Patients' attitudes to totally implantable venous access port systems for gynecological or breast malignancies

Psychological experiences and needs of tumor patients with implanted intravenous infusion ports: a qualitative study

Background

There are many problems of psychological burden in patients with tumor implanted in port of intravenous infusion. However, more attention is paid to its complications in the literature, and psychological problems are seldom concerned. The purpose of this study was to explore the psychological state and needs of tumor patients after implantation of an intravenous infusion port and provide valuable references for psychological interventions.

Method

A semi-structured interview was conducted with 11 patients with intravenous infusion ports. Colaizzi's 7-step analysis was used to analyze the interview data.

Results

According to the primary information, four themes and nine sub-themes were extracted: (1) lack of self-worth, (2) multiple emotional experiences (guilt, doubt, worry, and gain). (3) Poor self-management and self-maintenance awareness (over-reliance on medical staff, unchanged family roles, lack of related knowledge). (4) Expectations and suggestions for the future (inner expectations, suggestions for infusion ports).

Conclusion

The patient's psychological state should be carefully monitored during tube implantation, to relieve the patient's tension and anxiety and improve nursing satisfaction and patient outcomes.

Basilic vein variation encountered during surgery for arm vein port: A case report

BACKGROUND

Venous variations are uncommon and usually hard to identify, and basilic vein variation is particularly rare. Basilic vein variation usually presents without any clinical symptoms and is often regarded as a benign alteration. This case was a patient with congenital basilic vein variation encountered during surgery for an infusion port.

CASE SUMMARY

We documented and analyzed an uncommon anatomical variation in the basilic vein encountered during arm port insertion. This peculiarity has hitherto remained undescribed in the literature. We offer remedial strategies for addressing this anomaly in the future and precautionary measures to circumvent its occurrence. We conducted a comprehensive review of analogous cases in the literature, offering pertinent therapeutic recommendations and solutions, with the aim of enhancing the efficacy and safety of future arm port implantations.

CONCLUSION

Venous variation is rare and requires detailed intraoperative and postoperative examination to ensure accuracy, so as not to affect subsequent treatment.

Correlations between activation, family adaptation, and self-perceived burden in breast cancer patients with an implanted venous access port: A cross-sectional study

We found that activation and family adaptation on the self-perceived burden of breast cancer patients with an implanted venous access port (IVAP), and to analyze the correlations among these scores. A total of 256 patients completed a general data questionnaire, the Patient Activation Measure (PAM), the Family adaptation and Cohesion Scale II-Chinese version (FACES-II-CV), and the Self-perceived Burden Scale (SPBS). The total scores for activation, family adaptation, and self-perceived burden were 63.31 ± 18.92, 42.72 ± 7.937, and 28.55 ± 7.89, respectively. We analyzed activation and family adaptation were associated with self-perceived burden (P < .05) the patients' self-perceived burden main factors is included Main caregiver, disease stage, complications, Type of health insurance, activation, and family adaptation. The activation, family adaptation, and self-perceived burden of breast cancer patients with an IVAP are closely related, which suggests that clinical workers should consider the patient family to formulate an intervention plan to improve patient activation, and thus reduce the self-perceived burden. For example, hospitals regularly conduct breast cancer health education activities, or invite psychological counselors to provide services to patients.

A GAVeCeLT bundle for PICC-port insertion: The SIP-Port protocol

In the last decade, a new type of brachial port has been introduced in clinical practice, the so-called "PICC-port." This is a brachial port, but inserted according to the methodologies and technologies currently adopted for the insertion of peripherally inserted central catheters (PICCs). Several studies have shown that PICC-port insertion is safe, not associated with any relevant immediate or early complication, and that the expected incidence of late complications is significantly lower if compared to "traditional" brachial ports (i.e. inserted without ultrasound guidance). Furthermore, PICC-ports yield excellent esthetic results and are associated with optimal patient compliance. This paper describes an insertion bundle-developed by GAVeCeLT, the Italian Group of Long Term Venous Access Devices, and nicknamed "SIP-Port" (Safe Insertion of PICC-Ports)-which consists of few evidence-based strategies aiming to further minimize all immediate, early, or late complications potentially associated with PICC-port insertion. Also, this insertion bundle has been developed for the purpose of defining more closely the differences between a traditional brachial port and a PICC-port. The SIP-Port bundle is currently adopted by all training courses on PICC-port insertion held by GAVeCeLT. It includes eight steps: (1) preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; (2) appropriate skin antiseptic technique and maximal barrier precautions; (3) choice of appropriate vein, in terms of caliber and site; (4) clear identification of the median nerve and of the brachial artery during the venipuncture; (5) ultrasound-guided puncture and cannulation of the vein; (6) ultrasound-guided tip navigation; (7) intra-procedural assessment of tip location by intracavitary ECG or by trans-thoracic echocardiography; (8) appropriate creation and closure of the subcutaneous pocket.

A novel incision technique of a totally implanted venous access port in the upper arm for patients with breast cancer

BACKGROUND

A totally implanted venous access port (TIVAP) in the upper arm is a safe and cost-effective vascular access device and is widely used in breast cancer patients. Traditional tunnelling technique increases the operation time and has an unsatisfied cosmetic effect, so we explored the feasibility, cosmetic effect and complications of an upper arm port with a novel incision in this retrospective study.

METHODS

We reviewed 489 cases of totally implantable venous access port implantation in the upper arm with two types of incisions in our centre from 1 January 2018 to 30 January 2022. The patients were divided into two different incision groups including the puncture site incision group (n = 282) and the conventional tunnelling group (n = 207). The comparison of the results was collected between the two groups, and contributing factors were analyzed for major complications.

RESULTS

A total of 489 patients were successfully implanted with arm ports using the puncture site incision technique (n = 282, 57.7%) and conventional tunnelling technique (n = 207, 42.3%). The average operation time of the two types of incisions was 36.5 ± 15 min in the puncture site incision group and 55 ± 18.1 min in the tunnel needle group (P < 0.05). In terms of complications, 33 catheter-related complications occurred (6.4%), including 9 cases of infection, 15 cases of catheter-related thrombosis and 7 cases of skin exposure. Fourteen patients in the puncture site incision group developed complications compared with 17 in the traditional incision group. There were no significant differences between the two groups in terms of overall complication events (5.0% and 8.2%, P = 0.145) while the same result was found in each complication event. Weight, total cholesterol and diabetes were found to be associated with device-related infections in the univariate Cox proportional hazard regression models. Diabetes was found to be associated with device-related infections in multivariate analysis while hypertension was associated with thrombosis.

CONCLUSIONS

The puncture site incision method is a novel technique with a better cosmetic appearance and less operation time than the traditional tunnelling technique, providing a comparable overall rate of complications. It offers a preferable choice for clinicians when dealing with different situations of patients. It is worthy of being used and promoted for patients requiring the totally implanted venous access port in the upper arm.

Community-based Intravenous Treatment and Central Venous Access Devices: A Scoping Review of the Consumer and Caregiver Experience, Information Preferences, and Supportive Care Needs

PURPOSE

Map existing research and describe the consumer/caregiver experience of community-based intravenous treatment, central venous access devices (CVADs), supportive care needs, and information preferences.

DESIGN

Scoping review.

METHODS

Five databases (Joanna Briggs Institute, Cochrane library, Emcare, Embase, and Medline) were searched. Screening and data extraction were performed independently by two reviewers.

FINDINGS

Forty-eight studies were included.

CONCLUSIONS

Although community-based intravenous treatment and CVADs have a significant impact on consumers and caregivers, there is scant research on their supportive care needs and information preferences.

CLINICAL EVIDENCE

Some consumers and caregivers may require additional support while undergoing community-based intravenous treatment.

Effects of Cold Therapy on Pain and Anxiety During Needle Removal From Implanted Ports

This study was conducted as a quasiexperimental, single-blind study to examine the effect of cold therapy on pain and anxiety during port needle removal. Patients in the experimental group received cold therapy 10 minutes before port needle removal. Patients in the control group received no intervention before port needle removal. Data were collected using the visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI). After cold therapy was applied to the patients in the experimental group, the second and third VAS scores were found to be statistically significant and lower than those in the control group ( P < .05). There was no statistically significant difference between the anxiety levels of the experimental group and the control group before cold therapy ( P > .005). However, the STAI scores of the experimental group were found to be statistically and significantly lower than those of the control group after cold therapy ( P < .05). This study determined that cold therapy before port needle removal reduces pain and anxiety. Cold therapy may be recommended as an effective nonpharmacological pain control method with ease of application to prevent pain induced by port needle removal.

A multicenter retrospective study on 4480 implanted PICC-ports: A GAVeCeLT project

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.

Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

BACKGROUND

Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts.

OBJECTIVE

To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents.

MATERIALS AND METHODS

Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal.

RESULTS

Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur.

CONCLUSION

Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.

Totally Implantable Venous Access Device (Chemoport) in Oncology: Study of 168 Polyurethane Chemoport Catheter System

Background Chemoport (totally implantable venous access device) and its catheter system are used to administer long-term chemotherapy in cancer patients. The objective of this study was to analyze the complications associated with chemoport insertion in various cancer patients.

Material and Methods A total number of 168 chemoports along with polyurethane catheters were inserted in various cancer patients over a period of 3 years. 9.6 F polyurethane catheters were put by a team of surgical oncologists in operation theater under general or local anesthesia. Analysis of the complications was done until the chemoport was removed due to any reason.

Results Out of 168 patients, 30 (17.85%) developed complications. Complications included arterial puncture, malposition of the catheter tip, pneumothorax, hematoma, seroma, deep vein thrombosis, fracture of the catheter, a reversal of port, infections, and thrombosis of the catheter. Only a few required premature port and catheter removal.

Conclusion There was a low rate of complications associated with chemoport using a polyurethane type of catheter system. However, infection-related complications were comparatively more common in our series. Chemoport requires expert handling, patient education, strict follow-up, and dedicated teamwork to minimize complications.

Totally Implantable Venous Access Device (Chemoport) in Oncology: Study of 168 Polyurethane Chemoport Catheter System

Background Chemoport (totally implantable venous access device) and its catheter system are used to administer long-term chemotherapy in cancer patients. The objective of this study was to analyze the complications associated with chemoport insertion in various cancer patients.

Material and Methods A total number of 168 chemoports along with polyurethane catheters were inserted in various cancer patients over a period of 3 years. 9.6 F polyurethane catheters were put by a team of surgical oncologists in operation theater under general or local anesthesia. Analysis of the complications was done until the chemoport was removed due to any reason.

Results Out of 168 patients, 30 (17.85%) developed complications. Complications included arterial puncture, malposition of the catheter tip, pneumothorax, hematoma, seroma, deep vein thrombosis, fracture of the catheter, a reversal of port, infections, and thrombosis of the catheter. Only a few required premature port and catheter removal.

Conclusion There was a low rate of complications associated with chemoport using a polyurethane type of catheter system. However, infection-related complications were comparatively more common in our series. Chemoport requires expert handling, patient education, strict follow-up, and dedicated teamwork to minimize complications.

Totally Implantable Venous Access Device (Chemoport) in Oncology: Study of 168 Polyurethane Chemoport Catheter System

Background Chemoport (totally implantable venous access device) and its catheter system are used to administer long-term chemotherapy in cancer patients. The objective of this study was to analyze the complications associated with chemoport insertion in various cancer patients. Material and Methods A total number of 168 chemoports along with polyurethane catheters were inserted in various cancer patients over a period of 3 years. 9.6 F polyurethane catheters were put by a team of surgical oncologists in operation theater under general or local anesthesia. Analysis of the complications was done until the chemoport was removed due to any reason. Results Out of 168 patients, 30 (17.85%) developed complications. Complications included arterial puncture, malposition of the catheter tip, pneumothorax, hematoma, seroma, deep vein thrombosis, fracture of the catheter, a reversal of port, infections, and thrombosis of the catheter. Only a few required premature port and catheter removal. Conclusion There was a low rate of complications associated with chemoport using a polyurethane type of catheter system. However, infection-related complications were comparatively more common in our series. Chemoport requires expert handling, patient education, strict follow-up, and dedicated teamwork to minimize complications.

Tailored approach to the choice of long-term vascular access in breast cancer patients

This study compared the possible options for vascular access in breast cancer patients by analyzing the complications of each method. We retrospectively evaluated the vascular access procedures for intravenous chemotherapy in breast cancer patients from 2016 to 2018. A total of 300 consecutive patients were included, 100 each who received peripherally inserted central catheters (PICCs), arm ports, and chest ports. When selecting a catheter, a PICC was considered when four cycles of chemotherapy were expected. Otherwise, patient preference was considered. All but one patient with an arm port were women, with mean age of 51.7 ± 9.1 years. The total mean complication-free catheter indwelling time was 1357.6 days for chest ports, 997.8 days for arm ports, and 366.8 days for PICCs (p = 0.004). There were 11 catheter-related complications (3.7%), one in a chest port patient, five in arm port patients, and eight in PICC patients. There was no patient with catheter related blood stream infection or deep vein thrombosis. All three types of catheters could be used in breast cancer patients without causing serious complications. The selection of catheter considering the clinical situation was effective for providing a safe and secure chemotherapy delivery route.

Venous access devices for the delivery of long-term chemotherapy: the CAVA three-arm RCT

BACKGROUND

Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs).

OBJECTIVES

To evaluate the clinical effectiveness, safety, cost-effectiveness and acceptability of these devices for the central delivery of chemotherapy.

DESIGN

An open, multicentre, randomised controlled trial to inform three comparisons: (1) peripherally inserted central catheters versus Hickman, (2) PORTs versus Hickman and (3) PORTs versus peripherally inserted central catheters. Pre-trial and post-trial qualitative research and economic evaluation were also conducted.

SETTING

This took place in 18 UK oncology centres.

PARTICIPANTS

Adult patients (aged ≥ 18 years) receiving chemotherapy (≥ 12 weeks) for either a solid or a haematological malignancy were randomised via minimisation.

INTERVENTIONS

Hickman, peripherally inserted central catheters and PORTs.

PRIMARY OUTCOME

A composite of infection (laboratory confirmed, suspected catheter related and exit site infection), mechanical failure, venous thrombosis, pulmonary embolism, inability to aspirate blood and other complications in the intention-to-treat population.

RESULTS

Overall, 1061 participants were recruited to inform three comparisons. First, for the comparison of peripherally inserted central catheters (n = 212) with Hickman (n = 212), it could not be concluded that peripherally inserted central catheters were significantly non-inferior to Hickman in terms of complication rate (odds ratio 1.15, 95% confidence interval 0.78 to 1.71). The use of peripherally inserted central catheters compared with Hickman was associated with a substantially lower cost (-£1553) and a small decrement in quality-adjusted life-years gained (-0.009). Second, for the comparison of PORTs (n = 253) with Hickman (n = 303), PORTs were found to be statistically significantly superior to Hickman in terms of complication rate (odds ratio 0.54, 95% confidence interval 0.37 to 0.77). PORTs were found to dominate Hickman with lower costs (-£45) and greater quality-adjusted life-years gained (0.004). This was alongside a lower complications rate (difference of 14%); the incremental cost per complication averted was £1.36. Third, for the comparison of PORTs (n = 147) with peripherally inserted central catheters (n = 199), PORTs were found to be statistically significantly superior to peripherally inserted central catheters in terms of complication rate (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). PORTs were associated with an incremental cost of £2706 when compared with peripherally inserted central catheters and a decrement in quality-adjusted life-years gained (-0.018) PORTs are dominated by peripherally inserted central catheters: alongside a lower complications rate (difference of 15%), the incremental cost per complication averted was £104. The qualitative work showed that attitudes towards all three devices were positive, with patients viewing their central venous access device as part of their treatment and recovery. PORTs were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. The main limitation was the lack of adequate power (54%) in the non-inferiority comparison between peripherally inserted central catheters and Hickman.

CONCLUSIONS

In the delivery of long-term chemotherapy, peripherally inserted central catheters should be considered a cost-effective option when compared with Hickman. There were significant clinical benefits when comparing PORTs with Hickman and with peripherally inserted central catheters. The health economic benefits were less clear from the perspective of incremental cost per quality-adjusted life-years gained. However, dependent on the willingness to pay, PORTs may be considered to be cost-effective from the perspective of complications averted.

FUTURE WORK

The deliverability of a PORTs service merits further study to understand the barriers to and methods of improving the service.

TRIAL REGISTRATION

This trial is registered as ISRCTN44504648.

FUNDING

This project was funded by the National Institute for Health Research (NHIR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 47. See the NIHR Journals Library website for further project information.

Availability of totally implantable venous access devices in cancer patients is high in the long term: a seven-year follow-up study

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.

Chinesization of the quality of life assessment, venous device-port, and its reliability and validity tests for patients with breast cancer

OBJECTIVE

To translate the assessment item sets of the Canadian version of the quality of life assessment, venous device-port for breast cancer patients with chest and arm ports (i.e. different implanting sites) into Chinese version, and to conduct a test of reliability and validity for it.

METHODS

According to the Brislin translation model, quality of life assessment, venous device-port underwent literal and back translations, and the Chinese version of quality of life assessment, venous device-port was preliminarily revised by consulting an expert and a preliminary test. A total of 270 cancer patients undergoing chemotherapy were assessed during the use of ports, and the reliability and the validity of the Chinese version of quality of life assessment, venous device-port scale were then tested.

RESULTS

The scale consisted of 23 yes/no items and seven numerical rating scales. The total Cronbach's α coefficient of the scale was 0.829, and each item ranged from 0.812 to 0.845. The item-level content validity index was 0.67-1.00, and the scale-level content validity index/average and the scale-level content validity index/universal agreement were 0.98 and 0.90, respectively. The correlation coefficient of the repeated measurement results of the scale was 0.554 (p < 0.01). Exploratory factor analysis showed that the cumulative explained variance of five common factors was 64.197%.

CONCLUSION

The Chinese version of quality of life assessment, venous device-port scale is an effective assessment tool for quality of life with good reliability and validity in breast cancer patients with different implantation sites for totally implanted venous access devices in northern China.

Experience and Satisfaction of Cancer Patients With a Central Venous Catheter at a Tertiary Hospital in South Korea

As cancer chemotherapy transitions from inpatient care to outpatient care, the number of patients who receive a central venous catheter (CVC) and the interest in CVCs as a safe intravenous administration route have increased recently in South Korea. The purpose of this study was to investigate the discomforts and satisfaction that cancer patients with a CVC may experience in daily activities as an outpatient and to provide rationale for nursing interventions. Data collection was conducted between April 11, 2011, and August 31, 2011. Forty-three questionnaires were collected, and a total of 41 questionnaires were used for the final analysis. The mean age of patients was 45.1 years (SD = 11.1 years; range, 18-64 years). The average score of experience of the CVC insertion procedure, daily life experiences of patients with a CVC, the satisfaction and fear of using a CVC, and the acceptance of CVCs were 2.48 ± 0.56, 2.18 ± 0.50, 2.56 ± 0.49, and 2.35 ± 0.39, respectively. The results showed that more detailed information on CVCs, as well as sufficient emotional support, should be provided to the patient to minimize discomfort during CVC insertion. Patient-centered education helps empower patients to master CVC self-management, as well as an understanding of the cultural aspect of South Korean patients who practice the traditional Confucian ethics of "unaltering one's body" and are therefore reluctant to have CVCs inserted into their bodies.

Implanting totally implantable venous access ports in the upper arm is feasible and safe for patients with early breast cancer

PURPOSE

Totally implantable venous access ports are widely used in chemotherapy for malignant tumors. This retrospective study investigated the safety, technical feasibility, and device-related complications of totally implantable venous access ports implanted in the upper arm.

METHODS

Between May 2016 and June 2018, 570 women with early breast cancer received chemotherapy and were successfully implanted with a totally implantable venous access port in the upper arm. Device-related complications were collected and influencing factors were analyzed for major complications.

RESULTS

Only one case underwent premature port removal before the end of chemotherapy. Device-related complications were observed in 32 cases, including 31 late complications. The rate of complications was 0.263/1000 catheter-days. Infection and thrombosis were the most common complications, occurring in 13 and 8 cases, respectively. Other complications were catheter occlusion, catheter dislocation, arrhythmia, and so on. Patients with higher body mass index were significantly more prone to infection and those who experienced catheter-related thrombosis had longer implantation times and higher body mass indices.

CONCLUSION

Implanting totally implantable venous access ports in the upper arm is feasible and safe for patients with early breast cancer, with a low rate of complications, providing good alternative to central venous ports.

Ultrasound-guided totally implantable venous access ports via the right innominate vein: a new approach for patients with breast cancer

Background

To evaluate the feasibility and safety of ultrasound-guided totally implantable venous access port (TIVAP) implantation via the right innominate vein in patients with breast cancer.

Methods

Sixty-seven breast cancer patients underwent ultrasound-guided implantation of TIVAPs via the right innominate vein for administration of chemotherapy. Clinical data including technical success, success rate for the first attempt, periprocedural, and postoperative complications were recorded and retrospectively studied.

Results

All patients underwent successful surgery. The success rate of the first attempt was 95.52% (64/67). The operation time was 28 to 45 min, with an average of 36 ± 6 min. Periprocedural complications included artery punctures in 1 (1.50%, 1/67) patient. Prior to this study, the mean TIVAP time was 257 ± 3 days (range 41 to 705 days). The rate of postoperative complications was 4.48% (3/67), including catheter-related infections in 1 case and fibrin sheath formation in 2 cases. Up to the present study, three people had unplanned port withdrawal due to complications, and the TIVAPs for 25 patients were still in normal use.

Conclusions

The success rate of ultrasound-guided TIVAPs via the right innominate vein is high with low complications, thus safe and feasible. This technique can provide a new option for chemotherapy of breast cancer patients.

PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy

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.

Risk factors of catheter-related thrombosis in early-stage breast cancer patients: a single-center retrospective study

Purpose

Totally implantable venous access devices (TIVADs) are widely used in cancer patients. The main purpose of our study is to observe the incidence and identified risk factors of catheter-related thrombosis (CRT) in breast cancer patients with TIVAD.

Patients and methods

We performed a retrospective cohort study of consecutive breast cancer patients who received the ultrasound-guided TIVAD implantation for the administration of chemotherapy from 2013 to 2016. The primary outcome was CRT (both symptomatic and asymptomatic detected by ultrasound). Univariable and multivariable logistic regression analyses were used to identify the risk factors for breast cancer TIVAD-related CRT.

Results

A total of 209 breast cancer patients with a newly implanted TIVAD for chemotherapy were included in this study. The average time of port duration was 7 months. Of the enrolled 209 patients, 33 patients (15.8%) had CRT, 2 of the 33 cases were symptomatic (1 pulmonary embolism, 1 deep-venous thrombosis [DVT]), the other 31 cases were asymptomatic detected by routine ultrasound examination of the catheter-associated vein before TIVAD removal with all cycles of chemotherapy completed. In total, 19 (57.6%) of CRT patients underwent directly TIVAD removal without any further treatments, 14 patients received anticoagulation treatments for 3–30 days followed by TIVAD removal. No DVT event was observed within at least 1.5 years of follow-up. In the multiple-variable analysis, tumor size >2 cm (OR 2.735, 95% CI 1.042–7.177; P=0.032), positive HbsAg (OR 2.803 95% CI 1.027–7.856; P=0.047) and low-density lipoprotein (LDL) >3.6 mmol/L (OR 2.360, 95% CI 1.059–5.351; P=0.040) were the significant independent risk factors of breast cancer TIVAD-related CRT.

Conclusion

CRT is a common complication in breast cancer patients with TIVAD for chemotherapy. Tumor size, HbsAg status and LDL level were independent predictors of breast cancer for TIVAD-related CRT. Removal of the port without anticoagulation treatments might be a feasible choice for asymptomatic TIVAD-related CRT.

Patient acceptability of three different central venous access devices for the delivery of systemic anticancer therapy: a qualitative study

OBJECTIVE

Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices.

DESIGN

Eight focus groups were audio-recorded, transcribed and thematically analysed.

SETTING

Six outpatient cancer treatment centres in the UK.

PARTICIPANTS

Forty-two patients (20 female, mean age 61.7 years) who had taken part or were taking part in the broader trial.

INTERVENTION

As part of the larger, randomised controlled trial, participants had been randomly assigned one of three CVADs for the administration of SACT.

RESULTS

Attitudes towards all three devices were positive, with patients viewing their CVAD as part of their treatment and recovery. Participants with PICCs and Hickmans tended to compare their device favourably with peripheral cannulation. By comparison, participants with Ports consistently compared their device with PICCs and Hickmans, emphasising the perceived superiority of Ports. Ports were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships.

CONCLUSIONS

Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes.

TRIAL REGISTRATION NUMBER

ISRCTN44504648.

Ultrasound-guided totally implantable venous access device through the right innominate vein in older patients is safe and reliable

AIM

Ultrasound guidance has become the routine method for catheterization, dramatically reducing failure and complication rates for totally implantable venous access devices (TIVAD) placement. The aim of the present study was to report the safety and efficacy of ultrasound-guided right innominate vein TIVAD placement in older patients.

METHODS

Between September 2015 and September 2017, 55 older patients underwent right innominate vein TIVAD placement under ultrasound guidance. Intraoperative fluoroscopy was always carried out. The technical success rate and complications were recorded and retrospectively analyzed.

RESULTS

The technical success rate was 100%. The success rate of the first puncture was 96.36% (53/55). The mean operation time was 28 ± 7 min (range 23-39 min), and the mean length of catheter introduction was 19.24 ± 2.65 cm (range 17-21 cm). The overall incidence of complications was 7.27% (4/55), including one arterial puncture with self-limiting hematoma, two cases of catheter-related infection and one case of fibrin sheath. No catheter malposition or catheter fracture was observed. At the time of this study, three TIVAD were pulled out unexpectedly, and 32 TIVAD are still in functional use.

CONCLUSIONS

Ultrasound-guided puncture of the right innominate vein is safe and reliable to implant TIVAD, which can provide new options for older patients. Geriatr Gerontol Int 2019; 19: 218-221.

Efficacy and safety of ultrasound-guided totally implantable venous access ports via the right innominate vein in adult patients with cancer: Single-centre experience and protocol

BACKGROUND

Totally implantable venous access ports (TIVAPs) are widely used and are an essential tool in the efficient delivery of chemotherapy. This study aimed to evaluate the feasibility and safety of implantation of ultrasound (US)-guided TIVAPs via the right innominate vein (INV) for adult patients with cancer.

METHODS

This study retrospectively reviewed the medical records of 283 adult patients with cancer who underwent US-guided INV puncture for TIVAPs between September 2015 and September 2017. It also analysed the technical success rate, operation time, and short-term and long-term surgical complications.

RESULTS

Technical success was achieved in all patients (100%). The mean operation time was 28.31 ± 7.31 min (range: 23-39 min), and the puncture success rate for the first attempt was 99.30% (281/283). Minor complications included artery puncture during the operation in one patient, but no pneumothorax was encountered. The mean TIVAP time was 304.16 ± 42.54 days (range: 38-502 days). The rate of postoperative complications was 2.83% (8/283), including poor healing of the incision in one patient, catheter-related infections in three patients, port thrombosis in one patient, and fibrin sheath formation in three patients; no catheter malposition, pinch-off syndrome, catheter fracture, or other serious complications were observed.

CONCLUSIONS

TIVAPs are widely employed for chemotherapy. The present study found that the novel approach of using US-guided INV puncture to implant TIVAPs in adult patients with cancer is both short-termly feasible and safe for long-term central venous access.

Optimal vascular access strategies for patients receiving chemotherapy for early-stage breast cancer: a systematic review

IMPORTANCE

Systemic chemotherapy can be administered either through a peripheral vein (IV), or centrally through peripherally inserted central catheter (PICC), totally implanted vascular access devices (PORTs) or tunnelled cuffed catheters. Despite the widespread use of systemic chemotherapy in patients with breast cancer, the optimal choice of vascular access is unknown.

OBJECTIVE

This systematic review evaluated complication rates and patient satisfaction with different access strategies for administering neo/adjuvant chemotherapy for breast cancer.

EVIDENCE REVIEWED

Ovid Medline, EMBASE and the Cochrane Central Register of Controlled Trials were searched from 1946 to September 2017. Two reviewers independently assessed each citation. The Newcastle-Ottawa scale was used to assess the quality of cohort and case-control studies.

FINDINGS

Of 1584 citations identified, 15 unique studies met the pre-specified eligibility criteria. There were no randomised studies comparing types of vascular access. Reports included six single-institution retrospective cohort studies, one retrospective multi-institution cohort, one retrospective cohort database study, five prospective single-institution studies, one prospective multi-institution study and one nested case-control study. Median complication rates were infection: 6.0% PICC (2 studies) versus 2.1% PORT (8 studies); thrombosis: 8.9% PICC (2 studies) versus 2.6% PORT (9 studies); extravasation: 0 PICC (1 study) versus 0.4% PORT (4 studies) and mechanical issues: PICC 3.8% (1 study) versus 1.8% PORT (9 studies). Satisfaction/quality of life appeared high with each device.

CONCLUSION

In the absence of high-quality data comparing vascular access strategies, randomised, adequately powered, prospective studies would be required to help inform clinical practice and reduce variation.

Central Venous Port Catheters: Evaluation of Patients' Satisfaction with Implantation under Local Anesthesia

Purpose

Evaluation of pain perception and patient satisfaction after implantation of a central venous port catheter system under local anesthesia.

Methods

A total of 100 consecutive patients (25 outpatients, 75 inpatients) who underwent successful implantation of a port catheter into the internal jugular vein from May through August 2007 were given an 8-item questionnaire. The extent of information about the implantation, the pain perception during implantation and the friendliness of the physician and nurse were evaluated. Furthermore, the patients were asked to assess their degree of anxiety and the pain they experienced during the intervention and to give an appraisal of whether local anesthesia was adequate. Each question was assessed on a 10–point scale (10 = very true to 1 = not at all true). In addition, the overall duration of the intervention (including patient preparation, implantation, patient aftercare, disinfection of the room) was documented.

Results

Patients felt highly satisfied with the way they were informed (mean score of 9.65) and considered the treating physician (9.89) and nurse (9.9) extremely friendly. Local anesthesia was rated as nearly completely adequate (9.56) and the degree of pain experienced was low (9.05; 10 = no pain). The average anxiety score was 8.56 (10 = not afraid at all). Overall satisfaction with the treatment was very high (9.62; outpatients: 9.72) and patients would recommend port catheter implantation at our department to others (9.77). The mean overall duration of the intervention was 76 min (range 40–120 min).

Conclusion

Positive patient reactions indicate that radiologic port catheter implantation under local anesthesia is a minimally invasive intervention with high patient satisfaction that can be performed on an outpatient basis and is a valid alternative to surgical implantation.

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

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.

Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable vascular access device (TIVAD) placement

PURPOSE

Totally implantable vascular access devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients' perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients' comfort level and aesthetic satisfaction with regard to TIVAD insertion.

METHODS

Patients with breast cancer admitted for chemotherapy at an outpatient clinic completed a previously validated survey evaluating three main domains: symptoms (pain, discomfort) related to the TIVAD itself in daily activity, information received before and during the surgical procedure, and cosmetic aspects regarding the port insertion site (scar, port, and catheter location).

RESULTS

Between September 2010 and June 2011, 232 patients were evaluated. Cosmetic satisfaction with scar location was high (93.3 %). Information given to patients before and during the procedure had a major impact on both symptom perception in daily activity and on cosmetic satisfaction.

CONCLUSIONS

Obtaining a more aesthetic scar by placing the TIVAD in the deltopectoral groove contributed to a high rate of cosmetic satisfaction. Furthermore, the relevance of information given to patients before and/or during surgery had a major impact on symptom perception. Therefore, we suggest including a pre-operative information session in the care pathway.

Morbidity-mortality conference for adverse events associated with totally implanted venous access for cancer chemotherapy

PURPOSE

Although considered safer than central venous catheters for administration of cancer chemotherapy, totally implanted venous access (TIVA) is associated with adverse events that may impair prognosis and quality of life of patients receiving chemotherapy. Our aim was to assess the feasibility and interest of surveillance of cancer chemotherapy TIVA-adverse events (AE), associated with morbidity-mortality conferences (MMCs) on TIVA-AE.

METHODS

We performed a prospective interventional study in two hospitals (a university hospital and a comprehensive care center). For each cancer chemotherapy care pathway within each hospital, we set up surveillance of TIVA-AE and MMC on these events. Patients included in surveillance were those with a TIVA either placed or used for chemotherapy cycles in one of the participating wards. Feasibility of MMC was assessed by the number of MMC meetings that actually took place and the number of participants at each meeting. The interest of MMC was assessed by the number of TIVA-AE identified and analyzed, and the number and type of improvement actions selected and actually implemented.

RESULTS

We recorded 0.41 adverse events per 1000 TIVA-day. MMCs were implemented in all care pathways, with sustained pluriprofessional attendance throughout the survey; 39 improvement actions were identified during meetings, and 18 were actually implemented.

CONCLUSIONS

Surveillance of TIVA-AE associated with MMC is feasible and helps change practices. It could be useful for improving care of patients undergoing cancer chemotherapy.

More Benefits Than Problems

Chemotherapy often requires a central venous access such as a peripherally inserted central catheter (PICC-line). The purpose of this study is to describe patients’ experiences with the PICC-line during curative oncological treatment. A quantitative cross-sectional study including 36 questionnaires (response rate 97%) comprising 14 questions was used. The results are presented in four dimensions: information, discomfort, anxiety, and restrictions in daily life. Patients are generally satisfied with their PICC-lines compared with peripheral pinpricks; however, some restrictions regarding dressings, movement, and hygiene routines were reported. Moreover, patients described anxiety using the PICC-line regarding lack of functionality and risk of infection. Therefore, patients need information based on everyday life situations, and nurses’ information skills may significantly increase patient safety and patient satisfaction during curative oncological treatment.

Provider Differences in Use of Implanted Ports in Older Adults With Cancer

BACKGROUND

Identifying unwarranted variation in health care can highlight opportunities to reduce harm. One often discretionary process in oncology is use of implanted ports to administer intravenous chemotherapy. While there are benefits, ports carry risks. This study's objective was to assess provider-driven variation in port use among cancer patients receiving chemotherapy.

RESEARCH DESIGN

Retrospective assessment using population-based SEER-Medicare data to assess differences in port use across health care providers of older adults with cancer. Participants included over 18,000 patients ages 66 and older diagnosed with breast, colorectal, lung, or pancreatic cancer in 2005-2007, treated by approximately 2900 providers. We identified port use for patients receiving treatment from hospital outpatient facilities versus physicians' offices. Our main analysis assessed the likelihood of a patient receiving a port given port use by the provider's last patient. For a subset of high-use providers, we examined individual provider-level variation by estimating the risk-adjusted likelihood of insertion.

RESULTS

Patients receiving chemotherapy in hospital outpatient facilities were significantly less likely to receive a port than those treated in physicians' offices, with adjusted odds ratios (AOR) varying from 0.50 to 0.75 across cancer sites. Implanting a port was associated with increased likelihood of port insertion in the provider's next patient (AOR varied from 1.71 to 2.25). Significant between-provider variation was found among providers with at least 10 patients.

CONCLUSIONS

Our findings support the idea that there is provider-driven variation in the use of ports for chemotherapy administration. This variation highlights an opportunity to standardize practice and reduce unnecessary use.

Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer

PURPOSE

Despite some advantages to their use, long-term central venous catheters (CVCs) are associated with complications for patients who require chemotherapy. Understanding of these risks in commercially insured populations is limited. This information can inform medical policies that ensure the appropriate use of venous access devices. This study's objectives were to assess the extent of variation in use of long-term CVCs in a cohort of commercially insured women with breast cancer, and to assess risks of associated complications.

METHODS

Retrospective cohort analysis was conducted using health insurance claims between January 2006 and October 2013. The cohort included commercially insured women age ≥ 18 years diagnosed with breast cancer who received infusion chemotherapy (N = 31,047). We conducted matched and case-mix adjusted Cox proportional hazard modeling to assess differences in bloodstream infections and thrombovascular complications between patients using long-term CVCs and those using temporary intravenous catheters.

RESULTS

Approximately two thirds of the cohort had a long-term CVC, although rates varied across regions (57% to 75%), health plans (65% to 70%), and insurance coverage (63% to 68%). After propensity score matching, the adjusted hazard ratio for infection was 2.70 (95% CI, 2.31 to 3.16) and thrombovascular complications, 2.61 (95% CI, 2.33 to 2.93) in patients with long-term CVCs compared with those with temporary intravenous catheters.

CONCLUSION

Although long-term CVCs may have benefits, they are associated with increased morbidity. Regional and health plan variation in long-term CVC insertion suggests that some of their use reflects provider- or institution-driven variation in practice. Evidence-based guidelines and tools may help decrease discretionary use of long-term CVCs.

[Multicenter validation study of a questionnaire assessing patient satisfaction with and acceptance of totally-implanted central venous access devices]

OBJECTIVE

Most cancer patients require a totally-implanted central venous access device (TIVAD) for their treatment. This was a prospective, multicenter, open study to: (i) develop and validate a French-language questionnaire dubbed QASICC (Questionnaire for Acceptance of and Satisfaction with Implanted Central Venous Catheter) assessing patient's satisfaction with and acceptance of their TIVAD; (ii) develop a mean score of patient's acceptance and satisfaction; (iii) look for correlation between QASICC score and TIVAD patient/tumor pathology/device characteristics.

METHODS

From 2011 November to 2012 December, the first version of the QASICC questionnaire that included 27 questions assessing seven dimensions was re-tested among 998 cancer patients in eleven French cancer hospitals (eight cancer research institutes and three university/general hospitals). The goal was: (i) to reduce the questionnaire item and dimension number (pertinency, saturation effect, item correlation); (ii) to assess its psychometric properties, demonstrate its validity and independency compared to (EORTC) QLQC30; (iii) to correlate clinical and pathological patient's/tumor's/TIVAD's parameters with the QASICC questionnaire score (the higher the overall score, the greater the acceptance and satisfaction). The questionnaire was administered to the patient 30 days (±15 days) after TIVAD's implantation.

RESULTS

Among 998 questionnaires given to cancer patients, 658 were analyzed and 464 were fully assessed as there was no missing data. Time to fill-in the questionnaire was five minutes in 90% patients. Final QASICC tool included twenty-two questions assessing four homogeneous dimensions (65%<Cronbach coefficient<85%): (i) impact on daily activities and professional activities; (ii) esthetics and privacy; (iii) pain, contribution to the comfort of the treatment; (iv) local discomfort. Respective assessment scores were 23.6%, 32.9%, 20.4% and 18.0%. Overall satisfaction score was 75.8%; global assessment score was 76.2%. These scores were significantly linked to patient's gender, anesthesia type, TIVAD's implantation side, patient's age and tumor type.

CONCLUSIONS

This second and final methodological and statistical validation of this auto-questionnaire QASICC allows us to propose it as a dedicated questionnaire to TIVAD's cancer patients by using a score assessing acceptance and satisfaction regarding their device.

Feeling Confident in Using PICC Lines

Treatments involving chemotherapy require central venous access, such as a Peripherally Inserted Central (PICC) line. The aim of the study was to describe patients’ experiences of living with a PICC line during chemotherapy treatment. The study comprised interviews with 10 patients and was analyzed using manifest qualitative content analysis. The categories The importance of security, The importance of contentedness, and Feeling confident in using the PICC line were identified. To contribute to patient safety and empowerment in health care, nurses must be well trained in PICC line care. Therefore, evidence-based knowledge about central venous access is necessary for patients’ security and contentedness and to improve quality of care and increase patients’ well-being in central venous access care activities in the future.

Implanting totally implantable venous access port via the internal jugular vein guided by ultrasonography is feasible and safe in patients with breast cancer

Background

Because of long-term use for chemotherapy and fluid administration in cancer patients, a totally implantable venous access port (TIVAP) has been advised as a feasible catheter. The purpose of this study was to evaluate the effectiveness and safety of ultrasound (US)-guided internal jugular vein (IJV) puncture for TIVAP implantation in patients with breast cancer.

Methods

We reviewed the medical records of 492 patients who underwent US-guided IJV puncture for TIVAP implantation at our oncology department between 2010 and 2013. Indications, surgical complications, and early and long-term complications were analyzed.

Results

All TIVAPs were implanted successfully. Indications for TIVAP were chemotherapy alone (88 patients), chemoradiotherapy (387 patients), surgery (12 patients), and parenteral nutrition (5 patients). Complications were observed in 65 (13.21%) patients. The median duration of the TIVAP was 359 days (range, 28 to 712 days) without damage to the port or catheter, or leakage of drugs outside of the port system.

Conclusions

A TIVAP can be employed for chemotherapy and parenteral nutrition on the implantation day. Using a US-guided IJV puncture to completely implant a TIVAP is feasible and safe in patients with breast cancer.

Short-term and long-term outcome of radiological-guided insertion of central venous access port devices implanted at the forearm: a retrospective monocenter analysis in 1704 patients

OBJECTIVES

The objectives are to analyze the technical success rate as well as the short-term and long-term complications of totally implantable venous access ports (TIVAPs) at the forearm.

METHODS

Retrospective analysis of 1,704 consecutively implanted TIVAPs was performed. Primary endpoints were defined as technical success rate, clinical outcome, device service interval, and rates of major complications. Minor complications not requiring port explantation were defined as secondary endpoints.

RESULTS

The technical success rate was 99.2 % with no major complications. During follow-up, a total of 643,200 catheter-days were documented, the mean device service interval was 380.6 days/patient. A total of 243 complications (14.4 %) in 226 patients were observed (0.4/1000 catheter-days), in 140 patients (8.3 %) the port device had to be explanted. Disconnection between the port device and the catheter (1.6 %) was more frequent than fracture (0.8 %) and leakage (0.6 %) of the catheter, which occurred more frequently when the catheter was inserted via the cephalic versus the brachial vein.

CONCLUSION

TIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications.

Cost effectiveness of different central venous approaches for port placement and use in adult oncology patients: evidence from a randomized three-arm trial

BACKGROUND

No randomized trials have so far investigated the cost effectiveness of different methods for implantation and use of central venous ports in oncology patients.

PATIENTS AND METHODS

Overall, 403 patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of port, either through a percutaneous landmark access to the internal jugular vein, an ultrasound (US)-guided access to the subclavian vein, or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Insertion and maintenance costs were estimated by obtaining the charges for an average implant and use, while the costs of the management of complications were analytically assessed. The total cost was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any.

RESULTS

A total of 401 patients were evaluable-132 with the internal jugular vein, 136 with the subclavian vein and 133 with the cephalic vein access. No differences were found for the rate of early complications. The US-guided subclavian insertion site had significantly lower failures. Infections occurred in 1, 3, and 3 patients (internal jugular, subclavian, and cephalic access, respectively; p = 0.464), whereas venous thrombosis was observed in 15, 8, and 11 patients, respectively (p = 0.272). Mean cost for purchase, implantation, diagnosis and treatment of complications in each patient was <euro>2,167.85 for subclavian US-guided, <euro>2,335.87 for cephalic, and <euro>2,384.10 for internal jugular access, respectively (p = 0.0001).

CONCLUSION

US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.

Variability in management of implantable ports in oncology outpatients

PURPOSE OF THE RESEARCH

To describe the variability in practice regarding the management of vascular access ports in adult oncology patients at Spanish outpatient clinics and to evaluate its compliance with the recommended procedural guidelines.

METHODS AND SAMPLE

Three e-mailings or three postal mail-outs were sent to all Spanish outpatient clinics, in accordance with the hospital's preference. An additional fourth postal mail-out was made to all units. In total 185 units at Spanish outpatient clinics out of a total 256 completed the survey questionnaire.

KEY RESULTS

A number of variations exist in the techniques used for insertion, withdrawal of needle from vascular access ports, blood sampling and unblocking procedure. There is considerable agreement in relation to the use of a special beveled needle, the use of gloves in the access and withdrawal procedures and checking of reservoir permeability by aspirating blood. In most cases, sterile gloves are used but there is a lesser occurrence of both scrubbed hands and correct antiseptic use.

CONCLUSIONS

There are considerable differences in the management of the vascular access ports in terms of the recommendations published in the main international guidelines, though these are based on low level evidence. The results highlight the need for further quality studies in ports use and manipulation to lessen the variability between published recommendations and clinical practice.

A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital

BACKGROUND

Reliable central vein access is a fundamental issue in modern advanced oncological care. The aim of this study was to determine the incidence of complications and patient perception regarding central vein access ports.

METHODS

We prospectively studied 249 single lumen access ports implanted between 1 July 2008 and 15 March 2010 in a mixed patient population at a 500-bed secondary level hospital in Sweden. We determined the number of catheter days, infection rate and mechanical complications, as well as patient satisfaction regarding the access port, over a six-month follow-up period.

RESULTS

Two hundred and forty-four different patients received 249 ports yielding a total of 37 763 catheter days. Ultrasound and fluoroscopic guidance was used in 98% of procedures. Vein access was obtained percutanously by an anaesthesiologist in all cases. There was no case of pneumo- or haemothorax. The incidence of catheter-related bloodstream infection, was 0.05/1000 catheter days and the incidence of pocket/tunnel infection was 0.39/1000 catheter days. Clinically apparent deep vein thrombosis occurred in four patients (1.6%). Patient satisfaction was overall high.

CONCLUSION

These results confirm that our team-based approach with written easily accessible evidence-based guidelines and a structured education programme leads to a very low complication rate and a high degree of patient satisfaction.

Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis

BACKGROUND

Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer.

AIM

The aim of this study was to assess the risk of port system failure in patients with advanced cancer.

DESIGN

We conducted a retrospective cohort study in a comprehensive cancer centre.

SETTING/PARTICIPANTS

A detailed chart review was conducted among 566 patients with 573 ports inserted during January-June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion.

RESULTS

Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2-46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m(2) (HR = 3.4, P = 0.029) increased the risk of port system occlusion.

CONCLUSIONS

Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.

Common and uncommon complications of totally implantable central venous ports: a pictorial essay

PURPOSE

The purpose of this study is to present the characteristic radiologic features of common and uncommon complications in totally implantable central venous ports.

MATERIAL AND METHODS

The authors reviewed 138 implantations of central venous ports in oncologic patients during an 18-month period and present the characteristic imaging features of the complications detected.

RESULTS

All chest ports were placed via the internal jugular vein using both fluoroscopic and ultrasound guidance. The technical success rate was 99.3% (137/138). All catheter or port-related complications were retrospectively assessed. Sixteen complications were detected during the follow-up period, and catheter removal was required in 10 patients.

CONCLUSIONS

Image-guided central venous port catheter implantation is a very safe procedure with a low rate of complications. The typical imaging features of common and uncommon complications are very helpful in establishing the correct diagnosis and thus tailoring the appropriate therapy.