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Wang Y, Zhao J, Wan GM. Prolong the flushing and locking interval of TIVAD is feasible in COVID-19: An overview of systematic reviews. J Vasc Access 2023; 24:1253-1259. [PMID: 35430915 DOI: 10.1177/11297298221086129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
The aim of the overview was to synthesize existing systematic reviews (SRs) of flushing interval for patients who inserted totally implanted venous catheter devices (TIVAD). Regular flushing is indispensable for catheter patency, the recommended flushing interval of TIVAD is 4 weeks, however, there is an argument for prolonging the maintenance interval, which has been proved by many SRs. However, the flushing interval range from 4-week to 3-month. The discrepancy in maintenance period could puzzle health professionals and hinder best practice into the clinic. So, we performed the overview by following the PRISMA statement. The PubMed, Ovid, Wan Fang database, Web of Science, CINAHL, CNKI, EMBASE, Cochrane Library were searched from inception to November 2021. The AMSTAR-2, the PRISMA statement, and ROBIS tool were used to assess SRs' method, report quality, and risk of bias, respectively. Then all results were synthesized, the quality of SRs' results was evaluated with GRADE. Finally, five SRs were included. However, non-randomized and small sample size of original studies result in the limitation of SRs. The evidence grade of conclusions is low, bias of mixed factors in included studies, further large sample sizes, RCTs need to be conducted in the future. Prolonged flushing interval was feasible based on the recent evidence, especially during the COVID-19 pandemic because the overwhelming healthcare system and inconvenience of transportation made maintenance not as easy as it used to be. There is no difference of complication between prolonged flushing interval (⩾4-week) and 4-week period, and it can also reduce healthcare cost with no harm to patients.
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Affiliation(s)
- Yan Wang
- RN School of nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Zhao
- RN School of nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Guang-Ming Wan
- RN Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Erdemir A, Rasa HK. Impact of central venous port implantation method and access choice on outcomes. World J Clin Cases 2023; 11:116-126. [PMID: 36687176 PMCID: PMC9846971 DOI: 10.12998/wjcc.v11.i1.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing, there is still no “gold standard” for the implantation technique.
AIM To identify the implantation technique that should be favored.
METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated. Patients were assigned into two groups according to the access method. The first group comprised patients whose jugular veins were used, and the second group comprised patients whose subclavian veins were used. Groups were evaluated regarding age, sex, application side, primary diagnosis, active follow-up period in the hospital, chemotherapy agents administered, number of complications, and the Clavien-Dindo severity score. The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test. The χ2 test was used to analyze the variables.
RESULTS There was no statistically significant difference between the groups regarding age, sex, side, number of chemotherapy drugs, and duration of port usage (P > 0.05). Only 2 patients in group 1 had complications, whereas in group 2 we observed 19 patients with complications (P < 0.05). No port occlusion was found in group 1, but the catheters of 4 patients were occluded in group 2. One port was infected in group 1 compared to three infected ports in group 2. Two port ruptures, two pneumothorax, one revision due to a mechanical problem, one tachyarrhythmia during implantation, and four suture line problems were also recorded in group 2 patients. We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.
CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.
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Affiliation(s)
- Ayhan Erdemir
- Department of General Surgery, Anadolu Medical Center, Kocaeli 41400, Turkey
| | - Huseyin Kemal Rasa
- Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
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Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Front Oncol 2022; 12:1021488. [DOI: 10.3389/fonc.2022.1021488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
AimTo investigate the safety and feasibility of extending the flushing interval for the totally implantable venous access port (TIVAP) during the non-treatment stage in patients with breast cancer (BC) by retrospectively analyzing the patients’ clinical data, including the incidence of TIVAP-related complications.MethodsThis single-center retrospective study included patients with BC who underwent TIVAP implantation at our hospital between January 2018 and March 2021 during their non-treatment phase and visited the hospital regularly for TIVAP flushing. Among the 1013 patients with BC who received TIVAP implantation, 617 patients were finally included on the basis of the inclusion and exclusion criteria and divided into three groups according to the length of the flushing interval: group 1 (≤30 days, n = 79), group 2 (31–90 days, n = 66), and group 3 (91–120 days, n = 472). The basic characteristics of patients in each group and the incidence of TIVAP-related complications (catheter obstruction, infection, and thrombosis) were analyzed.ResultsNo significant intergroup differences were observed in age, body mass index (BMI), tumor stage, pathological staging, implantation approach, chemotherapy regimen, duration of treatment, and TIVAP-related blood return rate (P > 0.05). Among patients from all three groups, 11 cases of catheter pump-back without blood and eight cases of TIVAP-related complications such as infection, thrombosis, and catheter obstruction were recorded. However, no significant differences in TIVAP-related complications were observed among the three groups (P > 0.05).ConclusionExtending the TIVAP flushing interval beyond three months during the non-treatment stage in BC patients is safe and feasible and did not increase the incidence of TIVAP-related complications.
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Lang T, Jaboury S, West A, O'Sullivan J, Seletto K, Wilson L, Gleisner E, Richardson G. Is There a Relationship Between Frequency of Port-Care Maintenance and Related Complications in Patients With Cancer? JCO Oncol Pract 2022; 18:e1438-e1446. [PMID: 35671437 PMCID: PMC9509187 DOI: 10.1200/op.22.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Totally implantable ports require regular maintenance to prevent port-related complications. Manufacturers recommend monthly maintenance port flushes for patients for the life of the port. Previous studies show that extending intervals between maintenance port flushes up to 16 weeks does not increase incidence of port-related complications. To date, no prospective study has been conducted to evaluate the medical safety of extending flush intervals from monthly to every 12 weeks within a heterogeneous disease cohort. Research Question: Is it feasible and medically safe to extend intervals between maintenance port flushes to every 12 weeks in patients with cancer not on active treatment?
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Affiliation(s)
- Tali Lang
- Department of Medical Oncology, Cabrini Research, Malvern, Victoria, Australia
| | - Sarah Jaboury
- Department of Medical Oncology, Cabrini Research, Malvern, Victoria, Australia
| | - Alexander West
- Department of Medical Oncology, Cabrini Research, Malvern, Victoria, Australia
| | - Jo O'Sullivan
- Day Oncology and Infusion Services, Cabrini Health, Brighton, Victoria, Australia
| | - Kirsten Seletto
- Day Oncology and Infusion Services, Cabrini Health, Malvern, Victoria, Australia
| | - Lucy Wilson
- Business Technology Services, Cabrini Health, Malvern, Victoria, Australia
| | - Elizabeth Gleisner
- Department of Medical Imaging, Cabrini Health, Malvern, Victoria, Australia
| | - Gary Richardson
- Department of Medical Oncology, Cabrini Research, Malvern, Victoria, Australia.,Oncology Clinics Victoria, Cabrini Health, Brighton, Victoria, Australia
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Cia-Arriaza M, Cabrera-Jaime S, Cano-Soria R, Manzano-Castro M, Domínguez-Gómez M, Prieto-Arenas M, Benito-Yagüe M, Sánchez-Martín A, González-Alonso C, Fernández-Ortega P. “Evidence On Port-locking With Heparin versus Saline in Cancer Patients Not Receiving Chemotherapy. Randomized Clinical Trial”. Asia Pac J Oncol Nurs 2022; 9:100085. [PMID: 35935884 PMCID: PMC9345785 DOI: 10.1016/j.apjon.2022.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the safety and efficacy of port-locking with heparin every 2 months vs. every 4 months and vs. saline solution every 2 months in patients with cancer not receiving active chemotherapy. The hypothesis stated that locking with heparin at four-month intervals and saline at two-month intervals would not increment > 10% of port obstructions. Methods Multicentre, phase IV parallel, post-test control group study took place at the two chemotherapy units of oncology hospitals. Included patients with cancer with ports that completed the chemotherapy treatment but still having port maintenance care or blood samples taken up to four months. A sample of 126 patients with cancer in three arms was needed to detect a maximum difference of 10% for bioequivalence on the locking methods. Consecutive cases non-probabilistic sampling and randomized to one of the three groups; group A: received heparin 60 IU/mL every two months (control) vs. group B heparin every four months and vs. saline every two months in group C. Primary variables were the type of locking regimen, port obstruction, and absence of blood return, port-related infection, or venous thrombosis during the study period. Clinical and sociodemographic variables were also collected. Results A total of 143 patients were randomly assigned; group A, 47 patients with heparin every 2 months, group B, 51 patients with heparin 4 months, and group C, 45 patients with saline every 2 months. All participants presented an adequate blood return and no obstructions, until the month of the 10th, when one participant in the group A receiving was withdrawn due to an absence of blood flow (P = 0.587). Conclusions Port locks with heparin every 4 months or saline every 2 months did not show differences in safety maintenance, infection, or thrombosis compared to heparin every 2 months.
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Wu X, Zhang T, Chen L, Chen X. Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis. J Vasc Access 2021; 22:814-821. [PMID: 32873129 DOI: 10.1177/1129729820950998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, some studies have shown that prolonging flush interval is safe and feasible for patients who complete chemotherapy. However, there is no consensus about the optimal flush interval for those patients. OBJECTIVE The purpose of this review was to evaluate whether the flush interval could be prolonged based on monthly interval for regular maintenance and to explore the optimal flush interval. DATA SOURCES We searched the following databases for articles published between 1 January 1982 and 21 February 2020: PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and Ovid. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, retrospective and prospective cohort studies of flush interval less than 4 weeks versus longer than 4 weeks for patients who completed chemotherapy, were included. RESULTS Two reviewers extracted information and assessed the quality of the articles independently. In total, 389 articles were retrieved, and 4 studies including 862 cases fulfilled the inclusion criteria. There was no statistical heterogeneity (I2 = 0, p > 0.05) among the included studies. Hence, the fixed-effects model was used for the meta-analysis. The meta-analysis showed that the total complication rate associated with longer than 4-week interval was higher than that associated with less than 4-week interval. Nevertheless, there was no significant difference between the two groups (7.2% vs 7.6%, p = 0.83). Moreover, the meta-analysis showed that the total complication and catheter occlusion rates associated with the 4-week interval were higher than those associated with the 8-week interval. However, there was no significant difference between the two groups (total complications: 11.4% vs 9.5%, p = 0.68; catheter occlusions: 4.9% vs 4.1%, p = 0.89). LIMITATIONS Only four non-randomized controlled studies were included, and the outcomes of the included studies were reported incompletely. CONCLUSION Extending the flush interval to longer than 4 weeks is safe and feasible. Based on previous studies, extending the flush interval to 8 weeks might not increase the incidence of total complications and catheter occlusions. However, there is no conclusion on whether the flush interval could be extended to 3 months or longer.
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Affiliation(s)
- Xiaohong Wu
- Shantou University Medical College, Shantou, China
| | | | - Lichan Chen
- Shantou University Medical College, Shantou, China
| | - Xisui Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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He J. A totally implantable venous access device (TIVAD) abandoned for 5 years is re-accessed normally: A case report and literature review. J Vasc Access 2021; 24:502-506. [PMID: 34396820 DOI: 10.1177/11297298211039656] [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] [Indexed: 11/15/2022] Open
Abstract
Regular flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. In this case report, a 73-year-old male patient received radical resection for rectal carcinoma in January 2010. A TIVAD was implanted in 2014 and a total of 12 rounds of chemotherapy of FOLFIRI was completed in 2015. During the period from 2015 to 2020, the patient never used or conducted the monthly infusion port flushing because of the inconvenience, the COVID-19 pandemic, and so on. On 18th April 2020, the patient was admitted to the radiotherapy department of Yiwu Central Hospital. The nurse evaluated the TIVAD upon admission, finding that the skin around the reservoir was normal without any sign of infection as erythema or induration of the skin overlying the implantable port but there was intraluminal occlusion of the devices. In order to re-access the catheter, discussion of a MDT was performed and several days of unremitting efforts were tried. Gratifyingly, the patient's port was re-accessed successfully without any adverse reactions. This is a rare infusion port that has not been used and maintained for 5 years. For the port that has not been used and maintained for a long time up to 5 years, the medical staff should not give up easily. During the COVID-19 pandemic, prolonging the flushing interval of TIVADs can be an optimal clinical strategy without negative outcomes.
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Affiliation(s)
- Jiaobo He
- Department of Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang, China
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Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely: A Systematic Review and Meta-analysis. Cancer Nurs 2021; 44:205-213. [PMID: 32384421 DOI: 10.1097/ncc.0000000000000819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. Although manufacturers' recommendations indicate monthly access for TIVAD maintenance, there is a tendency in real life to prolong this interval. OBJECTIVES To assess the effectiveness of prolonged versus short flushing and locking intervals to prevent TIVAD occlusions in adults with cancer. METHODS A systematic search was carried out in MEDLINE, EMBASE, CINAHL, and Web of Science. Two reviewers independently selected studies, assessed quality, and extracted data. Study findings were summarized, and a meta-analysis conducted. RESULTS Six articles were included in the review, with a total of 1255 participants. Differences in types of cancers, flushing and locking techniques, and volume and concentration of heparin were described. Pooled results from 4 studies showed fewer catheter occlusions in favor of prolonged flushing and locking intervals (relative risk, 0.81), even if not statistically significant (95% confidence interval, 0.41-1.61) with no heterogeneity among studies (I2 = 0.00%, P = .69). The quality of evidence was very low. CONCLUSIONS Very low-quality evidence suggests that prolonged schedule flushing and locking intervals has no effect on catheter patency. However, because of low number and poor quality of evidence derived from the studies analyzed, findings of this meta-analysis should be interpreted with caution. IMPLICATIONS FOR PRACTICE No statistically significant difference in occlusion rate between short and long timing of flushing was found. However, further studies are necessary to strengthen the safe implementation of longer intervals in clinical practice.
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Xiong ZY, Zhou HM, Li SY. Prolonged flushing and locking interval for totally implantable vascular access device: A systematic review and meta-analysis. J Vasc Access 2021; 22:969-978. [PMID: 33752495 DOI: 10.1177/11297298211003003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of this systematic review is to evaluate the safety ad feasibility of the totally implantable vascular access devices (TIVADs) flushed more than 4 weeks. We searched the following electronic databases from the date their build-up to February 2020: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The final selection resulted in 14 trials fulfilling the inclusion criteria and being included in our review. A pooled frequency of port-related late complications with longer flushing intervals (>4 weeks) was 8.0%, and the pooled frequency of occlusions, infections, and mechanical complications was 5.0%, 2.0%, and 3.0%, respectively. Then, we compared the frequency of port-related complications between standard and longer flushing intervals. There were no differences between the group's changes in the frequency of total late complications, occlusions, infections, and mechanical complications. This systematic review and meta-analysis demonstrates that longer flushing intervals for ports are safe. However, more prospective, power appropriated randomized trials are needed to explore the specific flushing time for ports.
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Affiliation(s)
- Zhao-Yu Xiong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui-Min Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su-Yun Li
- Department of Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Oh SB, Park K, Kim JJ, Oh SY, Jung KS, Park BS, Son GM, Kim HS, Kim DH, Jung HJ, Lee SS. Safety and feasibility of 3-month interval access and flushing for maintenance of totally implantable central venous port system in colorectal cancer patients after completion of curative intended treatments. Medicine (Baltimore) 2021; 100:e24156. [PMID: 33466189 PMCID: PMC7808472 DOI: 10.1097/md.0000000000024156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/04/2020] [Indexed: 01/05/2023] Open
Abstract
Patients with colorectal cancer (CRC) treated with curative intent surgery undergo continuous fluorouracil (5-FU) infusion-based chemotherapy using totally implantable central venous port system (TICVPS) in cases with high risk of recurrence. Approximately 30% of patients relapse after therapy completion, especially within 2 years. Hence, many patients with high risk CRC keep the TICVPS for 6 to 24 months after treatment with regular intervals of TICVPS flushing. However, little is known about the proper interval duration of the port. The aim of this study is to investigate whether a 3 months extended interval is safe and if port maintenance is feasible.A retrospective cohort was compiled of patients with CRC who underwent curative intent surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. The primary end point was TICVPS maintenance rate, including maintenance of TICVPS for at least 6 months, planned TICVPS removal after 6 months, and regaining the use of TICVPS at the time of recurrence.A total of 214 patients with CRC underwent curative intent treatments during the study period. Among them, 60 patients were excluded, including 6 patients for early recurrence within 3 months and 54 patients with violation of flushing interval. Finally, 154 patients were analyzed. Mean flushing interval was 98.4 days (95% confidence interval [CI], 96.2-100.6; range, 60-120). In December 2018, 35 patients kept the TICVPS, 92 patients had planned removal, 25 patients reused the TICVPS, and 2 patients had to unexpectedly remove the TICVPS due to site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8% (152/154). Thirty-eight patients relapsed, and 30 patients were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) reused the maintained TICVPS without a reinsertion procedures.Our study demonstrated that 3-month interval access and flushing is safe and feasible for maintaining TICVPS during surveillance of patients with CRC. An extended interval up to 3 months can be considered because it is compatible with CRC surveillance visit schedules.
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Affiliation(s)
- Sang-Bo Oh
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute
| | - Kwonoh Park
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute
| | - So-Yeon Oh
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute
| | - Ki-Sun Jung
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute
| | | | | | | | - Dong-Hyun Kim
- Division of Vascular and Endovascular, Department of Surgery, School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyuk-Jae Jung
- Division of Vascular and Endovascular, Department of Surgery, School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang-Su Lee
- Division of Vascular and Endovascular, Department of Surgery, School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Availability of totally implantable venous access devices in cancer patients is high in the long term: a seven-year follow-up study. Support Care Cancer 2020; 29:3531-3538. [PMID: 33155092 PMCID: PMC8163709 DOI: 10.1007/s00520-020-05871-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Totally implantable venous access devices (TIVADs) currently have an important place in medical oncology practice; however, their long-term availability deserves further investigation, since they are usually required by patients for prolonged periods. This study aimed to evaluate long-term availability of TIVADs in adult cancer patients, in conjunction with complication/removal rates over time and associated risk factors during 7-year follow-up. METHODS A total of 204 adult cancer patients who underwent TIVAD placement via subclavian vein using the Seldinger technique were included in this study. Medical data and catheter follow-up records were investigated retrospectively. Complications and port removals due to complications were evaluated over time. RESULTS During median 21.9 (range, 0.7-82.9) months of follow-up, great majority of the patients did not require catheter removal due to complications (91.7%). During a total follow-up of 183,328 catheter days, 20 (9.8%) patients had complications with an incidence of 0.109 cases per 1000 catheter days and 18 (8.8%) of them required TIVAD removal (0.098 cases per 1000 catheter days). Most device removals due to complications (15/18, 83.3%) occurred within the first 24 months. Multivariate analysis identified left-sided device location as the only significant independent predictor of short device availability (OR, 3.5 [95% CI, 1.1-11.1], p = 0.036). CONCLUSION TIVADs in cancer patients appear to be safe and their availability appears to be high in the long term. A decision for early removal might be revisited. Opting for the accustomed side (right side in the present study) for implantations seems to be associated with better outcomes.
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de Oliveira FJG, Rodrigues AB, Ramos IC, Caetano JÁ. Dosage of heparin for patency of the totally implanted central venous catheter in cancer patients. Rev Lat Am Enfermagem 2020; 28:e3304. [PMID: 32578754 PMCID: PMC7304977 DOI: 10.1590/1518-8345.3326.3304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 03/07/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE to analyze the evidence available in the literature about the lowest necessary dose of heparin to maintain the patency of the totally implanted central venous catheter in adult cancer patients. METHOD an integrative literature review, carried out in the following databases: Literatura Latino-Americana e do Caribe em Ciências de Saúde, Sciverse Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, including thirteen studies. RESULTS the evidence showed that the dose of heparin (300 IU/ml) is the most used in maintaining the patency of the totally implanted central venous catheter. CONCLUSION according to the selected studies, the lowest dose of heparin found in maintaining the patency of the totally implanted central venous catheter in cancer patients was 10 UN/ml with a volume of 5 ml of the heparin solution.
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Affiliation(s)
- Francisca Jane Gomes de Oliveira
- Universidade Federal do Ceará, Fortaleza, CE, Brazil
- Hospital Monte Klinikum, Unidade de Terapia Intensiva, Fortaleza,
CE, Brazil
| | | | - Islane Costa Ramos
- Universidade Federal do Ceará, Departamento de Enfermagem,
Fortaleza, CE, Brazil
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Chou PL, Fu JY, Cheng CH, Chu Y, Wu CF, Ko PJ, Liu YH, Wu CY. Current port maintenance strategies are insufficient: View based on actual presentations of implanted ports. Medicine (Baltimore) 2019; 98:e17757. [PMID: 31689833 PMCID: PMC6946320 DOI: 10.1097/md.0000000000017757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022] Open
Abstract
Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.
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Affiliation(s)
- Pin-Li Chou
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jui-Ying Fu
- Chang Gung University, Taiwan
- Division of Chest, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Hui Cheng
- Laboratory of Cardiovascular Physiology, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yen Chu
- Chang Gung University, Taiwan
- Laboratory of Cardiovascular Physiology, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Feng Wu
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Po-Jen Ko
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yun-Hen Liu
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yang Wu
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Rasero L, Golin L, Ditta S, Di Massimo DS, Dal Molin A, Piemonte G. Effects of prolonged flushing interval in totally implantable venous access devices (TIVADs). ACTA ACUST UNITED AC 2019; 27:S4-S10. [PMID: 29683741 DOI: 10.12968/bjon.2018.27.8.s4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Totally implantable venous access device (TIVAD) lumen occlusion is a long-term complication of central venous catheters, associated with risks of infection, therapy interruptions and increased healthcare costs. The role of flushing and locking in maintaining TIVAD patency is paramount. Most flushing protocols are based on manufacturers' recommendations, which indicate that 4 weeks is the safest interval between two consecutive flushing procedures during periods when TIVADs are not in use. Conversely, results of several studies suggest that extended flushing intervals (FIs) do not increase the rate of obstructive or infective complications. The study aimed to describe the effects of prolonged FIs in a cohort of 317 patients with cancer. The authors found no significant difference in terms of TIVAD problems between long (>45 days) and short (≤45 days) FI groups, which raises questions over the validity of current practice.
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Affiliation(s)
- Laura Rasero
- Associate Professor, Department of Health Science, University of Florence, Careggi Teaching Hospital, Florence, Italy
| | - Lisa Golin
- Nurse, Oncology Outpatient Clinic, Careggi Teaching Hospital, Florence, Italy
| | | | | | - Alberto Dal Molin
- Nurse Researcher, Department of Translational Medicine, University of Piemonte Orientale, Italy
| | - Guya Piemonte
- Nurse and PhD Student, Department of Health Science, University of Florence, Italy
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Fornaro C, Piubeni M, Tovazzi V, Cosentini D, Gelmi M, Rota G, Berta B, Barucco W, Lombardi E, Moles L, Faustini T, Fettolini T, Motta P, Ferrari VD, Berruti A, Conti E. Eight‐week interval in flushing and locking port‐a‐cath in cancer patients: A single‐institution experience and systematic review. Eur J Cancer Care (Engl) 2018; 28:e12978. [DOI: 10.1111/ecc.12978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Carla Fornaro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Maria Piubeni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Valeria Tovazzi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Maria Gelmi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Gabriella Rota
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Barbara Berta
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Wilma Barucco
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Eleonora Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Luisa Moles
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Tiziana Faustini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Tiziana Fettolini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Paolo Motta
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Nursing School University of Brescia Brescia Italy
| | - Vittorio D. Ferrari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
| | - Elisabetta Conti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology University of Brescia at ASST Spedali Civili Brescia Italy
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Wu S, Li W, Zhang Q, Li S, Wang L. Comparison of complications between peripheral arm ports and central chest ports: A meta-analysis. J Adv Nurs 2018; 74:2484-2496. [PMID: 29917252 DOI: 10.1111/jan.13766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/15/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to compare peripheral arm ports versus central chest ports in complication rates. BACKGROUND Late complications of arm ports versus chest ports, including catheter-related infection, venous thrombosis and catheter obstruction, remain controversial. DESIGN A meta-analysis conducted following the Cochrane handbook. DATA SOURCES Studies published between 1950-August 2017 were searched through Pubmed, Embase, Web of science and Cochrane library. REVIEW METHODS Two authors independently searched the eligible studies and extracted the data. Studies reporting complications of arm ports compared with chest ports, published in full texts and abstracts, were included. The quality of the studies was assessed with the Newcastle-Ottawa Scale. We did subgroup analyses according to cancer type, age, follow-up and anticoagulant. Relative ratios were calculated with different models. RESULTS A total of 15 articles covering 3,524 tumour patients met the eligibility criteria. There was no difference in catheter-related infection and catheter obstruction between arm ports and chest ports. After reducing the high heterogeneity, no difference was observed in thrombosis overall; however, arm ports had a lower thrombosis rate than chest ports in patients with head and neck cancer, while a higher thrombosis rate was observed in patients <60 years old or follow up ≥1 year. Further studies are needed in venous thrombosis. CONCLUSIONS Arm ports are a safe option beside chest ports for adult patients with malignancy, especially in patients with head-neck cancer or breast cancer. Patients should be well informed of the advantages and disadvantages of different vascular access devices and provided a choice.
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Affiliation(s)
- Shanshan Wu
- Nursing Department of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wanjiao Li
- Oncology Department of Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qiongxiao Zhang
- Nursing Department of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuting Li
- Oncology Department of Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lizi Wang
- Nursing Department of Zhujiang Hospital, Southern Medical University, Guangzhou, China
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17
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Shaw CM, Shah S, Kapoor BS, Cain TR, Caplin DM, Farsad K, Knuttinen MG, Lee MH, McBride JJ, Minocha J, Robilotti EV, Rochon PJ, Strax R, Teo EYL, Lorenz JM. ACR Appropriateness Criteria ® Radiologic Management of Central Venous Access. J Am Coll Radiol 2018; 14:S506-S529. [PMID: 29101989 DOI: 10.1016/j.jacr.2017.08.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 01/15/2023]
Abstract
Obtaining central venous access is one of the most commonly performed procedures in hospital settings. Multiple devices such as peripherally inserted central venous catheters, tunneled central venous catheters (eg, Hohn catheter, Hickman catheter, C. R. Bard, Inc, Salt Lake City UT), and implantable ports are available for this purpose. The device selected for central venous access depends on the clinical indication, duration of the treatment, and associated comorbidities. It is important for health care providers to familiarize themselves with the types of central venous catheters available, including information about their indications, contraindications, and potential complications, especially the management of catheters in the setting of catheter-related bloodstream infections. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Colette M Shaw
- Principal Author, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Shrenik Shah
- Research Author, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Drew M Caplin
- Hofstra Northwell School of Medicine, Manhasset, New York
| | | | | | - Margaret H Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Jeet Minocha
- University of California San Diego, San Diego, California
| | - Elizabeth V Robilotti
- Memorial Sloan Kettering Cancer Center, New York, New York; Infectious Diseases Society of America
| | - Paul J Rochon
- University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | | | - Elrond Y L Teo
- Emory University School of Medicine, Atlanta, Georgia; Society of Critical Care Medicine
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18
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Dal Molin A, Guerretta L, Mazzufero F, Rasero L. The Management of Totally Implanted Venous Ports in the Ambulatory Oncologic Patient. J Vasc Access 2018; 10:22-6. [DOI: 10.1177/112972980901000104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Totally implanted venous access devices (ports) are widely used in all oncology units, because of the many advantages that they offer if compared to external central venous catheters, particularly in terms of safety. Nonetheless, infection, lumen occlusion and venous thrombosis may still occur, and they are often caused or facilitated by inappropriate insertion or inappropriate management. Reviewing the management protocols of ports in ambulatory patients of 50 Italian oncology units, we have been able to detect the lack of common standardized behavior regarding the technical management of these devices: in addition, some aspects of management differ significantly from what suggested by international guidelines.
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Affiliation(s)
- A. Dal Molin
- Oncology Unit, Ospedale degli Infermi, Biella - Italy
| | - L. Guerretta
- Oncology Unit, Ospedale degli Infermi, Biella - Italy
| | | | - L. Rasero
- Department of Public Health, University of Florence, Florence - Italy
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19
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Kim H, Ku H, Choi SE. A Prospective Study of Extending the Implanted Port Heparin Flushing Cycle in Outpatients with Solid Tumors. ACTA ACUST UNITED AC 2018. [DOI: 10.7475/kjan.2018.30.2.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hyekyung Kim
- Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyunkyung Ku
- Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - So-Eun Choi
- Department of Nursing, The Research Institute of Women, Mokpo National University, Muan, Korea
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20
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21
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Diaz JA, Rai SN, Wu X, Chao JH, Dias AL, Kloecker GH. Phase II Trial on Extending the Maintenance Flushing Interval of Implanted Ports. J Oncol Pract 2016; 13:e22-e28. [PMID: 28084883 DOI: 10.1200/jop.2016.010843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retrospective studies suggest that it may be safe to extend the maintenance flushing interval of implanted ports from once every month, as recommended by the manufacturer, to once every 3 months, but no prospective cohort studies have been done specifically assessing the safety and feasibility of this intervention. METHODS This was a phase II study in oncologic patients who retained a functional port after completion of systemic chemotherapy. Patients enrolled in the study had their port flushed once every 3 months and were observed until completion of five scheduled flushes (one on enrollment and four additional flushes, one every 3 months) or development of any port-related complication, including infections, thrombosis, and occlusions. The primary end points were frequency of port-related complications and port failure requiring removal. RESULTS A total of 87 patients were enrolled in the study. The median follow-up time was 308 days, accounting for a total of 24,202 catheter-days. There were 10 port-related complications (11.49%; 95% CI, 4.85% to 18.14%). No infection or symptomatic thrombosis occurred. The mean time to port-related complication was 184 days. No patients developed port failure while on protocol, but on subsequent medical record review, four patients developed a complication that required port removal or port revision within 30 days of being removed from the trial (4.6%; 95% CI, 0.4% to 8.8%; 0.17/1,000 catheter-days). CONCLUSION Extending the maintenance flushes of implanted ports in adult oncologic patients to once every 3 months is safe, effective, and likely to increase patient adherence and satisfaction while decreasing the associated cost.
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Affiliation(s)
- Jorge A Diaz
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Shesh N Rai
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Xiaoyoung Wu
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Ju-Hsien Chao
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Ajoy L Dias
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Goetz H Kloecker
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
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22
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Fernández-de-Maya J, Richart-Martínez M. Factors associated with variability in management of vascular access ports. Eur J Cancer Care (Engl) 2015; 25:871-82. [DOI: 10.1111/ecc.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Fernández-de-Maya
- Day Hospital and Home Hospitalization; Vinalopó Hospital-Torrevieja Hospital; Alicante Spain
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23
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Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014; 3:80-94. [PMID: 25374804 PMCID: PMC4220141 DOI: 10.5492/wjccm.v3.i4.80] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
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Dougherty L. Evidence-based practice requires research and data. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S3. [PMID: 25158359 DOI: 10.12968/bjon.2014.23.sup14.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Pires NN, Vasques CI. Nurses' knowledge regarding the handling of the totally-implanted venous access device. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014000830013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the light of nurses' questions regarding the handling of the totally-implanted venous access device, this study aimed to evaluate these professionals' knowledge. This is a descriptive study with a qualitative approach, whose sample was made up of 28 nurses working on the Internal Medicine ward and in the Emergency Room. The study was undertaken in two stages: interviewing, to evaluate knowledge regarding the handling of the implanted port; and an integrative review to clarify the doubts identified. The results indicated that the nurses' knowledge was inadequate regarding when to use the implanted port, its purpose, the puncture technique, maintenance and handling. It is concluded that the knowledge of the subjects evaluated is inadequate, and that it is necessary for these professionals' clinical skills to be standardized and for them to receive theoretical-practical training.
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26
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Flushing the central venous catheter: is heparin necessary? J Vasc Access 2014; 15:241-8. [PMID: 24811598 DOI: 10.5301/jva.5000225] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this systematic review was to assess the efficacy of heparin flushing in the lock of central venous catheters. METHODS We searched MEDLINE and CINAHL databases. Eligible studies were randomized controlled trials evaluating the use of heparin versus normal saline or other solution in the flushing of central catheter among adult patients. No language restrictions were applied. Two reviewers independently screened titles and abstracts in order to identify relevant publications. The same two reviewers retrieved and evaluated full texts. Parameter estimates regarding catheter occlusion were pooled using network meta-analysis with Bayesian hierarchical modeling. RESULTS We identified 462 references. Eight studies were included. There was no evidence that heparin was more effective than normal saline in reducing occlusions. It was unclear whether urokinase and lepirudin were more effective than heparin in reducing occlusions. Vitamin C solution does not appear to prolong catheter patency. CONCLUSIONS There is no evidence of a different effectiveness between heparin flushing and normal saline or other solutions in reducing catheter occlusions. Due to the little and inconclusive evidence available in this field, further studies might be necessary.
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Palese A, Baldassar D, Rupil A, Bonanni G, Capellari Maria T, Contessi D, De Crignis L, Vidoni A, Piller Roner S, Zanini A. Maintaining patency in totally implantable venous access devices (TIVAD): a time-to-event analysis of different lock irrigation intervals. Eur J Oncol Nurs 2013; 18:66-71. [PMID: 24100090 DOI: 10.1016/j.ejon.2013.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/16/2013] [Accepted: 09/03/2013] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the effectiveness of irrigating totally implantable venous access devices (TIVADs) every eight weeks instead of every four in maintaining the patency of the device. METHODS An explorative, pragmatic, prospective study design was conducted in two day hospital centres located in the northeast of Italy, from January 2011 to September 2012. Twenty patients who had skipped an appointment and were thus washing their TIVAD every eight weeks (exposed) were included, as were 17 patients following the typical wash regimen of every four weeks (controls). TIVAD occlusion-defined as the inability of the device to aspirate blood and/or the inability to properly irrigate the device-was the principal study end-point. RESULTS A total of six occlusions were documented in six patients. Four cases were observed among the exposed group (4/20; 20.0%), while two were observed among the control group (2/17; 11.7%). No statistically significant differences were observed in the occurrence of occlusion between the groups (RR: 1.29, 95%CI: 0.67-2.50, p = 0.49). No statistically significant differences emerged between groups in the time that elapsed from study inclusion to occlusion occurrence according to the time-to-event analysis performed using the Kaplan-Meier estimation model (Log Rank [Mantel-Cox] = χ(2) 0.284, df 1, p = 0.594). CONCLUSIONS Within the limitations of the study which should be addressed with further research based on double-blinded randomised clinical trials, postponing the irrigation regimen of TIVADs to eight weeks seems to be sufficient to maintain device patency.
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Affiliation(s)
- Alvisa Palese
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy.
| | - Debra Baldassar
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Alessandro Rupil
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Graziella Bonanni
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Teresa Capellari Maria
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Daniela Contessi
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Laura De Crignis
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Adriana Vidoni
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Sonia Piller Roner
- Oncologic Day Hospitals, Gemona and Tolmezzo, Azienda per i Servizi Sanitari n. 3 'Alto Friuli', Italy
| | - Antonietta Zanini
- School of Nursing, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
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Fernández-de-Maya J, Richart-Martínez M. Variability in management of implantable ports in oncology outpatients. Eur J Oncol Nurs 2013; 17:835-40. [PMID: 24012190 DOI: 10.1016/j.ejon.2013.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 06/01/2013] [Accepted: 06/27/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE RESEARCH To describe the variability in practice regarding the management of vascular access ports in adult oncology patients at Spanish outpatient clinics and to evaluate its compliance with the recommended procedural guidelines. METHODS AND SAMPLE Three e-mailings or three postal mail-outs were sent to all Spanish outpatient clinics, in accordance with the hospital's preference. An additional fourth postal mail-out was made to all units. In total 185 units at Spanish outpatient clinics out of a total 256 completed the survey questionnaire. KEY RESULTS A number of variations exist in the techniques used for insertion, withdrawal of needle from vascular access ports, blood sampling and unblocking procedure. There is considerable agreement in relation to the use of a special beveled needle, the use of gloves in the access and withdrawal procedures and checking of reservoir permeability by aspirating blood. In most cases, sterile gloves are used but there is a lesser occurrence of both scrubbed hands and correct antiseptic use. CONCLUSIONS There are considerable differences in the management of the vascular access ports in terms of the recommendations published in the main international guidelines, though these are based on low level evidence. The results highlight the need for further quality studies in ports use and manipulation to lessen the variability between published recommendations and clinical practice.
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Affiliation(s)
- José Fernández-de-Maya
- Day Hospital and Home Hospitalization, Vinalopó Hospital - Torrevieja Hospital, Calle Tonico Sansano n° 14, CP 03293 Elche, Alicante, Spain.
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29
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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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30
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Girda E, Phaeton R, Goldberg GL, Kuo DYS. Extending the interval for port-a-cath maintenance. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/mc.2013.22003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Totally Implantable Central Venous Access Ports in Patients with Cystic Fibrosis: A Multicenter Prospective Cohort Study. J Vasc Access 2012; 13:290-5. [DOI: 10.5301/jva.5000036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2011] [Indexed: 11/20/2022] Open
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Baskin JL, Reiss U, Wilimas JA, Metzger ML, Ribeiro RC, Pui CH, Howard SC. Thrombolytic therapy for central venous catheter occlusion. Haematologica 2011; 97:641-50. [PMID: 22180420 DOI: 10.3324/haematol.2011.050492] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. DESIGN AND METHODS This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. RESULTS Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. CONCLUSIONS Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.
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Affiliation(s)
- Jacquelyn L Baskin
- Division of Hematology and Oncology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA.
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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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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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The late complications of totally implantable central venous access ports: the results from an Italian multicenter prospective observation study. Eur J Oncol Nurs 2010; 15:377-81. [PMID: 21167777 DOI: 10.1016/j.ejon.2010.11.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/10/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The principal aim of this study is to analyze the incidence of late complications in oncologic patients with totally implanted central venous access ports. METHODS A prospective multicenter observational study was conducted in 26 Italian oncologic outpatient clinics. 1076 cancer patients with Totally Implanted Central Venous Access Ports (TIAP) were observed. 515 devices were observed in patients under treatment and 561 in patients who went to the outpatient clinic only for flushing. RESULTS Late complications observed in patients under treatment were: 3 pocket infections (0.09/1000 days of port observation), 1 cutaneous infection (0.03/1000 days of port observation), 8 occlusions (0.24/1000 days of port observation) and 12 others. In patients using the device only for flushing we observed 4 cases of device related bacteremia (0.04/1000 days of port observation), 1 pocket infection (0.01/1000 days of port observation), 1 cutaneous infection (0.01/1000 days of port observation), 3 occlusions (0.03/1000 days of port observation) and 7 other complications. CONCLUSIONS The low incidence of complications suggests that TIAP is safe and reliable for long term intermittent venous access. Our results support the use of TIAP in the oncology patients.
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HEIBL C, TROMMET V, BURGSTALLER S, MAYRBAEURL B, BALDINGER C, KOPLMÜLLER R, KÜHR T, WIMMER L, THALER J. Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: a single-centre prospective analysis. Eur J Cancer Care (Engl) 2009; 19:676-81. [DOI: 10.1111/j.1365-2354.2009.01115.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baskin JL, Pui CH, Reiss U, Wilimas JA, Metzger ML, Ribeiro RC, Howard SC. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet 2009; 374:159-69. [PMID: 19595350 PMCID: PMC2814365 DOI: 10.1016/s0140-6736(09)60220-8] [Citation(s) in RCA: 262] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Long-term central venous catheters (CVCs) are important instruments in the care of patients with chronic illnesses, but catheter occlusions and catheter-related thromboses are common complications that can result from their use. In this Review, we summarise management of these complications. Mechanical CVC occlusions need cause-specific treatment, whereas thrombotic occlusions usually resolve with thrombolytic treatment, such as alteplase. Prophylaxis with thrombolytic flushes might prevent CVC infections and catheter-related thromboses, but confirmatory studies and cost-effectiveness analysis of this approach are needed. Risk factors for catheter-related thromboses include previous catheter infections, malposition of the catheter tip, and prothrombotic states. Catheter-related thromboses can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. Catheter-related thromboses are usually diagnosed by Doppler ultrasonography or venography and treated with anticoagulation therapy for 6 weeks to a year, dependent on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of catheter-related thromboses includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not currently recommended.
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Affiliation(s)
- Jacquelyn L. Baskin
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Hematology and Oncology, Children’s Hospital of Los Angeles, Los Angeles, California
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Ulrike Reiss
- Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Judith A. Wilimas
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Monika L. Metzger
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Scott C. Howard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
- Correspondence to: Scott Howard, St Jude Children’s Research Hospital, 332 N. Lauderdale Ave., MS 721, Memphis, TN 38105-2794. Tel. 901-495-2972; fax: 901-495-2099;
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Abstract
OBJECTIVES To present an overview of clinical dilemmas regarding maintenance care and managing complications of vascular access devices (VADs). DATA SOURCES Current research and published literature. CONCLUSION The use of VADs has increased over the past three decades because they have proven to be an effective and convenient method of accessing the venous system. The difficulty of maintaining VADs during the course of treatment however, continues to be a challenge resulting in practice dilemmas. IMPLICATIONS FOR NURSING PRACTICE Although VADs have been in use for more than 30 years, no universal standard of maintenance care exists. Research is still needed to establish evidence-based practice regarding the care and maintenance of VADs.
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Vescia S, Baumgärtner AK, Jacobs VR, Kiechle-Bahat M, Rody A, Loibl S, Harbeck N. Management of venous port systems in oncology: a review of current evidence. Ann Oncol 2007; 19:9-15. [PMID: 17846025 DOI: 10.1093/annonc/mdm272] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Over the last decades, many changes have occurred in oncology with new chemotherapy combinations and more complex application schemes becoming available. Central venous catheters and implantable venous port systems have become widely used and have facilitated the problem of vascular access. However, important complications are associated with permanent central venous catheters. MATERIAL AND METHODS This review summarizes evidence on venous port system use published in Medline up to February 2007. Moreover, recent guidelines for the prevention and management of catheter-related infections issued by the Infectious Diseases Society of America, the American College of Critical Care Medicine, the Society for Healthcare Epidemiology of America, the Center for Disease Control and Prevention, Atlanta, and the Infectious Diseases Working Party of the German Society of Hematology and Oncology are included. RESULTS Sterile precautions are essential when implanting and accessing port systems. Infections must be treated with adequate antimicrobial therapy. Catheter-related thromboembolic complications were found at a rate of 12-64% in retrospective studies. Five current clinical trials investigated the effect of prophylactic anticoagulation with either low molecular weight heparin or warfarin in cancer patients with central venous devices. On the basis of these results, routine anticoagulation cannot be recommended. CONCLUSIONS This article reviews the current literature on long-term complications of venous port systems, focusing on infection and thrombosis. In addition, it summarizes the evidence regarding routine maintenance of port systems in follow-up care.
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Affiliation(s)
- S Vescia
- German Breast Group, Neu Isenburg, Germany
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