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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [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] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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Wang M, Tang L, Xu R, Qin S, Zhang S. Clinical application of ultrasound-guided totally implantable venous access ports implantation via the posterior approach of the internal jugular vein. J Chin Med Assoc 2024; 87:126-130. [PMID: 38016115 DOI: 10.1097/jcma.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND To determine the feasibility and safety of ultrasound-guided totally implantable venous access port (TIVAP) implantation via the posterior approach of the internal jugular vein (IJV). METHODS From September 2021 to August 2022, 88 oncology patients underwent ultrasound-guided implantation of TIVAPs via the posterior approach of the IJV for the administration of chemotherapy. The catheter tip was adjusted to be positioned at the cavoatrial junction under fluoroscopic guidance. Clinical data including surgical success, success rate for the first attempt, intraoperative, and postoperative complications were all collected and analyzed. RESULTS All patients underwent successful surgery (100%), whereby 58 were via the right IJV and 30 via the left IJV, and the success rate for the first attempt was 96.59% (85/88). The operation time was 20 to 43 minutes, with an average of 26.59 ± 6.18 minutes with no intraoperative complications. The follow-up duration ranged from 1 to 12 months (mean = 5.28 ± 3.07) and the follow-up rate was 100%. The rate of postoperative complications was 4.55% (4/88), including port-site infection in two cases, fibrin sheath formation in one case, and port flip in one case. No other complications were observed during follow-up. CONCLUSION Ultrasound-guided TIVAP implantation via the posterior approach of the IJV is feasible, safe, and effective, with a low rate of intraoperative and postoperative complications. Not only was the curvature of the catheter device smooth, but patients were satisfied with the comfort and cosmetic appearance. Additionally, we could reduce the possible complications of pinching and kinking of the catheter by using this approach. Therefore, further large-sample, prospective, and randomized controlled trials are warranted.
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Affiliation(s)
- Minghai Wang
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Linna Tang
- Department of Hospital Infection Control, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Rongwei Xu
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Shiyong Qin
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Shuguang Zhang
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Zhou Y, Lan Y, Zhang Q, Song J, He J, Peng N, Peng X, Yang X. Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures. Phlebology 2022; 37:279-288. [DOI: 10.1177/02683555211069772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method. Methods Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis. Results A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43–1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15–3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14–8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22–3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22–1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01–2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16–89.76, p = .41) between the two implantation paths. Conclusions There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.
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Affiliation(s)
- Ya Zhou
- Department of Oncology, Chongqing General Hospital, Chomgqing, China
| | - Yanqiu Lan
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Qiang Zhang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Jifang Song
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Juan He
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Na Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xingqiao Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xinxin Yang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
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D'Angelo TD, Persano G, Crocoli A, Martucci C, Parapatt GK, Natali GL, Inserra A. Case report: Bilateral pleural effusion secondary to late migration of a tunneled central venous catheter in a patient affected by high risk neuroblastoma. Front Pediatr 2022; 10:947351. [PMID: 35989984 PMCID: PMC9386129 DOI: 10.3389/fped.2022.947351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
The insertion of long-term central venous catheters is a standard of care for children affected by malignancies, although it can be associated with life-threatening complications. The present paper reports an unusual mechanical complication related to the use of a long term tunneled central venous catheter in a pediatric oncologic patient. An 18 months old child, diagnosed with stage M high-risk retroperitoneal neuroblastoma, underwent ultrasound-guided placement of a 6 Fr bilumen long-term tunneled central venous catheter in the right internal jugular vein prior to the beginning of induction chemotherapy. The correct position of the distal tip of the catheter was confirmed by fluoroscopy. After 4 months of regular use of the device, the patient experienced neck swelling during high-dose chemotherapy infusion. A chest x-ray showed a dislocated catheter and bilateral pleural effusion. CT scan demonstrated the tip of the catheter rupturing the medial wall of the right jugular vein and entering the mediastinum; furthermore, pneumomediastinum, subcutaneous neck emphysema and bilateral pleural effusion were noticed and a thrombus was evident in the right jugular vein at the insertion in the brachiocephalic vein. The patient was then transferred to the Intensive Care Unit and bilateral thoracostomy tubes were placed urgently (500 mL of clear fluid were evacuated from pleural spaces). The dislocated catheter was removed electively on the following day under fluoroscopy. Despite ultrasound-guided placement and long-term uneventful use of the catheter, life-threatening central venous catheter-related mechanical complications can occur; the current case report emphasizes the importance of careful monitoring of patients with central venous catheters in order to quickly diagnose and treat potentially lethal complications.
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Affiliation(s)
- Tommaso Domenico D'Angelo
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgio Persano
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Cristina Martucci
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - George Koshy Parapatt
- Radiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gian Luigi Natali
- Radiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alessandro Inserra
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Forty years after the first totally implantable venous access device (TIVAD) implant: the pure surgical cut-down technique only avoids immediate complications that can be fatal. Langenbecks Arch Surg 2021; 406:1739-1749. [PMID: 34109472 PMCID: PMC8481188 DOI: 10.1007/s00423-021-02225-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Aim Even though TIVADs have been implanted for a long time, immediate complications are still occurring. The aim of this work was to review different techniques of placing TIVAD implants to evaluate the aetiology of immediate complications. Methods A systematic literature review was performed using the PubMed, Cochrane and Google Scholar databases in accordance with the PRISMA guidelines. The patient numbers, number of implanted devices, specialists involved, implant techniques, implant sites and immediate complication onsets were studied. Results Of the 1256 manuscripts reviewed, 36 were eligible for inclusion in the study, for a total of 17,388 patients with equivalent TIVAD implantation. A total of 2745 patients (15.8%) were treated with a surgical technique and 14,643 patients (84.2%) were treated with a percutaneous technique. Of the 2745 devices (15.8%) implanted by a surgical technique, 1721 devices (62.7%) were placed in the cephalic vein (CFV). Of the 14,643 implants (84.2%) placed with a percutaneous technique, 5784 devices (39.5%) were placed in the internal jugular vein (IJV), and 5321 devices (36.3%) were placed in the subclavian vein (SCV). The number of immediate complications in patients undergoing surgical techniques was 32 (1.2%) HMMs. In patients treated with a percutaneous technique, the number of total complications were 333 (2.8%): 71 PNX (0.5%), 2 HMT (0.01%), 175 accidental artery punctures AAP (1.2%) and 85 HMM (0.6%). No mortality was reported with either technique. Conclusion The percutaneous approach is currently the most commonly used technique to implant a TIVAD, but despite specialist’s best efforts, immediate complications are still occurring. Surgical cut-down, 40 years after the first implant, is still the only technique that can avoid all of the immediate complications that can be fatal.
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