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Chang YL, Sae-Lim C, Lin SL, Lai HW, Huang HI, Lai YC, Chen ST, Chen DR. Scarless totally implantable venous access port (TIVAP) implantation: Surgical technique, preliminary results, learning curve, and patients-reported outcome in 125 breast cancer patients. Surg Oncol 2024; 53:102048. [PMID: 38412756 DOI: 10.1016/j.suronc.2024.102048] [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: 09/06/2023] [Revised: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Minimal-access (endoscopic or robotic-assisted) breast surgery has been increasingly performed and shown better cosmetic results. However, location of totally implantable venous access port (TIVAP) for systemic treatment at anterior chest may compromise its aesthetic benefits. Therefore, we proposed a new scarless technique for TIVAP implantation, and reported the preliminary results, learning curve, and patients-surveyed outcome. METHODS Surgical technique of the new "scarless" TIVAP implantation was proposed. Patients receiving this procedure in a single institution were included. The preliminary results of the scarless TIVAP implantation, learning curve, and patient-reported outcome were analyzed and reported. RESULTS A total of 125 breast cancer patients received scarless TIVAP procedures were enrolled. The primary success rate of the scarless TIVAP implantation was 100%. Mean operative time was 46 ± 14 min. Mean amount of blood loss was 8.5 ± 3.2 ml. The cumulative sum plot showed operation time significantly decreased after 24th cases. In the initial learning phase, the mean operative time was 55 ± 17 min, and decreased to 43 ± 12 min in the later mature phase (P = 0.003). There were 5 (4%) complications detected, which included 1 (0.8%) seroma formation, 2 (1.6%) revisions, and 2 (1.6%) unplanned explantations. From patients-evaluated questionnaires, more than 90% of responders were satisfied with aesthetic results, experience during surgery, and application of scarless TIVAP for systemic therapy. CONCLUSIONS The scarless TIVAP implantation is a safe & reliable procedure with high patients-reported aesthetic satisfaction, and could be an alternative TIVAP procedure for patients requiring chemotherapy and desiring a less noticeable scar.
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Affiliation(s)
- Yi-Lin Chang
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
| | - Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Hung-Wen Lai
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Hsin-I Huang
- Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan.
| | - Yuan-Chieh Lai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Shou-Tung Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Dar-Ren Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
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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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3
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Qiu X, Jin G, Zhang X, Xu L, Ding J, Li W, Yu L, Wang Y, Shen Y, Wang H, Wang J, Xu H, Kong W, Yuan L, Bai X, Liu Y, Liu H, Cai M, Luo F, Yang Y, Xiao W, Shen L, Fang Y, Lin J, Zhao L, Qin L, Gao Y, Chang L, Dong L, Wei H, Wei L. Expert consensus on the clinical application of totally implantable venous access devices in the upper arm (2022 Edition). J Interv Med 2023; 6:53-58. [PMID: 37409058 PMCID: PMC10318320 DOI: 10.1016/j.jimed.2023.04.005] [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: 03/26/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/07/2023] Open
Abstract
With the widespread adoption of ultrasound guidance, Seldinger puncture techniques, and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years, an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices (TIVADs) in the upper arm. This approach has the advantage of completely avoiding the risks of hemothorax, pneumothorax, and neck and chest scarring. Medical specialties presently engaged in this study in China include internal medicine, surgery, anesthesiology, and interventional departments. However, command over implantation techniques, treatment of complications, and proper use and maintenance of TIVAD remain uneven among different medical units. Moreover, currently, there are no established quality control standards for implantation techniques or specifications for handling complications. Thus, this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach, reduce complication rates, and ensure patient safety. This consensus elaborates on the technical indications and contraindications, procedures and technical points, treatment of complications, and the use and maintenance of upper-arm TIVAD, thus providing a practical reference for medical staff.
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Affiliation(s)
- Xiaoxia Qiu
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guangxin Jin
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuebin Zhang
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lichao Xu
- Affiliated Cancer Hospital of Fudan University, China
| | - Jinxia Ding
- The First Affiliated Hospital of Anhui Medical University, China
| | - Weisong Li
- The First Affiliated Hospital of Anhui Medical University, China
| | - Lejing Yu
- Liao Ning Cancer Hospital & Institute, China
| | - Yapeng Wang
- The Second Xiangya Hospital of Central South University, China
| | - Yanfang Shen
- The Second Xiangya Hospital of Central South University, China
| | | | - Jue Wang
- The First Affiliated Hospital with Nanjing Medical University, China
| | - Haiping Xu
- The First Affiliated Hospital with Nanjing Medical University, China
| | | | - Lin Yuan
- Nanjing Drum Tower Hospital, China
| | - Xuming Bai
- The Second Affiliated Hospital of Soochow University, China
| | - Ye Liu
- The First Hospital of China Medical University, China
| | - Hong Liu
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Ming Cai
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Feng Luo
- The First Affiliated Hospital of Chongqing Medical University, China
| | - Yiqun Yang
- The First Affiliated Hospital of Soochow University, China
| | - Weizhu Xiao
- The Second Affiliated Hospital of Fujian Medical University, China
| | - Lujun Shen
- Sun Yat-sen University Cancer Center, China
| | | | - Jinxiang Lin
- The Third Affiliated Hospital of Sun Yat-sen University, China
| | - Linfang Zhao
- Affiliated Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, China
| | - Li Qin
- Henan Cancer Hospital, China
| | | | - Lei Chang
- The First Affiliated Hospital of Zhengzhou University, China
| | - Lei Dong
- The First Affiliated Hospital of Zhengzhou University, China
| | | | - Lili Wei
- The Affiliated Hospital of Qingdao University, China
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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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Narita A, Takehara Y, Maruchi Y, Matsunaga N, Ikeda S, Izumi Y, Ota T, Suzuki K. Usefulness of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position: a new technique for cases unsuitable for conventional implantation. Jpn J Radiol 2023; 41:108-113. [PMID: 35943686 DOI: 10.1007/s11604-022-01317-7] [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: 03/07/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Totally implantable central venous access port implantation is typically performed in the supine position. However, some patients cannot adopt the supine position due to severe pain and/or dyspnea. The present study evaluated the technical feasibility of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position in such cases. MATERIALS AND METHODS In the sitting position method, PICC-PORT implantation was performed with the patients seated on a videofluoroscopy chair positioned between the limbs of an angiographic C-arm and the operative upper arm positioned on an arm stand. From January 2019 to September 2021, eight patients underwent PICC-PORT implantations using this sitting method. We also evaluated 251 consecutive patients with conventional supine position PICC-PORT implantation as controls. Differences in technical success, procedure time and complications were retrospectively assessed between the two groups. RESULTS Procedural success rates were 100% in both groups. Median procedure times in the sitting and conventional groups were 42 and 44 min, respectively. No complications were observed in the sitting group. There were no significant differences between the two groups in procedure time (p = 0.674) and complications (p = 1.000). CONCLUSION Implantation of PICC-PORT in the sitting position is technically feasible and useful.
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Affiliation(s)
- Akiko Narita
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan.
| | - Yumi Takehara
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuki Maruchi
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Shuji Ikeda
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan
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Bertoglio S, Annetta MG, Brescia F, Emoli A, Fabiani F, Fino M, Merlicco D, Musaro A, Orlandi M, Parisella L, Pinelli F, Reina S, Selmi V, Solari N, Tricarico F, Pittiruti M. A multicenter retrospective study on 4480 implanted PICC-ports: A GAVeCeLT project. J Vasc Access 2022; 24:11297298211067683. [PMID: 35034480 DOI: 10.1177/11297298211067683] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND PICC-ports may be defined as totally implantable central venous devices inserted in the upper limb using the current state-of-the-art techniques of PICC insertion (ultrasound-guided venipuncture of deep veins of the arm, micro-puncture kits, proper location of the tip preferably by intracavitary ECG), with placement of the reservoir at the middle third of the arm. A previous report on breast cancer patients demonstrated the safety and efficacy of these devices, with a very low failure rate. METHODS This retrospective multicenter cohort study-developed by GAVeCeLT (the Italian Group of Long-Term Venous Access Devices)-investigated the outcomes of PICC-ports in a large cohort of unselected patients. The study included 4480 adult patients who underwent PICC-port insertion in five Italian centers, during a period of 60 months. The primary outcome was device failure, defined as any serious adverse event (SAE) requiring removal. The secondary outcome was the incidence of temporary adverse events (TAE) not requiring removal. RESULTS The median follow-up was 15.5 months. Device failure occurred in 52 cases (1.2%), the main causes being local infection (n = 7; 0.16%) and CRBSI (n = 19; 0.42%). Symptomatic catheter-related thrombosis occurred in 93 cases (2.1%), but removal was required only in one case (0.02%). Early/immediate and late TAE occurred in 904 cases (20.2%) and in 176 cases (3.9%), respectively. CONCLUSIONS PICC-ports are safe venous access devices that should be considered as an alternative option to traditional arm-ports and chest-ports when planning chemotherapy or other long-term intermittent intravenous treatments.
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Affiliation(s)
- Sergio Bertoglio
- Department of Surgical Sciences, University of Genova, Genova, Italy
- General Surgery Unit 1, Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, "A. Gemelli" University Hospital Foundation, Rome, Italy
| | - Fabrizio Brescia
- Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Alessandro Emoli
- Department of Oncology, "A. Gemelli" University Hospital Foundation, Rome, Italy
| | - Fabio Fabiani
- Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Maria Fino
- Vascular Access Center - General Surgery Unit, University Hospital, Foggia, Italy
| | - Domenico Merlicco
- Vascular Access Center - General Surgery Unit, University Hospital, Foggia, Italy
| | - Andrea Musaro
- Department of Oncologic Gynecology, "A. Gemelli" University Hospital Foundation, Rome, Italy
| | - Marina Orlandi
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Laura Parisella
- Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Simona Reina
- General Surgery Unit 1, Ospedale Policlinico San Martino, Genova, Italy
| | - Valentina Selmi
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Nicola Solari
- General Surgery Unit 1, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, "A. Gemelli" University Hospital Foundation, Catholic University, Rome, Italy
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Otsubo R, Yano H, Matsumoto M, Tanaka A, Nonaka T, Hidaka S, Matsumoto K, Tsuchiya T, Sato S, Nagayasu T. Comparison of Central Venous Port Procedures Between Puncture vs. Cut-down and Residents vs. Senior Surgeons. In Vivo 2021; 35:1197-1204. [PMID: 33622921 DOI: 10.21873/invivo.12369] [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: 12/29/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To compare operative results between venous puncture (P) with real-time ultrasonography vs. cut-down (CD) with preoperative ultrasonography for totally implantable central vein access device (TICVAD) implantation performed by residents (R) vs. senior surgeons (S). PATIENTS AND METHODS Adult oncologic patients (n=268) undergoing TICVAD implantations were retrospectively compared between 172 Ps and 96 CDs. Then, we compared Ps performed by R (P-R, n=131) and S (P-S, n=41) and CDs performed by R (CD-R, n=59) and S (CD-S, n=37). RESULTS Median operation times were 40 min in the P group and 53.5 min in the CD group, and times were significantly shorter for P-S and CD-S. Completion rates were comparable for each method and each surgeon. Intraoperative complication rates were 3.8% (P-R), 2.4% (P-S), and 0% (CD-R and CD-S). CONCLUSION P with real-time ultrasonography did not avoid complications compared to CD with preoperative ultrasonography. The latter performed safely even by residents.
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Affiliation(s)
- Ryota Otsubo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;
| | - Hiroshi Yano
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Megumi Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Aya Tanaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigekazu Hidaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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8
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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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9
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Gu L, Xu L, Meng A, Shi R, Jiang D, Liu C, Mao J. Guidewire‐guided electrocardiogram for positioning the catheter tip of upper arm port in breast cancer patients. PRECISION MEDICAL SCIENCES 2021. [DOI: 10.1002/prm2.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lili Gu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Liyong Xu
- Department of General Surgery Nanjing Agriculture University Hospital Nanjing China
| | - Aifeng Meng
- Department of Nursing Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Ruchun Shi
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Dingbiao Jiang
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Chunli Liu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Jing Mao
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas. World J Gastroenterol 2020. [DOI: 10.3748/wjg.v26.i25.0000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
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Zhang KC, Chen L. Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas. World J Gastroenterol 2020; 26:3517-3527. [PMID: 32742123 PMCID: PMC7366063 DOI: 10.3748/wjg.v26.i25.3517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Totally implantable access port is a fully implantable drug delivery system that is implanted subcutaneously and can be retained for a long time. Advantages of ports include a simple nursing process, low risk of infection and embolism, and high patient comfort. In order to promote the standardized application of ports in the treatment of digestive tract tumors and reduce port-related complications, the Chinese Research Hospital Association Digestive Tumor Committee, the Chinese Association of Upper Gastrointestinal Surgeons, the Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association have organized multidisciplinary expert discussions at the General Hospital of the People’s Liberation Army and nation-wide expert letter reviews and on-site seminars, and formulated an expert consensus of the operation guidelines.
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Affiliation(s)
- Ke-Cheng Zhang
- Department of General Surgery & Institute of General Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery & Institute of General Surgery, The First Medical Centre, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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Bertoglio S, Cafiero F, Meszaros P, Varaldo E, Blondeaux E, Molinelli C, Minuto M. PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy. J Vasc Access 2019; 21:460-466. [PMID: 31674857 DOI: 10.1177/1129729819884482] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. METHODS The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. RESULTS Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%-7.1%). With regard to the patients' characteristics, body mass index <22.5 was the only significant risk for failure (p = 0.027). CONCLUSION The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.
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Affiliation(s)
- Sergio Bertoglio
- Department of Surgical Sciences (DISC), University of Genova, Genova, Italy.,General Surgery Unit 1, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ferdinando Cafiero
- General Surgery Unit 1, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Meszaros
- Breast Surgical Unit, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Emanuela Varaldo
- Department of Surgical Sciences (DISC), University of Genova, Genova, Italy.,General Surgery Unit 1, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- Oncologia Medica Unit 2, Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Molinelli
- Oncologia Medica Unit 2, Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michele Minuto
- Department of Surgical Sciences (DISC), University of Genova, Genova, Italy.,General Surgery Unit 1, Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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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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Schreckenbach T, Münch I, El Youzouri H, Bechstein WO, Habbe N. The Safety Level of Total Central Venous Access Port Implantation Performed by Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:182-192. [PMID: 30120065 DOI: 10.1016/j.jsurg.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/13/2018] [Accepted: 07/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The implantation of totally implantable venous access ports (TIVAPs) is one of the first procedures surgical residents learn. Complications after implantation procedures have a major impact on patient outcomes, as it may lead to a delay of chemotherapy regimens or of parenteral nutrition. The aim of this study was to compare the outcomes after totally implantable venous access ports implantations done by resident and attending surgeons. DESIGN The study was performed as a retrospective analysis. SETTING The study took place in primary care at the Department of General and Visceral Surgery at Frankfurt University Hospital. PARTICIPANTS A total of 760 primary totally implantable venous access ports implantations performed between March 2008 and December 2016 were included in a database. Three groups of surgeons doing the implantations were defined: Group A (residents alone), Group B (resident with help), and Group C (attending surgeons). RESULTS There was a significant difference between the surgeon groups in operation time (p < 0.001). The groups differed between Group A (mean, 49; SD, 22) and Group C (mean, 39; SD, 20); p < 0.001) and Group B (mean, 53; SD, 23) and Group C (mean, 39; SD, 20; p < 0.001). The incidence of surgical site infections between Groups A and C (3.6% vs. 0.3%; p = 0.003) and Groups B and C (2.5% vs. 0.3%; p = 0.027) differed also significantly. Based on multivariable logistic regression analysis operation time in minutes (OR, 1.04; 95%CI, 1.03-1.06; p < 0.001) was an independent risk factor for any intraoperative complications. For any postoperative complications younger age of the patient (OR, 0.98; 95%CI, 0.97-0.99; p = 0.004) and benign primary disease (OR, 3.25; 95%CI, 1.55-6.64; p = 0.002) were independent risk factors based on multivariable regression analysis. Based on multivariable regression analysis a lower body mass index of the patient (OR, 0.93; 95%CI, 0.86-0.99; p = 0.044), benign primary disease (OR, 2.89; 95%CI, 1.07-7.79; p = 0.036), and no chemotherapy (OR, 3.55; 95%CI, 1.50-8.39; p = 0.004) were independent risk factors for postoperative catheter infections. Surgeon group was no risk factor, neither for intraoperative and postoperative complications, nor for catheter explantation due to complications. CONCLUSION Residents performing alone or residents performing with help can safely handle a central venous access port implantation. In patients with several risk factors, however, an attending should assist.
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Affiliation(s)
- Teresa Schreckenbach
- Department of General and Visceral Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany.
| | - Indra Münch
- Department of General and Visceral Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Hanan El Youzouri
- Department of General and Visceral Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Nils Habbe
- Department of Surgery and Coloproctology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
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Çil BE, Öcal O, Eldem FG, Peynircioğlu B, Balkancı F. Trapezius Port Placement in Patients with Breast Cancer: Long-Term Follow-up and Quality-of-Life Assessment. J Vasc Interv Radiol 2018; 30:69-73. [PMID: 30527656 DOI: 10.1016/j.jvir.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the long-term results of and patient satisfaction with trapezius ports in breast cancer patients, as an alternative to chest ports. PATIENTS AND METHODS This retrospective study included all patients who underwent trapezius port placement from December 2007 to January 2017. Seventy female patients with breast cancer, with a mean age of 54 ± 9.9 years (range, 29-76 years), were included. Indications for trapezius implantation were bilateral breast surgery or unilateral breast surgery and contralateral breast involvement. Sixty-eight of 70 patients had long-term follow-up. A retrospective, questionnaire-based survey was conducted to assess satisfaction and the trapezius port's effect on the daily life of the patient. RESULTS All implantations were technically successful. Total catheter service time for 68 patients was 65,952 days (2 patients were lost to follow-up). Mean catheter service time was 969.8 days (range 7-3,458 days; median 570 days; 95% confidence interval, 739-1199; standard deviation, 947.7). No immediate procedural complications occurred. Port complications developed in 4 patients (5.9%); port infection developed in 2 patients (0.03/1,000 days); skin dehiscence developed in 1 patient (0.02/1,000 days); and port malfunction developed in 1 patient (0.02/1,000 days). The overall infection rate was 2.9% (2/68). All patients (n = 44) or a close relative (n = 17) who were interviewed with a phone call reported satisfaction regarding their ports. CONCLUSIONS Trapezius ports offer a safe and feasible option to patients with breast cancer who need an alternative site to chest ports. It is also associated with high overall patient satisfaction.
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Affiliation(s)
- Barbaros Erhan Çil
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara 34010, Turkey; Department of Radiology, Koç University Hospital, Istanbul, Turkey.
| | - Osman Öcal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara 34010, Turkey
| | - Fatma Gonca Eldem
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara 34010, Turkey
| | - Bora Peynircioğlu
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara 34010, Turkey
| | - Ferhun Balkancı
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara 34010, Turkey
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Yamamoto Y, Orii T, Yoshimura M, Kitahara H, Karasawa Y. Is there any correlation between venipuncture sites and complications of central venous port placement in the chest wall? INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rotzinger R, Gebauer B, Schnapauff D, Streitparth F, Wieners G, Grieser C, Freyhardt P, Hamm B, Maurer MH. Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve. Acta Radiol 2017; 58:1468-1475. [PMID: 28406048 DOI: 10.1177/0284185117695664] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions' durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.
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Affiliation(s)
- Roman Rotzinger
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gero Wieners
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Grieser
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Freyhardt
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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