Valved Central Venous Catheter Connected to Subcutaneous Port: A Multicenter Phase IV Study Based on a Cohort of 50 Oncology Patients

Catheter Lock Anchor Technique for Placement of Retrogradely Tunneled Implantable Ports

Objective Groshong valved catheters require retrograde tunneling and a port chamber needs to be attached to the catheter after trimming. During this process, working space constraints are generally faced by operators. We describe a novel technique to improve the comfort of the operator while working in a constrained space.

Materials and Method The port catheter with the distal valve is retrogradely tunneled and trimmed. Thread from absorbable surgical suture is used to anchor the catheter lock. Anchored catheter lock is comfortably pushed over the catheter into the subcutaneous tunnel without it being migrated proximally. Once the port chamber is attached to the catheter, the catheter lock is retrieved back and moved to the locking position. We retrospectively analyzed implantable ports for smoothness of curves and outcomes in terms of catheter days.

Results Technical success was achieved in all patients. There were no periprocedural complications. Clinical success was achieved in 27/29 cases. Early port removal was done due to infection in one patient and for nonhealing of the wound in one patient.

Conclusion The catheter lock anchor is a safe and useful technique for the placement of valved ports. A satisfactory catheter-nut angle can be achieved with this technique.

Current port maintenance strategies are insufficient: View based on actual presentations of implanted ports

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.

Totally Implantable Ports Connected to Valved Catheters for Chemotherapy: Experience from 350 Groshong Devices

Purpose

There are few studies regarding the use of totally implantable valved ports for chemotherapy. The objective of this study was to analyze the results obtained from consecutive implantation of 350 devices.

Methods

Adult patients submitted to port insertion in veins of the superior vena cava system over a 17-month period (July 2006 to December 2007) were considered. The device used was composed of a titanium and silicone rubber port (Dome Port™; Bard Inc, Salt Lake City, UT) connected to an 8.0 Fr silastic Groshong™ catheter tube. Follow-up was conducted on outpatient data and during clinical readmissions, until the device was removed or the patient died.

Results

Three hundred and fifty devices, total of 74,691 days in situ, were inserted, with a median follow-up of 176 days. There were 11 early complications (3.1%) and 49 late complications (14%), 21 of these (6%) were considered major ones. Early complications comprised four instances of phlebitis of the external jugular, three of pocket infection, two of technical failure and two of ecchymosis. Late complications comprised 33 instances of withdrawal difficulty, 12 of port-related bacteremia, two of deep venous thrombosis, one of occlusion and one of catheter fracture. Out of the 350 catheters implanted, 258 (73.5%) were still being used, 73 (21%) remained in use until the patient died, five (1.5%) were removed at the end of the treatment and 14 (4%) were removed because of complications.

Conclusions

There was a low rate of major complications associated with this valved system justifying its use.