Disconnection of a venous Port-A-Cath followed by embolization after saline flush: rare case report

Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol

Background

Catheter-related bloodstream infections (CRBSIs) are associated with high morbidity and mortality as well as increased medical costs. Cancer patients, who are often immunocompromised, are susceptible to CRBSI while receiving home parenteral nutrition (HPN). We evaluated the incidence of and factors associated with CRBSIs in cancer patients undergoing HPN managed using a standardized catheter care protocol.

Methods

This is a retrospective cohort study of 335 cancer patients receiving HPN between January 2012 and July 2015. The primary outcome of interest was the incidence of CRBSI expressed as events per 1000 HPN days. HPN days were calculated from the start date with the home infusion provider until the discontinuation of HPN, or the removal of the venous access device (VAD), or the death of the patient. The VADs used were either peripherally inserted central catheters (PICCs) or a subcutaneous implanted port or tunneled central catheters (TCCs). Univariate Poisson regression analyses were used to determine the variables associated with CRBSIs.

Results

Of 335 patients, 193 were females and 142 were males. The most common cancer types were colorectal, pancreatic, ovarian and stomach. A total of 408 VADs in 335 patients were studied, covering a total of 29,403 HPN days. Of 408 VADs, 206 (50.5%) were ports, 191 (46.8%) were PICCs, and 7 (2.7%) were TCCs. The median duration of HPN was 54 days. A total of 16 CRBSI episodes were recorded (8 in ports, 7 in PICCs and 1 in TCCs). The median duration from the start of HPN to the development of CRBSI episodes was 43.5 days. The overall incidence of CRBSI per 1000 HPN days was 0.54 (95% confidence interval: 0.32–0.86). Upon univariate analysis, no variables were found to be statistically significantly associated with CRBSI incidence.

Conclusions

We found a low rate of CRBSI following a standardized catheter maintenance protocol in a high-risk oncology population undergoing HPN.

Disconnection of chamber and catheter as a complication of central venous catheter type port-a-cath

The use of a central vein catheter (CVC) type port-a-cath (VPS), apart from the comfort it provides to the patient undergoing chemotherapy, also carries certain complications. In this study, our patient was subjected to chemotherapy after a radical breast cancer operation and was given a CVC type VPS. After further care, a rare complication was verified--disconnection of the chamber and catheter, which one was visually identified in the right heart chamber. As the patient was vitally endangered, she was immediately hospitalized and the catheter was removed by catheterization of the right femoral vein, with scopic imaging. Early diagnosis and localization of the problem prevented more severe complications and mortality.

A complication associated with central line removal in the pediatric population: retained fixed catheter fragments

BACKGROUND

There are many reports on the complications that occur at the time of insertion and during the life of central venous indwelling catheters. However, there is no literature that describes the complications that occur at the time of removal of these lines.

METHODS

A retrospective review of 136 central line (Broviacs [B], Port-A- Caths [PC] and Hickmans [HC]) removals during the last 5 years was undertaken.

RESULTS

A total of 97% were removed after completion of chemotherapy, and 3% because of sepsis or malfunction. Three PC lines broke at the time of removal resulting in a length of line remaining in the central venous system (the superior vena cava, innominate vein, and bracheo-cephalic subclavian junction). Two lines were inserted by a cut-down technique into the external jugular and one line by the percutaneous technique into the subclavian vein. At follow-up, none of the residual lines were associated with thrombus formation, and none showed any evidence of migration.

CONCLUSIONS

This review identifies a specific problem that can occur with central line removal. Both the long-term affects of residual catheter within the central venous system and the need to remove the foreign body have yet to be addressed.

Cough in a patient with an infusion port

In this case report, we describe a patient with a history of fallopian tube adenocarcinoma who had an infusion port in place for the past 4 years. During the course of her stay in the hospital for pneumonia, she developed a cough that became worse with the infusion of fluids through the port. A portogram done to investigate this problem revealed the presence of a portobronchial fistula. This is the first reported case of a portobronchial fistula. Various possibilities to explain the formation of portobronchial fistula are discussed.