Port in oncology practice: 3-monthly locking with normal saline for catheter maintenance, a preliminary report

Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review

BACKGROUND

Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation.

METHODS

A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data.

RESULTS

From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies.

CONCLUSION

Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.

Prolong the flushing and locking interval of TIVAD is feasible in COVID-19: An overview of systematic reviews

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.

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm (2022 Edition)

With the widespread adoption of ultrasound guidance, Seldinger puncture techniques, and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years, an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices (TIVADs) in the upper arm. This approach has the advantage of completely avoiding the risks of hemothorax, pneumothorax, and neck and chest scarring. Medical specialties presently engaged in this study in China include internal medicine, surgery, anesthesiology, and interventional departments. However, command over implantation techniques, treatment of complications, and proper use and maintenance of TIVAD remain uneven among different medical units. Moreover, currently, there are no established quality control standards for implantation techniques or specifications for handling complications. Thus, this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach, reduce complication rates, and ensure patient safety. This consensus elaborates on the technical indications and contraindications, procedures and technical points, treatment of complications, and the use and maintenance of upper-arm TIVAD, thus providing a practical reference for medical staff.

Impact of central venous port implantation method and access choice on outcomes

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.

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

Aim

To 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.

Methods

This 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.

Results

No 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 &gt; 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 &gt; 0.05).

Conclusion

Extending 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.

“Evidence On Port-locking With Heparin versus Saline in Cancer Patients Not Receiving Chemotherapy. Randomized Clinical Trial”

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.

Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis

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.

A totally implantable venous access device (TIVAD) abandoned for 5 years is re-accessed normally: A case report and literature review

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.

Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely: A Systematic Review and Meta-analysis

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.

Management of coping with the risks of COVID-19 in an onco-hematological outpatient clinic: an experience report

OBJECTIVE

to describe the experience of a private outpatient network for hematology and oncology treatment in the adoption of management tools to face the risk of contamination by SARS-CoV-2.

METHOD

an experience report on the use of a root cause analysis method to identify potential risks of contamination by COVID-19 among patients and employees. Through the risks identified through the Ishikawa Diagram, we built an action plan, linked to the 5W2H tool, for planning and decision-making implemented.

RESULTS

the number of attendances in person and people circulating in the units was reduced, protective distance measures and new protection barriers were fundamental to control the risks of spreading COVID-19 in patients and employees.

FINAL CONSIDERATIONS

the management tools served as a valuable tool in the construction of measures, making the measures in question more clearly and applicable.

Implanted Port Patency: Comparing Heparin and Normal Saline

BACKGROUND

To maintain implanted port patency, clinicians can better determine the difference between the use of heparin and normal saline, including risk to patients, unnecessary cost to the healthcare system, and whether heparin is effective in maintaining port patency.

OBJECTIVES

The aim is to compare the effectiveness of saline to heparin for maintaining implanted port patency and to evaluate the cost differences.

METHODS

Data were collected from 56 patients enrolled in oncology clinical trials; 37 had paired data.

FINDINGS

Results showed that saline was as effective as heparin in maintaining implanted port patency. The difference in mean cost of saline versus heparin was statistically significant. Eliminating heparin when locking implanted ports did not increase catheter occlusion rates.

Prolonged flushing and locking interval for totally implantable vascular access device: A systematic review and meta-analysis

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.

COVID-19 infection in cancer patients: what has been the contribution of Associazione Italiana Oncologia Medica (AIOM) to oncological care since the beginning of the first pandemic wave?

High mortality rates in elderly patients or in those with underlying chronic illnesses and/or a compromised immune system is a peculiar feature of COVID-19 infection. The possible coexistence of a cancer and COVID-19 infection in the same individual prompted concerns regarding their synergistic effect on prognosis. In order to balance patients’ needs with the risks related to the infection, the question oncologists have asked from the beginning of the first wave of the pandemic has been: ‘how can we deal with COVID-19 infection in cancer patients?’ In pursuing its mission, the Associazione Italiana Oncologia Medica (AIOM) has made every possible effort to support cancer patients, health care professionals and institutions in the decision-making processes the pandemic has engendered within this scenario. The relevant documents as well as the educational and institutional initiatives the AIOM has taken are reported in this article.

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AIOM made all efforts to support cancer patients, health care professionals and institutions during the COVID-19 pandemic.

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ConFederazione degli Oncologi, Cardiologi e Ematologi is the first technical round table in the world bringing together oncologists, cardiologists and hematologists.

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In November 2020, AIOM, COMU and CIPOMO updated specific COVID-19 recommendations for medical oncology.

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AIOM has recommended that authorities include cancer patients receiving therapy in the high priority group for vaccination.

A Look at 2021 Infusion Therapy Standards of Practice

The Infusion Therapy Standards of Practice provide evidence-based recommendations as published by the Infusion Nurses Society every 5 years. This article provides a brief overview of the development process and short summaries of selected standards with attention to highlighting the relevance to home care agencies and nurses. The Standards should be reviewed by any home care organization that provides home infusion therapy.

Management of outpatient with totally implantable venous access Ports during the COVID-19 epidemic

The purpose of this study was to explore the management experience of outpatient with totally implantable central venous access Ports (TIVAPs, Ports) during the epidemic, including whether the extension of the irrigation interval will affect the incidence of catheter occlusion, the reasons for the port removal rate, and the corresponding protective treatment strategies during the COVID-19 epidemic.We retrospectively analyzed the Ports evaluation and flushing procedure data between February 3, 2020 and April 3, 2020; the cases were divided into the normal group and delayed group according to the critical point of the maintenance interval of 28 days (4 weeks). We compared the incidence of catheter obstruction between the 2 groups, analyzed the causes of catheter removal events in the 2 groups, and proposed corresponding protective treatment recommendations.During the period, 329 cases were included in the study. There was no significant difference in the incidence of catheter obstruction between the 2 groups. There were 15 patients with catheter removal, 8 cases of infection, 5 cases of catheter obstruction, and 1 case of an ectopic catheter, as well as 1 case of an overturned port. During the epidemic, no hospital infections related to the Ports flushing procedure occurred.The interval of Ports flushing procedures for patients without clinical symptoms can be appropriately extended during the COVID-19 epidemic. However, once the local infection symptoms or other sources of discomfort appear, Ports assessment needs to be performed as soon as possible. Take enhanced protected and isolation measures did not increase cross-infection during outpatient's flushing procedure at non-COVID-19-designated diagnosis and treatment hospitals.

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

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.

Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease

INTRODUCTION

Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment.

METHODS

The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP.

RESULTS AND CONCLUSIONS

Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.

Extending the interval of flushing procedures of totally implantable vascular access devices in cancer patients: It is time for a change

Several recent literature reports regarding the flushing technique of TIVADs highlight how the definition of the optimal flushing interval is still a source of controversy. Several recent studies indicate more and more frequently how 4 weeks can be considered a too short interval for the flushing of a totally implantable access device (TIVAD); on the other hand most of the main guidelines and instructions for use provided by the device’s manufacturers still suggest an interval between 4 weeks and 1 month as the ideal one. The recent meta-analysis by Wu et al. on this topic, promotes an important strategy change, indicating the possibility of extending the flushing intervals at least up to 8 weeks. This editorial extensively discusses the flushing methods of TIVADs highlighting the need for important and substantial changes, both in extending the range of flushes and in the solutions and methods to be used. It represents an invitation to the scientific community and device manufacturers for a complete revision of the indications on flushing techniques.

Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak poses a major challenge in the treatment decision-making of patients with cancer, who may be at higher risk of developing a severe and deadly SARS-CoV-2 infection compared with the general population. The health care emergency is forcing the reshaping of the daily assessment between risks and benefits expected from the administration of immune-suppressive and potentially toxic treatments. To guide our clinical decisions at the National Cancer Institute of Milan (Lombardy region, the epicenter of the outbreak in Italy), we formulated Coronavirus-adapted institutional recommendations for the systemic treatment of patients with gastrointestinal cancers. Here, we describe how our daily clinical practice has changed due to the pandemic outbreak, with the aim of providing useful suggestions for physicians that are facing the same challenges worldwide.

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.

Effects of prolonged flushing interval in totally implantable venous access devices (TIVADs)

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.