care, and rehabilitation of cancer patients are interdisciplinary tasks. Optimal treatment and complication avoidance require a collaborative effort of all of the involved specialists-not just the physician implanting the port system, but also the oncologists, nutritionists, visiting nurses, and other home health care providers. Continuing medical education, too, plays a role in improving outcomes.
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Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011; 21:1224-32. [PMID: 21207035 DOI: 10.1007/s00330-010-2045-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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