Forty years after the first totally implantable venous access device (TIVAD) implant: the pure surgical cut-down technique only avoids immediate complications that can be fatal

Double port-a-cath implantation: initial experience in Brazil and technical note tips and tricks: a series report

BACKGROUND

This study was designed to evaluate the clinical benefit of double-lumen port catheters in patients receiving chemotherapy and parenteral nutrition concurrently or in those with vascular access failure. The advantages, complications, indications and duration of use of double port-a-cath were considered.

METHODS

Thirteen Brazilian patients received a double-lumen port catheter that was implanted under ultrasonographic and fluoroscopic guidance in the radiologic interventional suite.

RESULTS

All double-lumen port systems were successfully implanted in all patients without immediate complications. The port-a-cath was removed in two patients due to infection of the reservoir. Three deaths occurred due to underlying disease with no correlation to the port-a-cath. No temporal interference between the administration of chemotherapy and parenteral nutrition was observed.

CONCLUSION

The double-door approach is a safe technique with low complication rates. Indications for use of the dual port are numerous and should be encouraged because of the considerable benefits for critically ill patients.

A Monocentric Analysis of Implantable Ports in Cancer Treatment: Five-Year Efficacy and Safety Evaluation

BACKGROUND

Daily clinical practice requires repeated and prolonged venous access for delivering chemotherapy, antibiotics, antivirals, parenteral nutrition, or blood transfusions. This study aimed to investigate the performance and the safety of totally implantable vascular access devices (TIVADs) over a 5-year follow-up period through a standardized well-trained surgical technique and patient management under local anesthesia.

METHODS

In a retrospective, observational, and monocentric study, 70 patients receiving POLYSITE® TIVADs for chemotherapy were included. The safety endpoints focused on the rate of perioperative, short-term, and long-term complications. The performance endpoints included vein identification for device insertion and procedural success rate.

RESULTS

The study demonstrated no perioperative or short-term complications related to the TIVADs. One (1.4%) complication related to device manipulation was identified as catheter flipping, which led to catheter adjustment 56 days post-placement. Moreover, one (1.4%) infection due to usage conditions was observed, leading to TIVAD removal 3 years and 4 months post-surgery. Catheter placement occurred in cephalic veins (71.4%), subclavian veins (20%), and internal jugular veins (8.6%). The procedural success rate was 100%. Overall, the implantable ports typically remained in place for an average of 22.4 months.

CONCLUSIONS

This study confirmed the TIVADs' performance and safety, underscored by low complication rates compared to published data, thereby emphasizing its potential and compelling significance for enhancing routine clinical practice using a standardized well-trained surgical technique and patient management.

Cephalic Vein Cut Down for Total Implantable Venous Access Ports: A Retrospective Review of a Single Institution Series

Objective

The aim of this work was to describe the early and late success rates of cephalic vein cut down (CVC) in the implantation of totally implantable venous access ports (TIVAP) for chemotherapy treatment in oncological patients.

Methods

This was a retrospective study of 1 047 TIVAP performed in a private institution between 2008 and 2021. The CVC with pre-operative ultrasound (PUS) was the initial approach. All cephalic veins (CVs) were mapped pre-operatively with Doppler ultrasound, measuring their diameter and course in oncological patients who required a TIVAP. With a CV diameter ≥ 3.2 mm TIVAP was carried out by CVC; with CV diameter < 3.2 mm, subclavian vein puncture (SVP) was performed.

Results

1 047 TIVAPs were implanted in 998 patients. The mean age was 61.5 ± 11.5 years, 624 were women (65.5%). Male patients were significantly older and with a higher incidence of colonic, digestive system, and laryngeal cancer. Initially, TIVAP was indicated in 858 cases (82%) by CVC and 189 (18%) by SVP. The success rate was 98.5% for CVC and 98.4% for SVP. There were no complications for CVC (0%) but five early complications (2.5%) in the SVP group. The rates of late complications were 4.4% in the CVC group and 5.0% in the SVP group, foreign body infection being the most frequent (57.5% of the cases) (p = .85).

Conclusion

The CVC or SVP using PUS for TIVAP deployment, performed through a single incision, is a safe and effective technique. This open but minimally invasive technique should be considered in oncological patients.

Application of Chain Nursing Process in the Nursing of Elderly Inpatients with Implantable Venous Infusion Port

Objective

To explore the application effects of chain nursing process in the nursing of elderly inpatients with implantable venous infusion port.

Methods

81 elderly inpatients who were treated with implantable venous infusion port in the hospital were selected between February 2018 and December 2021, and they were divided into the routine group (given routine nursing of implantable venous infusion port, n = 40) and the study group (given chain nursing process intervention on the basis of the routine group, n = 41) according to the random number table method. The patients in both groups were intervened for 1 month. The catheter-related indicators and incidence rates of adverse events (drug extravasation, local hematoma, infusion port blockage, catheter-related infection) were compared between the two groups of patients. Generalized Anxiety Disorder 7-item scale (GAD-7) and Athens Insomnia Scale (AIS) were used to compare the psychological states of the two groups before and after intervention, and Newcastle Satisfaction with Nursing Scale (NSNS) was adopted to compare the nursing satisfaction of patients before and after intervention.

Results

After intervention, the catheter maintenance operation time in the study group was shorter than that in the routine group (P < 0.05), and there were no significant differences in the accidental extubation rate and re-intubation rate between the two groups (P > 0.05). The incidence rate of adverse reactions of 2.44% in the study group was lower than 15.00% in the routine group (P < 0.05). After intervention, the scores of GAD-7 and AIS in the two groups were reduced compared with those before intervention, and the above scores in the study group were lower than those in the routine group (P < 0.05). Before intervention, there were no significant differences in the NSNS scores between the two groups (P > 0.05). After intervention, the NSNS scores in the study group were higher than those in the routine group (P < 0.05).

Conclusion

Chain nursing process can help to enhance the maintenance quality of implantable venous infusion port, reduce the incidence of adverse events, relieve the tension and anxiety, and improve the satisfaction of patients with nursing.