1
|
Hamri H, Pop CF, Mauriac S, Degreve C, Khaled C, Vouche M, Moreau M, Liberale G. Evaluation of the position of the central venous catheter tip of implantable venous access devices in the occurrence of postoperative thrombotic and non-thrombotic complications. Support Care Cancer 2024; 32:355. [PMID: 38750256 DOI: 10.1007/s00520-024-08563-7] [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: 11/10/2023] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The position of the catheter tip of totally implantable venous access devices (TIVAD) is a risk factor for postoperative complications. The study aim was to assess the early and late complications (EC and LC) associated with the position of the catheter tip in cancer patients. METHODS We reviewed cancer patients who had a TIVAD placed in 2020. EC (≤ 90 days), LC (> 90 days) and risk factors for TIVAD-associated complications were assessed. The vertical mismatch of the catheter tip was compared to an "ideal position" (> 10 mm below the carina and ≥ 20 mm below the right main bronchus (RMB)) using chest x-ray, post-implantation. RESULTS 301 patients were included. Median follow-up after TIVAD implantation was 9.4 months. All TIVAD catheters were inserted via the internal jugular vein (IJV). The mean distance between the catheter tip and the carina and the RMB was 21.3 mm and 6.63 mm respectively. In total, 11.3% patients developed EC and 5.6% had LC. An association was found between the position of the catheter tip from the carina (≤ 10 mm vs. > 10 mm) and the occurrence of EC (18.3% vs. 8.6%, p = 0.01) and for the catheter insertion side (left IJV vs. right IJV) (19.1% vs. 9.0% p = 0.02). Multivariate analysis showed that left IJV catheter insertion (OR 2.76), and a catheter tip located ≤ 10 mm below the carina (OR 2.71) are significant independent risk factors of EC. CONCLUSIONS TIVAD catheter tip located at ≤ 10 mm below the carina, and a left-side inserted catheter, are higher risk of EC.
Collapse
Affiliation(s)
- Hicham Hamri
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - C Florin Pop
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium.
| | - Sybil Mauriac
- Department of Nursing, Institut Jules Bordet - HUB, Brussels, Belgium
| | - Caroline Degreve
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Charif Khaled
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michel Moreau
- Data Center and Statistics, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| |
Collapse
|
2
|
Gündogdu F, Semerci R, Bay F. Totally Implantable Venous Access Device Care Practices and Experiences of Pediatric and Adult Oncology Nurses. JOURNAL OF INFUSION NURSING 2024; 47:182-189. [PMID: 38744243 DOI: 10.1097/nan.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This study aimed to determine the practices of nurses working in pediatric and adult oncology clinics regarding totally implantable venous access device (TIVAD) care. The descriptive study was conducted with 227 oncology nurse members of the Oncology Nursing Association. The data were collected online with a survey form, which included questions about the participants' sociodemographic characteristics, professional experience, and TIVAD implementation practices. Descriptive statistics and ꭓ2 tests were used for the analysis of the data. It was determined that 44.1% of the nurses used 0.9% NaCl for active TIVAD flushing; 15.9% of them used a positive-pressure 0.9% NaCl-filled syringe; 12.3% used antireflux connectors; 85.5% used manual positive pressure technique; and 53.7% used the pulsatile technique. A statistical difference was found between nurses' training on TIVAD care and TIVAD occlusion rate in the clinic, TIVAD infection rate, following the guidelines, and using the pulsatile technique (P < .05). This study revealed that there are differences in the practices for TIVAD care and that the recommendations in the literature/guidelines are not implemented at the desired level to ensure continuity and prevent complications.
Collapse
Affiliation(s)
- Fatma Gündogdu
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| | - Remziye Semerci
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| | - Figen Bay
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Front Oncol 2022; 12:1021488. [DOI: 10.3389/fonc.2022.1021488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
AimTo investigate the safety and feasibility of extending the flushing interval for the totally implantable venous access port (TIVAP) during the non-treatment stage in patients with breast cancer (BC) by retrospectively analyzing the patients’ clinical data, including the incidence of TIVAP-related complications.MethodsThis single-center retrospective study included patients with BC who underwent TIVAP implantation at our hospital between January 2018 and March 2021 during their non-treatment phase and visited the hospital regularly for TIVAP flushing. Among the 1013 patients with BC who received TIVAP implantation, 617 patients were finally included on the basis of the inclusion and exclusion criteria and divided into three groups according to the length of the flushing interval: group 1 (≤30 days, n = 79), group 2 (31–90 days, n = 66), and group 3 (91–120 days, n = 472). The basic characteristics of patients in each group and the incidence of TIVAP-related complications (catheter obstruction, infection, and thrombosis) were analyzed.ResultsNo significant intergroup differences were observed in age, body mass index (BMI), tumor stage, pathological staging, implantation approach, chemotherapy regimen, duration of treatment, and TIVAP-related blood return rate (P > 0.05). Among patients from all three groups, 11 cases of catheter pump-back without blood and eight cases of TIVAP-related complications such as infection, thrombosis, and catheter obstruction were recorded. However, no significant differences in TIVAP-related complications were observed among the three groups (P > 0.05).ConclusionExtending the TIVAP flushing interval beyond three months during the non-treatment stage in BC patients is safe and feasible and did not increase the incidence of TIVAP-related complications.
Collapse
|
6
|
Wang YW, Qiu XX. Kinesiophobia and related factors in cancer patients with TIAPs during the long term: a cross-sectional survey. Support Care Cancer 2022; 30:4927-4934. [PMID: 35175418 DOI: 10.1007/s00520-022-06842-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/17/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study is designed to investigate the status of kinesiophobia and related factors in cancer patients with totally implantable venous access ports (TIAPs). METHODS This is a cross-sectional study; all the participants were recruited from the Oncology Department and the Daytime Chemotherapy Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, from April 1 to May 31, 2021. The participants were interviewed by researchers using the self-made general information questionnaire and the Tampa Scale of Kinesiophobia-11 (TSK-11) scale, which allows the fear of movement to be quantified. Eligible patients were aged ≥ 18 years, confirmed with cancer, and implanted with a port. The logistic regression model was used to evaluate clinical factors and the risk of kinesiophobia. RESULTS A total of 282 patients were recruited (aged 58.0 ± 11.5 years), of which gastrointestinal cancer accounted for 54.6%, breast cancer accounted for 22.7%, lung cancer accounted for 11.3%, and other types accounted for 11.3%. The TSK-11 score of the 282 patients was 17.84 ± 6.06 points, 45.7% of the patients reported mild kinesiophobia (TSK-11 ≥ 18), 18.4% of the patients reported moderate to severe kinesiophobia (TSK-11 ≥ 25), and the highest score reached 34 points. Results of logistic regression analysis showed that exercise habits (P = 0.025), pain (P = 0.023), and foreign body sensation (P = 0.003) were the risk factors of kinesiophobia. CONCLUSION Kinesiophobia is common in cancer patients with TIAPs, and it is closely related to the subjective experience of daily activities, which requires more attention and early intervention to reduce the potential adverse effects.
Collapse
Affiliation(s)
- Ya-Wen Wang
- School of Nursing, Xuzhou Medical University, Xuzhou, 221004, China
| | - Xiao-Xia Qiu
- School of Nursing, Xuzhou Medical University, Xuzhou, 221004, China. .,Department of Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| |
Collapse
|
7
|
Silveira ACMRL, Fernandes PSF, Fontinele DRDS, Costa REARD, Araújo JEP, Sousa Junior WDO, Vieira SC. Migração para veia hepática de cateter totalmente implantável para quimioterapia em paciente com carcinoma de mama: relato de caso. J Vasc Bras 2022; 21:e20210189. [PMID: 35571520 PMCID: PMC9083582 DOI: 10.1590/1677-5449.202101891] [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: 10/27/2021] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Resumo O cateter totalmente implantável (CTI) é utilizado na administração da quimioterapia. Em menos de 1% dos casos de complicação, pode ocorrer migração do CTI para quimioterapia para a circulação sistêmica. O objetivo deste estudo foi descrever um caso de migração do CTI para a veia hepática. Uma paciente do sexo feminino, de 44 anos de idade, teve diagnóstico de câncer de mama com indicação de quimioterapia neoadjuvante. Realizou-se a implantação de cateter port-a-cath. Durante o procedimento de punção do cateter, houve retorno normal de sangue, e foi realizada infusão de soro fisiológico. Em seguida, houve um aumento de volume no local do port e não retorno de sangue à aspiração. A radiografia de tórax mostrou embolização do cateter em topografia hepática. Retirou-se o cateter pela técnica do laço (sem complicações), e a paciente recebeu alta no dia seguinte. Possíveis alterações no funcionamento do CTI devem chamar atenção da equipe responsável.
Collapse
|
8
|
Silveira ACMRL, Fernandes PSF, Fontinele DRDS, Costa REARD, Araújo JEP, Sousa Junior WDO, Vieira SC. Hepatic vein migration of a totally implantable venous access port-a-cath for chemotherapy in a breast carcinoma patient: case report. J Vasc Bras 2022. [DOI: 10.1590/1677-5449.202101892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract A totally implantable venous access port (TIVAP) is used for chemotherapy administration. Venous port migration to the systemic circulation occurs in less than 1% of complications. The aim of this study is to describe a case of TIVAP migration to the hepatic vein. A 44-year-old female patient with breast cancer was prescribed neoadjuvant chemotherapy. A port-a-cath was surgically implanted for chemotherapy. During the port puncture procedure, blood returned normally when aspirated. When the port was first accessed and flushed with saline solution, swelling was observed at the port site and blood could no longer be aspirated. A chest radiography showed catheter embolization in the region of the hepatic vein. The catheter was retrieved using a snare technique (without complications) and the patient was discharged the next day. The care team should be alert to possible TIIVAP malfunction.
Collapse
|
9
|
Liu Z, Zheng X, Zhen Y, Liu X, Lin F, Ye Z, Liu P. Efficacy, safety, and cost-effectiveness of intracavitary electrocardiography-guided catheter tip placement for totally implantable venous access port. Ann Vasc Surg 2021; 83:168-175. [PMID: 34936891 DOI: 10.1016/j.avsg.2021.11.021] [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: 10/07/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Intracavitary electrocardiography (IC-ECG) has been extensively used for locating the catheter tip of the central venous access devices (CVADs) with favorable safety and accuracy. We aimed to evaluate the efficacy, safety, and cost-effectiveness of IC-ECG-guided catheter tip placement for totally implantable venous access port (TIVAP) by comparing with the standard fluoroscopy method. METHODS 231 patients who underwent TIVAP implantation from September 2019 to April 2021 were enrolled in the retrospective study. Fluoroscopy and IC-ECG were conducted intraoperatively to confirm the position of catheter tips. Demographic characteristics, surgical data, the catheter tip position, complication rate, and incidence, cost of procedures, and indwelling time were compared between the two groups. Univariate and multivariate analyses were used to identify the risk factors of TIVAP-related complications. RESULTS There was no significance between the fluoroscopy group and the IC-ECG group in terms of the rate of ideal position (p = 0.733). Nine patients (3.9%) developed TIVAP-related complications. Complication rates and incidence were similar in the fluoroscopy group and the IC-ECG group (3.1% and 0.114/1000 catheter days vs 4.4% and 0.105/1000 catheter days). The Kaplan-Meier curve showed that there was no significant difference in indwelling time between the two groups (Log Rank p = 0.634). Binary logistic regression analysis showed that body mass index (BMI) was an independent risk factor for TIVAP-related complications (OR = 1.334, 95%CI: 1.139 - 1.563, p < 0.001). The IC-ECG group was less costly than the fluoroscopy group (¥9928 ± 362 vs ¥11762 ± 431, p <0.001). CONCLUSIONS IC-ECG-guided catheter tip placement for TIVAP is feasible, safe, and cost-effective, with high accuracy, low risk of complications, and lower cost. It may be considered as an alternative to the standard fluoroscopy method for catheter tip placement of TIVAP.
Collapse
Affiliation(s)
- Zhan Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China; China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China
| | - Xia Zheng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Fan Lin
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China.
| |
Collapse
|
10
|
Forty years after the first totally implantable venous access device (TIVAD) implant: the pure surgical cut-down technique only avoids immediate complications that can be fatal. Langenbecks Arch Surg 2021; 406:1739-1749. [PMID: 34109472 PMCID: PMC8481188 DOI: 10.1007/s00423-021-02225-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Aim Even though TIVADs have been implanted for a long time, immediate complications are still occurring. The aim of this work was to review different techniques of placing TIVAD implants to evaluate the aetiology of immediate complications. Methods A systematic literature review was performed using the PubMed, Cochrane and Google Scholar databases in accordance with the PRISMA guidelines. The patient numbers, number of implanted devices, specialists involved, implant techniques, implant sites and immediate complication onsets were studied. Results Of the 1256 manuscripts reviewed, 36 were eligible for inclusion in the study, for a total of 17,388 patients with equivalent TIVAD implantation. A total of 2745 patients (15.8%) were treated with a surgical technique and 14,643 patients (84.2%) were treated with a percutaneous technique. Of the 2745 devices (15.8%) implanted by a surgical technique, 1721 devices (62.7%) were placed in the cephalic vein (CFV). Of the 14,643 implants (84.2%) placed with a percutaneous technique, 5784 devices (39.5%) were placed in the internal jugular vein (IJV), and 5321 devices (36.3%) were placed in the subclavian vein (SCV). The number of immediate complications in patients undergoing surgical techniques was 32 (1.2%) HMMs. In patients treated with a percutaneous technique, the number of total complications were 333 (2.8%): 71 PNX (0.5%), 2 HMT (0.01%), 175 accidental artery punctures AAP (1.2%) and 85 HMM (0.6%). No mortality was reported with either technique. Conclusion The percutaneous approach is currently the most commonly used technique to implant a TIVAD, but despite specialist’s best efforts, immediate complications are still occurring. Surgical cut-down, 40 years after the first implant, is still the only technique that can avoid all of the immediate complications that can be fatal.
Collapse
|