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Jia J, Fan X, Zhang W, Xu Z, Wu M, Zhan Y, Fan B. Predictive model for totally implanted venous access ports‑related long‑term complications in patients with lung cancer. Oncol Lett 2024; 28:326. [PMID: 38807672 PMCID: PMC11130750 DOI: 10.3892/ol.2024.14459] [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: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Totally implanted venous access ports (TIVAPs), which are typically used in oncological chemotherapy and parenteral nutritional support, are convenient and safe, and thus offer patients a higher quality of life. However, insertion or removal of the device requires a minor surgical operation. Long-term complications (>30 days post insertion), such as catheter migration, catheter-related thrombosis and infection, are major reasons for TIVAP removal and are associated with a number of factors such as body mass index and hemoglobin count. Since management of complications is typically time-consuming and costly, a predictive model of such events may be of great value. Therefore, in the present study, a predictive model for long-term complications following TIVAP implantation in patients with lung cancer was developed. After excluding patients with a large amount of missing data, 902 patients admitted to The First Affiliated Hospital with Nanjing Medical University (Nanjing, China) were ultimately included in the present study. Of the included patients, 28 had complications, indicating an incidence rate of 3.1%. Patients were randomly divided into training and test cohorts (7:3), and three machine learning-based anomaly detection algorithms, namely, the Isolation Forest, one-class Support Vector Machines (one-class SVM) and Local Outlier Factor, were used to construct a model. The performance of the model was initially evaluated by the Matthew's correlation coefficient (MCC), area under curve (AUC) and accuracy. The one-class SVM model demonstrated the highest performance in classifying the risk of complications associated with the use of the intracavitary electrocardiogram method for TIVAP implantation in patients with lung cancer (MCC, 0.078; AUC, 0.62; accuracy, 66.0%). In conclusion, the predictive model developed in the present study may be used to improve the early detection of TIVAP-related complications in patients with lung cancer, which could lead to the conservation of medical resources and the promotion of medical advances.
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Affiliation(s)
- Jian Jia
- Department of General Practice, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Xutong Fan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Zhiyang Xu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Mian Wu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yiyang Zhan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
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.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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Janatolmakan M, Awys L, Khatony A. Cancer patients' experience with implanted venous ports: A qualitative descriptive study. JOURNAL OF VASCULAR NURSING 2024; 42:74-79. [PMID: 38555181 DOI: 10.1016/j.jvn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/21/2023] [Accepted: 01/08/2024] [Indexed: 04/02/2024]
Abstract
AIM The aim of this study was to explore the experiences of cancer patients regarding venous access ports. BACKGROUND The utilization of intravenous access ports for administering chemotherapy drugs is on the rise. Understanding patients' experiences with these devices can provide valuable insights for nursing managers and nurses. METHODS A conventional qualitative content analysis approach was employed to explore the experiences of 14 patients who had venous access ports. The participants were selected from patients admitted to the oncology ward of a hospital affiliated with Kermanshah University of Medical Sciences. A purposive sampling method was used for participant selection. Semi-structured in-depth interviews were conducted as the data collection tool. MaxQda-10 software was utilized for data management. RESULTS The data analysis yielded three main categories and ten sub-categories. The categories consisted of positive aspects of venous access ports, negative aspects of venous access ports, and barriers to accepting venous access ports. CONCLUSIONS The participants highlighted both the positive and negative aspects of venous access ports, while also identifying insufficient knowledge and "fear and anxiety" as barriers to accepting these devices. Providing essential training and offering psychological support to newly hospitalized cancer patients could prove beneficial in this regard.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lyda Awys
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Chatani S, Tsukii R, Nagasawa K, Hasegawa T, Murata S, Kato M, Yamaura H, Onaya H, Matsuo K, Watanabe Y, Inaba Y. Difficult removal of totally implantable venous access devices in adult patients: Incidence, risk factors, and management. J Vasc Access 2023; 24:1150-1157. [PMID: 35081814 DOI: 10.1177/11297298211069256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Totally implantable venous access devices (TIVADs) have played an important role of medical oncology practice. However, operators sometimes encounter considerable difficulty when removing TIVADs. This study aimed to investigate the incidence of difficult TIVAD removal, determine associated risk factors, and investigate interventional radiology (IR) approaches to difficult removal. METHODS A total of 514 TIVAD removal procedures performed in a single-center between January 2014 and May 2021 were retrospectively analyzed to determine incidence of difficult removal and associated risk factors. IR approaches applied in difficult removal cases were also reviewed. RESULTS The incidence of difficult removal was 7.4% (38/514). In univariable analysis, indwelling duration, silicone catheter, and subcutaneous leakage of fluid were identified as significant risk factors for difficult removal. Multivariable analysis showed that indwelling duration per year (odds ratio (OR), 1.46; 95% confidence interval (CI), 1.28-1.67; p < 0.01) and subcutaneous leakage of fluid (OR, 6.04; 95% CI, 2.45-14.91; p < 0.01) were significantly associated with difficult removal. In the 38 difficult removal cases, 32 TIVADs could be removed using more dissection and traction than the standard removal method. In the other 6, TIVADs were successfully removed by using several IR techniques, including insertion of a guide wire (n = 1), dissection using an introducer sheath (n = 2), pushing with a dilator (n = 1), and pulling with a snare (n = 2). CONCLUSION Difficult TIVAD removal is uncommon. However, operators should expect it when removing long indwelling TIVADs and those with subcutaneous leakage. IR approaches to difficult removal are minimally invasive and can be useful.
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Affiliation(s)
- Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Ryota Tsukii
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kyohei Nagasawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Mina Kato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Division Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
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Shigyo H, Suzuki H, Tanaka T, Moriyama E, Shimotsuura Y, Nagasu S, Iwamoto H, Akagi Y, Murotani K, Kawaguchi T, Miwa K. Safety of Early Bevacizumab Administration after Central Venous Port Placement for Patients with Colorectal Cancer. Cancers (Basel) 2023; 15:cancers15082264. [PMID: 37190192 DOI: 10.3390/cancers15082264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Bevacizumab (BEV) requires an adequate withdrawal period to avoid BEV-related complications during major surgery. However, the safety of BEV administration immediately after surgical placement of the central venous (CV) port, a minor surgery, is still unclear. This study aimed to investigate whether BEV is safe when administered early after CV port placement. We retrospectively evaluated 184 patients with advanced colorectal cancer (CRC) treated with a BEV-containing regimen and divided them into two groups according to the interval between CV port implantation and chemotherapy initiation, with the early administration group being ≤7 days and late administration group being >7 days. Complications were then compared between the two groups. The early-administration group was significantly older and had a higher rate of colon cancer than the late-administration group. Overall, 24 (13%) patients developed CV port-related complications. Male sex was a risk factor for complications (odds ratio [OR], 3.154; 95% CI, 1.19-8.36). The two groups showed no significant difference in the frequency of complications (p = 0.84) or patient characteristics (after the inverse probability of treatment weighting, p = 0.537). In conclusion, the frequency of complications is not affected by the timing of BEV initiation after CV port implantation. Thus, early BEV administration after CV port placement is safe.
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Affiliation(s)
- Hirona Shigyo
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan
- Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Hiroyuki Suzuki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Toshimitsu Tanaka
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Etsuko Moriyama
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Yasutaka Shimotsuura
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Sachiko Nagasu
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan
- Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Hideki Iwamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Keisuke Miwa
- Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan
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Fritsch LM, Le M, Elrod J, Wössmann W, Vincent D, Reinshagen K, Boettcher M. Surgical Experience Affects the Outcome of Central Venous Access Catheter Implantation in Children: A Retrospective Cohort Study. J Pediatr Hematol Oncol 2023; 45:57-62. [PMID: 35398862 DOI: 10.1097/mph.0000000000002463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical complications occur in up to third of children, limiting the benefits of tunneled central venous catheters (tCVCs) in children. We aimed to identify risk factors for complications related to catheter implantation. METHODS All children and adolescents undergoing tCVC implantation at a single center over a period of 9 years were analyzed. Infection, thrombosis, dislocation, and catheter dysfunction were defined as complications. Both patient-related (ie, age, sex, vessel characteristics, revision surgery) and surgical factors (ie, sex of surgeon, surgical experience) were analyzed for their association with complications. RESULTS A total of 1024 catheters were inserted, 887 ports and 137 broviac catheters. In terms of patient-related factors, Broviac catheters, and nononcological patients had a higher complication rate. The use of the internal jugular vein and revision surgery was associated with significantly increased complications in patients with port catheters. Experience of the surgeon correlated with various outcome parameters. Implantation performed by an attending were associated with lower complication rates in comparison to those performed by residents. Within the resident group, insertions performed by experienced residents had more complications compared with those performed by residents during their first years. CONCLUSION The study suggests that the outcome of tCVCs insertion is affected by the type of catheter used, the utilized vessel and above all by surgical experience. Residents had significantly increased complication rates in comparison to board-certified surgeons and amongst resident's outcome got worse with increasing experience of the residents. The presence of an experienced attending did not compensate for this effect. To improve the outcome of tCVCs, strategies like direct feedback after every procedure to achieve proficiency should be implanted in residency programs.
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Affiliation(s)
| | | | - Julia Elrod
- Departments of Pediatric Surgery
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Wilhelm Wössmann
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | | | | | - Michael Boettcher
- Departments of Pediatric Surgery
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Kartsouni V, Moschouris H, Bersimis F, Gkeneralis G, Gkeli M, Dodoura S, Chouchourelou A, Fezoulidis I, Kotsakis A, Rountas C. Complications of Totally Implantable Central Venous Catheters (Ports) Inserted via the Internal Jugular Vein Under Ultrasound and Fluoroscopy Guidance in Adult Oncology Patients: A Single-Center Experience. Cureus 2022; 14:e27485. [PMID: 36060391 PMCID: PMC9421351 DOI: 10.7759/cureus.27485] [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] [Accepted: 07/30/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction In this retrospective study, the safety and complication rates of port implantations via the internal jugular vein under ultrasound and fluoroscopy guidance in adult oncology patients were analyzed. Material and methods Eight hundred seven ports implanted in 799 adult oncology patients at a tertiary Oncology-Anticancer Hospital during a 36-month period from January 1, 2017 to December 31, 2019 were retrospectively reviewed. Data acquisition was obtained until December 31, 2020. All procedures were performed by two specialized interventional radiologists under ultrasound and fluoroscopy guidance. The vein access was via the internal jugular vein. Catheter days (the total number of days of maintenance of the port by all of the patients until removal, death, or December 31, 2020), technical success rates, and complication rates were evaluated based on the interventional radiological reports and patient medical records. Multivariate analysis regarding patients such as age, sex, body mass index (BMI), marital status, educational level, cancer type, side of insertion, diameter of internal jugular vein, diabetes, anticoagulants/antiplatelets, purpose of implantation, and catheter material as to the risk of complications was conducted. Results A total of 369,329 catheter maintenance days were observed (457.7±345.0). The technical success rate was 99.9%, and a total of 85 (10.5%) complications occurred, of which 24 (28.2%) occurred early (<30 days) and the remaining 61 (71.8%) were late (>30 days) complications. Specifically, 28 (3.5%) were catheter-related thrombosis (CRT), 27 (3.4%) related to infection, 17 (2.1%) were mechanical complications (16 fibrin sheath formation and one catheter occlusion), six (0.7%) related to catheter migration, four (0.5%) related to incision healing problems, and the remaining three (0.4%) related to ischemic skin necrosis. Forty-seven (5.8%) ports were removed due to complications. On multivariate analysis, cancer type was found as a risk factor for the development of a complication. Additionally, there was an indication that hematologic malignancy is related to infection. Conclusion Placement of ports via the internal jugular vein under ultrasound and fluoroscopy guidance is a safe procedure, with low rates of early and late complications.
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Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Umakoshi N, Kajita S, Komaki T, Gobara H, Kanazawa S. Contrast examination of central venous access port implanted through internal jugular vein for evaluation of suspected complications. Jpn J Radiol 2021; 39:1103-1110. [PMID: 34021855 DOI: 10.1007/s11604-021-01142-4] [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] [Received: 03/04/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE We summarized the findings, diagnosis, and outcomes of cases for which contrast examination of central venous access ports (CV-ports) were attempted to detect complications. MATERIALS AND METHODS Fifty-seven contrast examinations were attempted for 45 patients with 46 CV-ports (median, 162 days after implantation). Contrast examination was performed due to three suspicion catheter fractures or 54 CV-port dysfunctions (combinations of an absence of blood reflux on aspiration and 9 sufficient, 21 insufficient, or 24 impossible drip infusions). RESULTS Contrast examination was successfully performed in 52 cases and revealed 45 normal findings, 5 pericatheter fibrin sheath formations, and 2 partial catheter fractures. In 23 of 45 cases with normal findings, the resistance to injection was initially mild or moderate but resolved after the CV-port was flushed slowly with heparinized saline solution. Subsequent contrast examination demonstrated normal findings. All fibrin sheath formations disappeared after thrombolytic therapy. Five cases could not undergo contrast examination due to high resistance. After contrast examination, nine of 46 CV-ports were removed or exchanged, while the use of the remaining 37 continued. CONCLUSION Contrast examination of CV-port allowed the assessment of suspected complications and early treatment.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Soichiro Kajita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
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Yun WS, Yang SS. Comparison of peripherally inserted central catheters and totally implanted venous access devices as chemotherapy delivery routes in oncology patients: A retrospective cohort study. Sci Prog 2021; 104:368504211011871. [PMID: 33950754 PMCID: PMC10455024 DOI: 10.1177/00368504211011871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate peripherally inserted central catheters (PICCs) and totally implanted venous access devices (TIVADs) as chemotherapy delivery routes. From May 2016 to April 2019, patients with malignancies who had PICCs or TIVADs inserted for chemotherapy were enrolled. We reviewed the patients' medical records for information concerning demographics, comorbidities, catheter-related complications, and catheter -service days. All patients included in both groups were also assessed for complication-free catheter survival and completion rates of chemotherapy. A total of 467 catheter insertions (185 PICCs and 282 TIVADs) were included in this study. The PICCs were associated with a higher rate of complication-related catheter removal than TIVADs (hazard ratio, 6.5954; 95% confidence interval, 2.394-18.168; p<0.001). The completion of chemotherapy was observed in 77 (41.6%) patients with PICCs and 128 (45.4%) with TIVADs (p = 0.442). The mean duration of catheter service-days was shorter for the patients in the PICC group who completed chemotherapy than those in the TIVAD group (101.3 ± 93.2 vs 245.3 ± 115.9, respectively, p < 0.001). Although PICC was an independent risk factor for complication-related catheter removal, there was no difference in the chemotherapy completion rate between the groups. Therefore, PICCs need to be considered preferentially in patients who require a chemotherapy delivery route for short-term chemotherapy.
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Affiliation(s)
- Woo-Sung Yun
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Yu Z, Sun X, Bai X, Ding W, Wang W, Xu L, Qin W, Wen L, Jin Y. Perioperative and Postoperative Complications of Supraclavicular, Ultrasound-Guided, Totally Implantable Venous Access Port via the Brachiocephalic Vein in Adult Patients: A Retrospective Multicentre Study. Ther Clin Risk Manag 2021; 17:137-144. [PMID: 33568912 PMCID: PMC7869700 DOI: 10.2147/tcrm.s292230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/20/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose The totally implantable venous access port (TIVAP) provides patients with safe, effective and long-term convenient venous access for the administration of medications such as chemotherapy drugs. The implantation and long-term use of TIVAP are related to thrombosis, infection and other complications. In this study, the medical records of multicentre patients were collected, and the perioperative and postoperative complications were retrospectively analysed to objectively evaluate the safety of the implantation of supraclavicular, ultrasound-guided TIVAP via the brachiocephalic vein (BCV). Patients and Methods We retrospectively analysed the clinical data of 433 adult patients who had undergone ultrasound-guided TIVAP implantation via the BCV at four hospitals in China from March 2018 to May 2019. The success rates of the first puncture, operation time, and perioperative and postoperative complications were analysed. Results All the TIVAPs were implanted successfully (100%). The average TIVAP carrying time was 318.15 ±44.22 days (range: 38–502 days) for a total of 197,694 catheter days. The success rate of the first puncture was 94.92% (411/433), and the average operation time was 29.66 ±7.45 min (range: 18–60 min). The perioperative complications included arterial puncture in 4 patients and pneumothorax in 1 patient. The incidence of postoperative complications was 5.08% (22/433), including poor incision healing (n = 2), catheter-related infection (n = 3), port infection (n = 6), thrombosis (n = 2) and fibrin sheath formation (n = 8). Another patient had infusion disturbance 2 days after the operation, and chest X-ray showed bending at the connection between the catheter and port. No other serious complications occurred, such as catheter rupture and drug leakage. The total incidence of complications was 6.24% (27/433). Conclusion This study showed excellent tolerance of supraclavicular, ultrasound-guided BCV puncture to implant TIVAP and a low incidence of complications. As a safe and effective method of TIVAP implantation, it can provide a new choice for clinicians.
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Affiliation(s)
- Zepeng Yu
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Wei Ding
- Department of Intervention, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, 214023, Jiangsu Province, People's Republic of China
| | - WeiDong Wang
- Department of Intervention, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, 214023, Jiangsu Province, People's Republic of China
| | - Liang Xu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, Jiangsu, People's Republic of China
| | - Wenming Qin
- Department of Anesthesiology, Bazhong Central Hospital, Bazhong, Sichuan, 636000, People's Republic of China
| | - Ling Wen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People's Republic of China
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Klaiber U, Probst P, Hackbusch M, Jensen K, Dörr-Harim C, Hüttner FJ, Hackert T, Diener MK, Büchler MW, Knebel P. Meta-analysis of primary open versus closed cannulation strategy for totally implantable venous access port implantation. Langenbecks Arch Surg 2021; 406:587-596. [PMID: 33420832 PMCID: PMC8106576 DOI: 10.1007/s00423-020-02057-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is still no reference standard for the implantation of totally implantable venous access ports (TIVAPs). A recently published multicentre randomised controlled trial (RCT) revealed a significantly greater risk of pneumothorax after closed cannulation than after an open strategy. The aim of this meta-analysis was to provide an update of the available evidence for the safety and effectiveness of primary open versus closed cannulation strategy. METHODS RCTs comparing outcomes of open cut-down of the cephalic vein and closed cannulation of the subclavian vein were sought systematically in MEDLINE, Web of Science and CENTRAL. The primary outcome was the occurrence of pneumothorax. A beta-binominal model was applied to combine the respective outcomes, and results are presented as odds ratios (OR) with 95% confidence interval (CI). RESULTS Six RCTs with a total of 1831 patients were included in final analysis. Meta-analysis showed statistically significant superiority of the open cut-down technique regarding pneumothorax (OR 0.308, 95% CI 0.122 to 0.776), but a statistically significant higher failure of the primary technique for the open cut-down technique than for closed cannulation (OR 2.364, 95% CI 1.051 to 5.315). There were no significant differences between the two procedures regarding other morbidity endpoints. CONCLUSION This meta-analysis shows a general superiority of open cut-down of the cephalic vein over closed cannulation of the subclavian vein regarding the occurrence of pneumothorax. Open cut-down should be the first-line approach for TIVAP implantation. Closed cannulation should be performed with ultrasound as second-line procedure if the open technique fails. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013005180.
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Affiliation(s)
- Ulla Klaiber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. .,Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
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Availability of totally implantable venous access devices in cancer patients is high in the long term: a seven-year follow-up study. Support Care Cancer 2020; 29:3531-3538. [PMID: 33155092 PMCID: PMC8163709 DOI: 10.1007/s00520-020-05871-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Totally implantable venous access devices (TIVADs) currently have an important place in medical oncology practice; however, their long-term availability deserves further investigation, since they are usually required by patients for prolonged periods. This study aimed to evaluate long-term availability of TIVADs in adult cancer patients, in conjunction with complication/removal rates over time and associated risk factors during 7-year follow-up. METHODS A total of 204 adult cancer patients who underwent TIVAD placement via subclavian vein using the Seldinger technique were included in this study. Medical data and catheter follow-up records were investigated retrospectively. Complications and port removals due to complications were evaluated over time. RESULTS During median 21.9 (range, 0.7-82.9) months of follow-up, great majority of the patients did not require catheter removal due to complications (91.7%). During a total follow-up of 183,328 catheter days, 20 (9.8%) patients had complications with an incidence of 0.109 cases per 1000 catheter days and 18 (8.8%) of them required TIVAD removal (0.098 cases per 1000 catheter days). Most device removals due to complications (15/18, 83.3%) occurred within the first 24 months. Multivariate analysis identified left-sided device location as the only significant independent predictor of short device availability (OR, 3.5 [95% CI, 1.1-11.1], p = 0.036). CONCLUSION TIVADs in cancer patients appear to be safe and their availability appears to be high in the long term. A decision for early removal might be revisited. Opting for the accustomed side (right side in the present study) for implantations seems to be associated with better outcomes.
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Ye F, Liu Y, Yu P, Li N, Wang Y, Xie X, Tang J. Intraoperative ipsilateral subclavian port catheter implantation in resectable breast cancer patients: A novel, safe, and convenient clinical practice. Cancer Med 2020; 9:8970-8978. [PMID: 33145946 PMCID: PMC7724495 DOI: 10.1002/cam4.3595] [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: 08/10/2020] [Revised: 09/17/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Port catheter (PC) is a classical route of administering chemotherapy for breast cancer patients. We established a standard operating procedure (SOP) of intraoperative ipsilateral subclavian PC implantation in selected resectable breast cancer patients. Methods We conducted a prospective clinical study to assess its safety and complications. A total of seventy six resectable breast cancer patients were included for intraoperative ipsilateral subclavian PC implantation. Thirty patients receiving conventional percutaneous contralateral PC implantation under local anesthesia at the same period were recruited as control group. The time consuming of implantation, and PC‐related complications were recorded. Visual analog scale questionnaires were used to assess patients’ satisfaction. Results Compared with conventional contralateral PC implantation under local anesthesia, SOP for intraoperative ipsilateral subclavian PC implantation significantly shortens the time consuming (11.6 vs. 28.6 min, p < 0.001). With a median retention time of 6.3 months, the overall incidence rate of PC‐related complications is 21%, of which the most common complications are infections and venous thromboembolism (7.9% for each). Most patients (86.8%) with intraoperative ipsilateral subclavian PC implantation have completed the whole chemotherapy successfully. Due to the general anesthesia and shorter time consuming, intraoperative implantation gains significantly more patients' satisfaction. Conclusions In the present study, we develop a SOP for intraoperative ipsilateral subclavian PC implantation in resectable breast cancer patients, which is noval, convenient, and safe. In selected breast cancer patients with indications for adjuvant chemotherapy, this practice could significantly shorten the time consuming of PC implantation and improve the degree of patients' satisfaction.
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Affiliation(s)
- Feng Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ping Yu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Na Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yan Wang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jun Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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