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Ikeda M, Matsuzuka T, Kakamu T, Nakaegawa Y, Kawase T, Saito Y, Kubota S, Imaizumi M, Murono S. Feasibility of totally implantable venous access ports in the upper arm for patients with head and neck cancer in the modern era of chemotherapy. J Vasc Access 2024:11297298241279623. [PMID: 39327697 DOI: 10.1177/11297298241279623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Abstract
BACKGROUNDS With recent developments in chemotherapy, the prognosis of head and neck cancer patients has been prolonged, and it is expected that totally implantable venous access devices will be developed for use as feasible and safe chemotherapy routes. We investigated the feasibility of implanting totally implantable venous access ports in the upper arms of head and neck cancer patients in this modern era of chemotherapy. METHODS Relevant data of a cohort of 210 patients with head and neck cancer who had had totally implantable venous access devices implanted between January 2013 and December 2022 were investigated retrospectively. The totally implantable venous access ports were used for chemoradiotherapy, chemotherapy, radiotherapy, and palliative treatment. Adverse events related to totally implantable venous access devices were investigated and the associated variables subjected to statistical analysis. RESULTS There were 22 (10.5%) adverse events, representing 0.201 adverse events per 1000 catheter days. Non-ultrasound-guided puncture (p = 0.015) and forearm implantation (p = 0.005) were associated with higher risk of adverse events according to univariate analysis. According to multiple logistic analysis, non-ultrasound-guided puncture was significantly associated with age and sex (OR = 2.89; 95% CI, 1.14, 7.36; p = 0.026). CONCLUSION Peripherally implanted totally implantable venous access devices in the upper arm are feasible and safe for head and neck cancer patients. Ultrasound-guided implantation of totally implantable venous access ports into the upper arms of head and neck cancer patients may reduce the adverse event rate.
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Affiliation(s)
- Masakazu Ikeda
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
| | - Takashi Matsuzuka
- Department of Head and Neck Surgery and Otolaryngology, Asahi University Hospital, Gifu, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima City, Japan
| | - Yuta Nakaegawa
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
| | - Tomotaka Kawase
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
| | - Yukiko Saito
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
| | - Satoshi Kubota
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima City, Japan
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Sugawara S, Sone M, Sakamoto N, Sofue K, Hashimoto K, Arai Y, Tokue H, Takigawa M, Mimura H, Yamanishi T, Yamagami T. Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version). INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:105-117. [PMID: 37485481 PMCID: PMC10359169 DOI: 10.22575/interventionalradiology.2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/22/2022] [Indexed: 07/25/2023]
Abstract
The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | | | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Japan
| | | | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
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Kitaya S, Kakuta R, Kanamori H, Ohkoshi A, Ishii R, Nomura K, Tokuda K, Katori Y. Clinical and Epidemiological Characteristics of Bloodstream Infections in Head and Neck Cancer Patients: A Decadal Observational Study. J Clin Med 2022; 11:jcm11164820. [PMID: 36013061 PMCID: PMC9409783 DOI: 10.3390/jcm11164820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
This retrospective study aims to describe the clinico-epidemiological characteristics of bloodstream infections (BSIs) and the risk factors in patients with head and neck cancer (n = 227) treated at the Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital between April 2011 and March 2021. Overall, 23.3% of blood cultures were positive. In the culture-positive group, catheter-related bloodstream infections (CRBSIs) were the most common (38.8%), followed by respiratory tract infections (19.4%), and catheter-associated urinary tract infections (6.0%). Methicillin-resistant Staphylococcus aureus (26.9%), Staphylococcus epidermidis (17.9%), and Pseudomonas aeruginosa (10.4%) infections were common. The most frequent treatment for head and neck cancer was surgery (23.9%), followed by treatment interval or palliative care (19.4%), and single radiotherapy (13.4%). The 30-day mortality rate was significantly higher in the BSI than in the non-BSI group (10.4% vs. 1.8%, respectively). CRBSIs are the most frequent source of BSIs in patients with head and neck cancer. In conclusion, central venous catheters or port insertion should be used for a short period to prevent CRBSIs. The risk of developing BSI should be considered in patients with pneumonia. Understanding the epidemiology of BSIs is crucial for diagnosing, preventing, and controlling infections in patients with head and neck cancer.
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Affiliation(s)
- Shiori Kitaya
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
- Correspondence: ; Tel.: +81-022-7177304
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Ryo Ishii
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai 980-8574, Japan
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Shi L, Chen H, Yang Y, Li H, Zhang J. Application of intracavitary ECG for positioning the totally implantable venous access port in the upper arm of cancer patients. Exp Ther Med 2022; 24:477. [PMID: 35761811 PMCID: PMC9214596 DOI: 10.3892/etm.2022.11404] [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: 03/30/2022] [Accepted: 05/20/2022] [Indexed: 11/09/2022] Open
Abstract
Accurate positioning of the catheter tip is one of the most critical procedures in central venous catheter insertion. The traditional surface measurement method frequently has a large deviation and increases the X-ray exposure of doctors and patients. In the present retrospective study, cancer patients who received a totally implantable venous access port (TIVAP) in the upper arm using intracavitary electrocardiogram (ECG) guidance were compared with those where the traditional surface measurement method was used in terms of the rate of correct placement of the catheter tip, the rate of achieving the best position, the operation time and the complications. The results indicated that the correct placement rate and the best position rate of the catheter tip at the first attempt were higher in the ECG-guided group than in the traditional surface measurement method group (95.65 vs. 82.91% and 90.58 vs. 68.38%, respectively). The mean operation time was shorter in the ECG-guided group than in the surface measurement group (46.28 vs. 63.26 min). The incidence of complications in the ECG-guided group was 6.52%, while that in the surface measurement group was 10.26%. This indicated that the intracavitary ECG-guided tip positioning technique may improve the accuracy of tip catheter placement and shorten the operation time, thus reducing ionizing radiation caused by repeated positioning. Therefore, the intracavitary ECG-guided tip positioning technique is able to effectively place the tip of the TIVAD in the upper arm, holding great promise as a clinical application.
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Affiliation(s)
- Lihua Shi
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| | - Huihui Chen
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| | - Yaping Yang
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| | - Huifen Li
- Nursing Department, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, P.R. China
| | - Jianfang Zhang
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
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Pike S, Tan K, Burbridge B. Complications Associated With Totally Implanted Venous Access Devices in the Arm Versus the Chest: A Short-Term Retrospective Study. Can Assoc Radiol J 2021; 73:581-588. [PMID: 34911380 DOI: 10.1177/08465371211040822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To retrospectively compare complications for totally implanted venous access devices (TIVADs or ports) in the arm vs. the chest. One participating institution implanted all TIVADs in the arm, whereas the other institution implanted them in the chest. METHODS Subjects were consecutive patients > 18 years with a device inserted between July 2017 and January 2019 at either Hospital A, where all devices were implanted in the arm, or at Hospital B, where all devices were implanted in the chest. Complications (rates/1,000 catheter-days and frequencies) were compared between the arm and chest locations. RESULTS 201 arm devices (71% female, mean age 59.4 years) and 203 chest devices (66% female, mean age 61.5 years) were assessed. Overall complication rates did not differ between the arm and chest [arm: 30 complications per 56,938 catheter-days (0.530/1,000 catheter-days) vs. chest: 47 complications per 63,324 catheter-days (0.742/1,000 catheter-days), p-value 0.173]. Periprocedural complications and mechanical malfunction also did not differ. Although prophylactic antibiotic use was higher in the chest (79.3% vs. 1.50%, p-value < 0.0001), infection rates did not differ. Arm venous thrombosis was significantly higher in the arm cohort (0.205 vs. 0.017/1,000 catheter-days, p-value 0.003) and pulmonary thromboembolism in the chest cohort (0.269 vs 0.056/1,000 catheter-days, p-value 0.002). CONCLUSIONS While arm venous thrombosis was higher in the arm and pulmonary thromboembolism in the chest cohort, other complications were similar. Antibiotic use was more frequent in the chest cohort, while infection rates remained similar in both cohorts.
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Affiliation(s)
- Samuel Pike
- Department of Medical Imaging, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Kiat Tan
- Department of Medical Imaging, University of Saskatchewan, Regina General Hospital Regina, Saskatchewan, Canada
| | - Brent Burbridge
- Department of Medical Imaging, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Skummer P, Kobayashi K, Schoeneck M, Patel J, Faridnia M. Single-session versus two-session placement of chest port and gastrostomy tube in patients with head and neck cancer: Is there any difference in the device-related early infection rates? Acta Radiol Open 2021; 10:20584601211037234. [PMID: 34484809 PMCID: PMC8408899 DOI: 10.1177/20584601211037234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is unknown whether placement of a chest port (port) and a gastrostomy tube (G-tube) in a single session increases the risk of the early device infections in patients with head and neck cancer (HNC) undergoing chemoradiation. PURPOSE To compare the incidence of early (≤30 days) port and G-tube infections placed in a single session compared to two separate sessions in patients with HNC. MATERIAL AND METHODS Between January 2012 and December 2019, 169 patients with HNC undergoing chemoradiation had a port and a G-tube placed in a single session (single-session group), while 25 had both devices placed in two separate sessions (two-session group) within 30 days of each other. The incidence of early device infections was compared between groups. Logistic regression analysis was conducted to determine if the number of sessions was a variable affecting device infections. RESULTS A total of 6 (3%) early port infections and 13 (6.7%) early G-tube infections were identified. The two groups did not significantly differ in the incidence of early port infections (3.0%, 5/169 and 4.0%, 1/25, p = 0.59) nor early G-tube infections (7.1%, 12/169 and 4.0%, 1/25, p = 1.0). The number of sessions for device placement was not a variable affecting overall device infections in logistic regression analyses (odds ratio: 1.24, 95% confidence interval: 0.20-7.82, p = 0.82) after controlling for potential confounding variables. CONCLUSIONS The risk of early device infections in single-session placement appeared to be the same as two-session placement in patients with HNC undergoing chemoradiation.
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Affiliation(s)
- Philip Skummer
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Mason Schoeneck
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jamynkumer Patel
- Department of Anesthesiology, New York University, NewYork, NY, USA
| | - Masoud Faridnia
- Department of Medicine, Virginia Common Wealth University, Richmond, VA, USA
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Tivnan P, Nannery M, Epelboym Y, Vilvendhan R. Single center experience with ultrasound guided axillary vein port placement. J Vasc Access 2021; 23:706-709. [PMID: 33827331 DOI: 10.1177/11297298211008094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To retrospectively review a single institution experience of ultrasound guided axillary vein port placement. METHODS In this retrospective study, a patient list was generated after searching our internal database from 1/1/2012 to 10/1/2018. Patients who had undergone axillary vein port placement were included. Chart review was performed to confirm approach, laterality and to gather demographic data, clinical indications, technical outcomes, and complications. Descriptive statistics were used to analyze this cohort. Chi-square statistics were used to compare outcomes by laterality. RESULTS Three hundred seven patients (51% female) with an average age of 58 years were included. The port was placed via the right axillary vein in 85% (261/307), predominantly for the indication of chemotherapy access (296/307). Technical success was achieved in all 307 cases. Peri procedural complications occurred in 1% (4/307) of cases and included port malpositioning requiring replacement and a case of port pocket hematoma. Post procedural complications including deep vein thrombosis and port malfunction occurred in 17% (52/307) of cases and port removal as a result of complication occurred in 9% (29/307) of cases. CONCLUSIONS Ultrasound guided placement of an axillary port is a safe procedure to perform and demonstrates good clinical outcomes.
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Affiliation(s)
- Patrick Tivnan
- Department of Radiology, Boston Medical Center, Boston, MA, USA
| | | | - Yan Epelboym
- Department of Radiology, Boston Medical Center, Boston, MA, USA
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Okazaki M, Oyama K, Kinoshita J, Miyashita T, Tajima H, Takamura H, Ninomiya I, Fushida S, Ohta T. Incidence of and risk factors for totally implantable vascular access device complications in patients with gastric cancer: A retrospective analysis. Mol Clin Oncol 2019; 11:343-348. [PMID: 31475061 PMCID: PMC6713938 DOI: 10.3892/mco.2019.1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/27/2019] [Indexed: 01/17/2023] Open
Abstract
Totally implantable vascular access devices (TIVADs) are often used to administer chemotherapy by prolonged intravenous infusion. The objective of the present study was to investigate the incidence of long-term complications and identify risk factors associated with TIVAD placement in patients with gastric cancer. A total of 121 patients with gastric cancer who had undergone 150 TIVAD placement procedures for chemotherapy or supportive care were enrolled in the present retrospective cohort study. A number of risk factors were analyzed, including age, sex, hypertension, diabetes mellitus, history of thrombosis, body mass index, disease stage, and site and purpose of TIVAD. In total, 40 TIVADs (26.7%) developed long-term complications, of which 27 (18.0%) were infections, seven (4.7%) were catheter-related deep vein thrombosis (CR-DVT), and six (4.0%) were obstructions. Chemotherapy was associated with an increased rate of infectious adverse events (odds ratio 2.925; 95% CI, 1.104-7.750; P=0.031) according to the multivariate analysis. CR-DVT occurred more frequently in upper arm ports than in chest wall ports; however, this difference was not statistically significant (7.5 vs. 0.0%; P=0.084) according to the univariable analysis. All CR-DVTs developed in the upper arm sites. Chemotherapy and the upper arm site were associated with long-term complications in patients with TIVAD. However, further studies are needed to confirm the findings of the present study and to determine the reasons for the high incidence of long-term complications in these patients.
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Affiliation(s)
- Mitsuyoshi Okazaki
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Katsunobu Oyama
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Jun Kinoshita
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Tomoharu Miyashita
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Hidehiro Tajima
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroyuki Takamura
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Itasu Ninomiya
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Sachio Fushida
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Tetsuo Ohta
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
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Li G, Zhang Y, Ma H, Zheng J. Arm port vs chest port: a systematic review and meta-analysis. Cancer Manag Res 2019; 11:6099-6112. [PMID: 31308748 PMCID: PMC6613605 DOI: 10.2147/cmar.s205988] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background Two prevailing, totally implantable venous access ports are routinely utilized in oncology: chest port or arm port. This systematic review with meta-analysis was conducted to compare safety and efficiency of the two techniques. Methods We performed evidence acquisition intensively from PubMed, Embase, and Cochrane Library. Available comparative studies that evaluated both techniques were identified. The outcomes of interest included total complication events, procedure-related infections, thrombosis, intra-operative complications, mechanical complications, conversion rate, early port removal, and operating time. Results Thirteen comparative studies including 3,896 patients (2,176 for chest ports, and 1,720 for arm ports) were identified. The present study showed that arm port was associated with higher procedure conversion rate (2.51% in chest port group and 8.32% in arm port group; odd ratios [OR] 0.27, 95% confidence interval [CI] 0.15-0.46; p<0.001), but lower incidence of intra-operative complications (1.38% in chest port group and 0.41% in arm port group; OR 2.38, 95% CI 1.07-5.29; p=0.03). There were no between-group differences with respect to total complication events, procedure-related infections, thrombosis, mechanical complications, early port removal, and operating time. Subgroup analysis of patients under 60 years revealed that no significant difference was detected in intra-operative events (1.19% in chest port group and 0.02% in arm port group, OR 2.59, 95% CI 0.74-9.08; p<0.14), indicating that age may be a risk factor for intra-operative events. Sensitivity analysis did not change conclusions of all endpoints of interest. Conclusion Arm port is associated with higher procedure conversion rate, but lower incidence of intra-operative complications, and age may be a risk factor for intra-operative events.
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Affiliation(s)
- Guanhua Li
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, People's Republic of China
| | - Yu Zhang
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, People's Republic of China
| | - Hongmin Ma
- Department of Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, People's Republic of China
| | - Junmeng Zheng
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, People's Republic of China
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Kehagias E, Tsetis D. The “Arm-to-Chest Tunneling” technique: A modified technique for arm placement of implantable ports or central catheters. J Vasc Access 2019; 20:771-777. [DOI: 10.1177/1129729819826039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Central venous catheters or “venous access devices” include totally implantable venous access devices or “ports,” peripherally inserted central catheters, and tunneled lines. Venous access devices are now the standard of care in patients requiring long-term intravenous drug administration. Arm venous access device placement is a valuable option for vascular access yet often complicated or rendered practically impossible by the condition and size of peripheral veins. We describe a modification of the arm venous access device implantation technique that we use in our department in order to offer this option to our patients, regardless of their peripheral veins condition. Methods: After ultrasound guided venous access of a suitable neck vein, we create a port pouch—in case of a totally implantable vascular access device—or a skin nick—in case of a venous access device—in the inner aspect of the mid-arm. Using a straight metal tunneler, we tunnel the line from the neck to the arm in two stages, externalizing and re-inserting the line into a skin nick made on the deltopectoral groove. We call this technique “Arm-to-Chest Tunneling” and use it to place venous access devices in the arm using a neck venous access. Results: The Arm-to-Chest Tunneling technique allows us to use larger arm venous access device catheters irrespective of the arm veins condition. Thus, this technique has the advantages of arm venous access device placement, with the added benefit of saving the arm veins. Conclusion: The “Arm-to-Chest Tunneling” method offers the alternative to place a venous access device in a more discreet site in the arm, even in cases in which arm veins are inadequate.
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Affiliation(s)
- Elias Kehagias
- Interventional Radiology Unit, Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
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11
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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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12
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Yang SS, Ahn MS. A Comparison Between Upper Arm and Chest for Optimal Site of Totally Implanted Venous Access Ports in Patients with Female Breast Cancer. Ann Vasc Surg 2018; 50:128-134. [DOI: 10.1016/j.avsg.2017.11.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/21/2017] [Accepted: 11/12/2017] [Indexed: 11/27/2022]
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Port Placement via the Anterior Jugular Venous System: Case Report, Anatomic Considerations, and Literature Review. Case Rep Radiol 2017; 2017:2790290. [PMID: 28487803 PMCID: PMC5402238 DOI: 10.1155/2017/2790290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/28/2017] [Indexed: 11/17/2022] Open
Abstract
We report on a patient who was referred for port implantation with a two-chamber pacemaker aggregate on the right and total occlusion of the central veins on the left side. Venous access for port implantation was performed via left side puncture of the horizontal segment of the anterior jugular vein system (AJVS) and insertion of the port catheter using a crossover technique from the left to the right venous system via the jugular venous arch (JVA). The clinical significance of the AJVS and the JVA for central venous access and port implantation is emphasised and the corresponding literature is reviewed.
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Li Y, Cai Y, Gan X, Ye X, Ling J, Kang L, Ye J, Zhang X, Zhang J, Cai Y, Hu H, Huang M, Deng Y. Application and comparison of different implanted ports in malignant tumor patients. World J Surg Oncol 2016; 14:251. [PMID: 27664131 PMCID: PMC5035459 DOI: 10.1186/s12957-016-1002-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/08/2016] [Indexed: 01/27/2023] Open
Abstract
Background The current study aims to compare the application and convenience of the upper arm port with the other two methods of implanted ports in the jugular vein and the subclavian vein in patients with gastrointestinal cancers. Methods Currently, the standard of practice is placement of central venous access via an internal jugular vein approach. Perioperative time, postoperative complications, and postoperative comfort level in patients receiving an implanted venous port in the upper arm were retrospectively compared to those in the jugular vein and the subclavian vein from April 2013 to November 2014. Results Three hundred thirty-four patients are recruited for this analysis, consisting of 107 in the upper arm vein group, 70 in the jugular vein group, and 167 in the subclavian vein group. The occurrence of catheter misplacement in the upper arm vein is higher than that in the other two groups (13.1 vs. 2.9 vs. 5.4 %, respectively, P = 0.02), while the other complications in the perioperative period were not significantly different. The occurrence of transfusion obstacle of the upper arm vein group is significantly lower than that of the jugular and subclavian groups (0.9 vs. 7.1 vs. 7.2 %, P = 0.01). The occurrence of thrombus is also lower than that of other two groups (0.9 vs. 4.3 vs. 3.6 %, P = 0.03). Regarding the postoperative comfort, the influences of appearance (0 vs. 7.1 vs. 2.9 %, P = 0.006) and sleep (0.9 vs. 4.2 vs. 10.7 %, P = 0.003) are significantly better than those of the jugular and subclavian vein groups. Conclusions Compared to the jugular and the subclavian vein groups, the implanted venous port in the upper arm vein has fewer complications and more convenience and comfort, and might be a superior novel choice for patients requiring long-term chemotherapy or parenteral nutrition.
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Affiliation(s)
- Yanhong Li
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Yonghua Cai
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Xiaoqin Gan
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Xinmei Ye
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Jiayu Ling
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Liang Kang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Junwen Ye
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Xingwei Zhang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Jianwei Zhang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Yue Cai
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Huabin Hu
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China
| | - Meijin Huang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510655, China.
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The “L-shaped Tunneling Technique”: A Modified Technique Facilitating a more Discreet Implantable Port Positioning. J Vasc Access 2016; 17:195-9. [DOI: 10.5301/jva.5000496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Venous port catheters, also known as “totally implantable venous access devices” (TIVADs), are now the standard of care in patients requiring long-term intermittent intravenous drug administration. We describe a modification of the implantation technique that we use in our department in order to improve the cosmetic result of a TIVAD. Methods After ultrasound-guided venous access in the internal jugular vein (IJV) or another appropriate vein has been obtained, we create a port pocket in the deltopectoral groove, in the upper-lateral chest wall, in a “far-lateral-oblique” orientation, respecting the individual patient's relaxed skin tension lines. Then we create a subcutaneous tunnel using a straight metal tunneler in two steps: first tunneling cranially and perpendicular to the port incision for a small distance, and then, after turning the tunneler at a right angle continuing in a straight line until we exit at the venous access site. Results This configuration not only prevents catheter kinking, to ensure uninhibited flow, but also allows us to place the port pocket in a more discreet position, in order to offer a better cosmetic result to our patients. Conclusions Adoption of a “far-lateral-oblique” port implantation site along with the “L-shaped tunneling technique” will offer doctors who are implanting TIVADs a useful alternative for a better cosmetic result.
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Abstract
The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.
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Abstract
AbstractPurpose: Various venous access devices are available, including peripheral venous lines, peripherally inserted central catheters lines, and subcutaneous port catheters. The latter provides medium-to long-term venous access and includes medical devices that can be inserted either on the chest (chest ports) or in the arm (arm ports). We report the techniques, dedicated indications, and main complications of arm port insertion using the ultrasonography (US) guidance method.Methods: Tips and tricks of percutaneous real-time US-guided vein access technique in the arm are reviewed, and a brief literature review is reported.Results: Technical feasibility is almost 99%. US guidance allows depiction of anatomic variants, reduces the number of failed attempts, and increases the technical access rate compared with venography-guided access. Comparison of arm ports to chest ports reveals a higher global complication rate. We also report typical (mechanical) complications and dedicated indications, including contraindications to chest port insertion and selected patients for whom chest ports are not possible (eg, those with breast, head, and neck cancer; obesity; cosmesis; and requiring upright position).Conclusions: Arm port insertion under US guidance is safe and effective, and has dedicated indications.
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Zhou J, Qian S, He W, Han G, Li H, Luo R. Implanting totally implantable venous access port via the internal jugular vein guided by ultrasonography is feasible and safe in patients with breast cancer. World J Surg Oncol 2014; 12:378. [PMID: 25487539 PMCID: PMC4265500 DOI: 10.1186/1477-7819-12-378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022] Open
Abstract
Background Because of long-term use for chemotherapy and fluid administration in cancer patients, a totally implantable venous access port (TIVAP) has been advised as a feasible catheter. The purpose of this study was to evaluate the effectiveness and safety of ultrasound (US)-guided internal jugular vein (IJV) puncture for TIVAP implantation in patients with breast cancer. Methods We reviewed the medical records of 492 patients who underwent US-guided IJV puncture for TIVAP implantation at our oncology department between 2010 and 2013. Indications, surgical complications, and early and long-term complications were analyzed. Results All TIVAPs were implanted successfully. Indications for TIVAP were chemotherapy alone (88 patients), chemoradiotherapy (387 patients), surgery (12 patients), and parenteral nutrition (5 patients). Complications were observed in 65 (13.21%) patients. The median duration of the TIVAP was 359 days (range, 28 to 712 days) without damage to the port or catheter, or leakage of drugs outside of the port system. Conclusions A TIVAP can be employed for chemotherapy and parenteral nutrition on the implantation day. Using a US-guided IJV puncture to completely implant a TIVAP is feasible and safe in patients with breast cancer.
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Affiliation(s)
| | | | | | | | - Hongsheng Li
- Cancer Center, Nanfang Hospital, Southern Medical University, No, 1838, Northern Guangzhou Road, 510515 Guangzhou, Guangdong, China.
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A retrospective statistical analysis of the late complications associated with central venous port placements. Jpn J Radiol 2014; 33:21-5. [DOI: 10.1007/s11604-014-0375-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Bos A, Ahmed O, Jilani D, Giger M, Funaki BS, Zangan SM. Dual-lumen chest port infection rates in patients with head and neck cancer. Cardiovasc Intervent Radiol 2014; 38:651-6. [PMID: 25118845 DOI: 10.1007/s00270-014-0973-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to investigate dual-lumen chest port infection rates in patients with head and neck cancer (HNC) compared to those with other malignancies (non-HNC). MATERIALS AND METHODS An IRB-approved retrospective study was performed on 1,094 consecutive chest ports placed over a 2-year period. Patients with poor follow-up (n = 53), no oncologic history (n = 13), or single-lumen ports (n = 183) were excluded yielding a study population of 845 patients. The electronic medical records were queried for demographic information, data regarding ports and infections, and imaging review. RESULTS HNC patients experienced more infections (42 vs. 30), an increased infection rate per 1,000 catheter days (0.68 vs. 0.21), and more early infections within 30 days compared to non-HNC patients (10 vs. 6) (p < 0.001, p < 0.001, p = 0.02, respectively). An existing tracheostomy at the time of port placement was associated with infection in the HNC group (p = 0.02) but was not an independent risk factor for infection in the study population overall (p = 0.06). There was a significant difference in age, male gender, and right-sided ports between the HNC and non-HNC groups (p < 0.01, p < 0.001, and p = 0.01), although these were not found to be independent risk factors for infection (p = 0.32, p = 0.76, p = 0.16). CONCLUSION HNC patients are at increased risk for infection of dual-lumen chest ports placed via a jugular approach compared to patients with other malignancies. Tracheostomy is associated with infection in HNC patients but is not an independent risk factor for infection in the oncologic population as a whole.
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Affiliation(s)
- Aaron Bos
- University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA,
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Shiono M, Takahashi S, Kakudo Y, Takahashi M, Shimodaira H, Kato S, Ishioka C. Upper arm central venous port implantation: a 6-year single institutional retrospective analysis and pictorial essay of procedures for insertion. PLoS One 2014; 9:e91335. [PMID: 24614412 PMCID: PMC3948863 DOI: 10.1371/journal.pone.0091335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/10/2014] [Indexed: 11/18/2022] Open
Abstract
Background The requirement of central venous (CV) port implantation is increasing with the increase in the number of cancer patients and advancement in chemotherapy. In our division, medical oncologists have implanted all CV ports to save time and consultation costs to other departments. Recently, upper arm implantation has become the first choice as a safe and comfortable method in our unit. Here we report our experience and discuss the procedure and its potential advantages. Methods All CV port implantations (n = 599) performed in our unit from January 2006 to December 2011 were analyzed. Procedural success and complication rates between subclavian and upper arm groups were compared. Results Both groups had similar patient characteristics. Upper arm CV port and subclavian implantations were equivalently successful and safe. Although we only retrospectively analyzed data from a single center, the upper arm group had a significantly lower overall postprocedural complication rate than the subclavian group. No pneumothorax risk, less risk of arterial puncture by ultrasound, feasibility of stopping potential arterial bleeding, and prevention of accidental arterial cannulation by targeting the characteristic solitary basilic vein were the identified advantages of upper arm CV port implantation. In addition to the aforementioned advantages, there is no risk of “pinch-off syndrome,” possibly less patient fear of manipulation, no scars on the neck and chest, easier accessibility, and compatibility with the “peripherally inserted central catheter” technique. Conclusions Upper arm implantation may benefit clinicians and patients with respect to safety and comfort. We also introduce our methods for upper arm CV port implantation with the videos.
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Affiliation(s)
- Masatoshi Shiono
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
| | - Shin Takahashi
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
| | - Yuichi Kakudo
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
- Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Aoba-ku, Sendai, Japan
| | - Masanobu Takahashi
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
| | - Hideki Shimodaira
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
| | - Shunsuke Kato
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
- Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Aoba-ku, Sendai, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Tohoku University Hospital, Tohoku University, Aoba-ku, Sendai, Japan
- Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Aoba-ku, Sendai, Japan
- * E-mail:
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22
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Is Ultrasound-guided Central Venous Port Placement Effective to Avoid Pinch-off Syndrome? J Vasc Access 2014; 15:311-6. [DOI: 10.5301/jva.5000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 11/20/2022] Open
Abstract
Purpose Ultrasound (US)-guided internal jugular vein access has been the standard practice of central venous port (CVP) placement. The subclavian vein (SCV) access has also been preferred, but has potential risk of pinch-off syndrome (POS). The purpose of this study was to examine the effect of US-guided SCV access to avoid POS in patients with CVP. Methods Included in this study were patients who had undergone CVP placement via the SCV. We mainly assessed the computed tomography (CT) findings from two different placement techniques of a CVP via the SCV: (i) venipuncture point described by the ratio between the distance from the venipuncture point to the sternoclavicular joint and the clavicular length; and (ii) presence of direct attachment of the catheter to the clavicle. Secondary outcome was POS rate associated with two different placement techniques of CVP via the SCV. Results A total of 237 patients were included in this study between August 2007 and January 2011. A total of 100 patients (42.2%) underwent CVP placement using the landmark technique while 137 patients (57.8%) underwent CVP placement by US guidance. CT revealed that the US-guided technique tended to be lateral SCV approach compared with the landmark technique (p<0.001). A total of four patients (1.7%) experienced POS, all of them in the landmark group. Conclusion Our results showed that the US-guided technique determines a more lateral SCV approach, with a reduced POS risk than the landmark venipuncture technique.
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Chang YF, Lo AC, Tsai CH, Lee PY, Sun S, Chang TH, Chen CC, Chang YS, Chen JR. Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis. Palliat Med 2013; 27:185-91. [PMID: 22126844 DOI: 10.1177/0269216311428777] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer. AIM The aim of this study was to assess the risk of port system failure in patients with advanced cancer. DESIGN We conducted a retrospective cohort study in a comprehensive cancer centre. SETTING/PARTICIPANTS A detailed chart review was conducted among 566 patients with 573 ports inserted during January-June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion. RESULTS Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2-46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m(2) (HR = 3.4, P = 0.029) increased the risk of port system occlusion. CONCLUSIONS Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.
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Affiliation(s)
- Yi-Fang Chang
- Department of Haematology and Oncology, Mackay Memorial Hospital, Taipei, Taiwan.
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Akahane A, Sone M, Ehara S, Kato K, Suzuki M, Tanaka R, Suwabe A, Itabashi T, Masahiro K. Central venous port-related infection in patients with malignant tumors: an observational study. Ups J Med Sci 2012; 117:300-8. [PMID: 22376242 PMCID: PMC3410290 DOI: 10.3109/03009734.2012.664178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated the characteristics of central venous port (CVP)-related infection with microbiological assessments in patients with malignant tumors. MATERIALS AND METHODS In a prospective setting, patients with CVP for the treatment of malignant tumors were enrolled in this study. The incidence of CVP-related infection during three months was determined. Microbiological surveillance from skin swab was performed before and after CVP placement. RESULTS Fifty-nine patients were enrolled in this study, and 60 CVPs were implanted. Thirty-six (61%) patients had head and neck malignancies. Access route was subclavian vein in 43 (71.7%) CVPs and forearm vein in 17 (28.3%). CVP-related infection was observed in three (5.1%) patients: port-pocket infection in one and probable CVP-related infection in two patients, respectively. No definitive CVP-related bloodstream infection was observed. Before the placement of CVP, colonization at the insertion site was observed in ten subclavian CVP patients, while no colonization was observed in the forearm CVP patients. At 1 and 4 weeks, detection rates of colonization were also higher in subclavian CVP patients. No definitive relationship was demonstrated between skin colonization and clinical development of CVP-related infection. CONCLUSION The rate of CVP-related infection in this prospective evaluation in patients with malignant tumors was comparable to previous studies. Colonization of the skin was more prominent in the subclavian site than in the forearm site. Although skin colonization was not proven to be a risk factor of infection, these results may draw attention to the adequate maintenance of CVP. ( TRIAL REGISTRATION UMIN000003664).
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Affiliation(s)
- Akio Akahane
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
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Aribaş BK, Arda K, Aribaş O, Ciledağ N, Yoloğlu Z, Aktaş E, Seber T, Kavak S, Coşar Y, Kaygusuz H, Tekin E. Comparison of subcutaneous central venous port via jugular and subclavian access in 347 patients at a single center. Exp Ther Med 2012; 4:675-680. [PMID: 23170125 PMCID: PMC3501443 DOI: 10.3892/etm.2012.649] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 07/26/2012] [Indexed: 12/03/2022] Open
Abstract
The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method.
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Affiliation(s)
- Bilgin Kadri Aribaş
- Department of Radiology, A. Y. Ankara Oncology Education and Research Hospital, Ankara 06200
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Re: criteria to choose between distal or proximal venous port device insertion in HNC patients. Cardiovasc Intervent Radiol 2012; 36:876. [PMID: 22678238 DOI: 10.1007/s00270-012-0403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
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Marcy PY, Lacout A, Amoretti N, Figl A, Thariat J, Simon JJ. Criteria to choose between distal or proximal venous port device insertion in HNC patients. Cardiovasc Intervent Radiol 2012; 36:874-5. [PMID: 22678237 DOI: 10.1007/s00270-012-0402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 04/17/2012] [Indexed: 11/25/2022]
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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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