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Jia J, Fan X, Zhang W, Xu Z, Wu M, Zhan Y, Fan B. Predictive model for totally implanted venous access ports‑related long‑term complications in patients with lung cancer. Oncol Lett 2024; 28:326. [PMID: 38807672 PMCID: PMC11130750 DOI: 10.3892/ol.2024.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Totally implanted venous access ports (TIVAPs), which are typically used in oncological chemotherapy and parenteral nutritional support, are convenient and safe, and thus offer patients a higher quality of life. However, insertion or removal of the device requires a minor surgical operation. Long-term complications (>30 days post insertion), such as catheter migration, catheter-related thrombosis and infection, are major reasons for TIVAP removal and are associated with a number of factors such as body mass index and hemoglobin count. Since management of complications is typically time-consuming and costly, a predictive model of such events may be of great value. Therefore, in the present study, a predictive model for long-term complications following TIVAP implantation in patients with lung cancer was developed. After excluding patients with a large amount of missing data, 902 patients admitted to The First Affiliated Hospital with Nanjing Medical University (Nanjing, China) were ultimately included in the present study. Of the included patients, 28 had complications, indicating an incidence rate of 3.1%. Patients were randomly divided into training and test cohorts (7:3), and three machine learning-based anomaly detection algorithms, namely, the Isolation Forest, one-class Support Vector Machines (one-class SVM) and Local Outlier Factor, were used to construct a model. The performance of the model was initially evaluated by the Matthew's correlation coefficient (MCC), area under curve (AUC) and accuracy. The one-class SVM model demonstrated the highest performance in classifying the risk of complications associated with the use of the intracavitary electrocardiogram method for TIVAP implantation in patients with lung cancer (MCC, 0.078; AUC, 0.62; accuracy, 66.0%). In conclusion, the predictive model developed in the present study may be used to improve the early detection of TIVAP-related complications in patients with lung cancer, which could lead to the conservation of medical resources and the promotion of medical advances.
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Affiliation(s)
- Jian Jia
- Department of General Practice, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Xutong Fan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, Jiangsu 210093, P.R. China
| | - Zhiyang Xu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Mian Wu
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yiyang Zhan
- Department of Geriatrics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Boqiang Fan
- Department of Oncology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Kozlowski KM, Jalaeian H, Travis LM, Zikria JF. A comparative analysis of infection and complication rates between single- and double-lumen ports. Infect Control Hosp Epidemiol 2024; 45:698-702. [PMID: 38272652 DOI: 10.1017/ice.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Port-a-caths are implanted intravascular chest ports that enable venous access. With more port placements performed by interventional radiologists, it is important to discern differences in infection and complication rates between double- and single-lumen ports. METHODS We retrospectively reviewed 1,385 port placements over 2 years at the University of Miami. Patients were grouped by single- or double-lumen ports. Data on duration of catheter stay, bloodstream infections, malfunctions, and other complications (fibrin sheath, thrombosis, catheter malposition) were collected. Multivariate Cox regression was performed to identify variables predicting port infection. RESULTS The mean patient age was 58.8 years; the mean BMI was 26.9 kg/m2; and 61.5% of these patients were female. Our search revealed 791 double-lumen ports (57.1%) and 594 single-lumen ports (42.9%). The median follow-up was 668 days (range, 2-1,297). Double-lumen ports were associated with significantly higher rates of bacteremia (2.78% vs 0.84%; P = .02), port malfunction (8.3% vs 2.0%; P < .001), fibrin sheath formation (2.2% vs 0.5%; P < .02), catheter tip malposition (1.0% vs 0; P = .01), and catheter-associated thrombosis (1.4% vs 0; P = .003). Multivariate Cox regression analysis, after adjusting for other variables, showed that double-lumen chest ports had 2.98 times (95% confidence interval, 1.12-7.94) the hazard rate of single-lumen ports for developing bloodstream infection (P = .029). CONCLUSIONS Double-lumen chest ports are associated with increased risk for bloodstream infection, malfunction, fibrin sheath formation, catheter tip malposition, and catheter-associated thrombosis. Interventional radiologists may consider placing single-lumen ports if clinically feasible; however, future studies are needed to determine clinical significance. The study limitations included the retrospective study design and the potential loss of patient follow-up.
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Affiliation(s)
- Konrad M Kozlowski
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Levi M Travis
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Joseph F Zikria
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Hamri H, Pop CF, Mauriac S, Degreve C, Khaled C, Vouche M, Moreau M, Liberale G. Evaluation of the position of the central venous catheter tip of implantable venous access devices in the occurrence of postoperative thrombotic and non-thrombotic complications. Support Care Cancer 2024; 32:355. [PMID: 38750256 DOI: 10.1007/s00520-024-08563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The position of the catheter tip of totally implantable venous access devices (TIVAD) is a risk factor for postoperative complications. The study aim was to assess the early and late complications (EC and LC) associated with the position of the catheter tip in cancer patients. METHODS We reviewed cancer patients who had a TIVAD placed in 2020. EC (≤ 90 days), LC (> 90 days) and risk factors for TIVAD-associated complications were assessed. The vertical mismatch of the catheter tip was compared to an "ideal position" (> 10 mm below the carina and ≥ 20 mm below the right main bronchus (RMB)) using chest x-ray, post-implantation. RESULTS 301 patients were included. Median follow-up after TIVAD implantation was 9.4 months. All TIVAD catheters were inserted via the internal jugular vein (IJV). The mean distance between the catheter tip and the carina and the RMB was 21.3 mm and 6.63 mm respectively. In total, 11.3% patients developed EC and 5.6% had LC. An association was found between the position of the catheter tip from the carina (≤ 10 mm vs. > 10 mm) and the occurrence of EC (18.3% vs. 8.6%, p = 0.01) and for the catheter insertion side (left IJV vs. right IJV) (19.1% vs. 9.0% p = 0.02). Multivariate analysis showed that left IJV catheter insertion (OR 2.76), and a catheter tip located ≤ 10 mm below the carina (OR 2.71) are significant independent risk factors of EC. CONCLUSIONS TIVAD catheter tip located at ≤ 10 mm below the carina, and a left-side inserted catheter, are higher risk of EC.
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Affiliation(s)
- Hicham Hamri
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - C Florin Pop
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium.
| | - Sybil Mauriac
- Department of Nursing, Institut Jules Bordet - HUB, Brussels, Belgium
| | - Caroline Degreve
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Charif Khaled
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michel Moreau
- Data Center and Statistics, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
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Lu MS, Chen CC, Chang CC, Lin CC, Hsieh CC. Risk Factors for Unplanned Early Implantable Port Catheter Removal in Adult Hematology Cancer Patients Receiving Chemotherapy: A Propensity Score Matching Study. Cancer Manag Res 2024; 16:445-454. [PMID: 38736587 PMCID: PMC11088845 DOI: 10.2147/cmar.s454063] [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: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Implantable port catheter is a reliable vascular access for chemotherapy infusion in cancer patients. However, patients with hematology malignancies usually present with a myriad of blood cell abnormalities that put them at risk of infection and mechanical problems requiring catheter removal. This study aims to determine the risk factors associated with unplanned (catheter removal other than completion of treatment plan) early (within 90 days of catheter implantation) implantable port catheter removal. Patients and Methods A retrospective, propensity score-matched study of 386 patients with hematology malignancies who received implantable venous access ports between January 2015 and December 2022. We conducted a univariate analysis to select the variables for propensity score matching. Patients with unplanned early implantable port catheter removal (early group) were matched 1:1 to patients without unplanned early removal (non-early group). Results Univariate analysis demonstrated a statistically significant difference between early and non-early groups for age (p = 0.048), hemoglobin level (p = 0.028), thrombocytopenia (p = 0.025), and PG-SGA (p < 0.001). Thrombocytopenia was the only independent risk factor with a statistically significant difference in Cox proportional hazard analysis, HR 2.823, 95 CI 1.050-7.589, p = 0.040. The median catheter survival for patients with thrombocytopenia was 61 days (95% CI 28.58-93.42) compared to 150 days (95% CI 9.81-290.19) for patients without thrombocytopenia, p = 0.015. Patient survival is not affected by early catheter removal. The median survival for patients in the early group was 28.28 months (95% CI 27.43-29.15) compared to 32.39 months (95% CI 24.11-40.68), for the non-early group, p = 0.709. Conclusion Hematology malignancy patients with thrombocytopenia are at high risk for unplanned early port catheter removal without survival difference.
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Affiliation(s)
- Ming-Shian Lu
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chen Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medicine, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Che-Chia Chang
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Chien-Chao Lin
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Ching-Chuan Hsieh
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wu J, Zhang L, Jia X, Mu Y, Lou Y. Application of pocket-first technique for implantation of totally implantable venous access ports. BMC Surg 2024; 24:118. [PMID: 38643077 PMCID: PMC11031911 DOI: 10.1186/s12893-024-02404-4] [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: 03/12/2023] [Accepted: 04/08/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND While vascular puncture is always performed before making port pocket in the implantation of totally implantable venous access ports (TIVAP), some surgeons preferred to make port pocket first. This study seeks to verify the safety and feasibility for the pocket-first technique. METHODS The study retrospectively reviewed 447 patients who undergone TIVAP implantation from July 2017 to November 2022. All the patients were divided into two groups based on vascular puncture first or making port pocket first. The general information, operation information and post-operative complications were reviewed and analyzed. RESULTS All the operations were performed successfully. No difference was observed in the sex, age, height, weight, BMI, port location and total complication rate between the two groups. The operation time of the Puncture Group and the Pocket Group were 46.9 ± 22.4 min and 33.8 ± 13.6 min ( P<0.00001 ). In the patients of SCV approach, the operation time between the two groups were 37.4 ± 14.8 min and 33.5 ± 10.9 min ( P<0.05 ). Multivariate analysis showed the variable BMI and first procedure were independent prognostic factors for operation time. In the cases using SCV/AxV approach the variable first procedure was the only independent prognostic factor for operation time (P = 0.002). CONCLUSIONS The pocket-first technique can be considered as a safe, feasible and convenient technique for TIVAP implantation. The time consuming is significantly shortened compared with the puncture-first technique and this advantage may be more obvious when using SCV/AxV approach.
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Affiliation(s)
- Jingjin Wu
- General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, China
| | - Li Zhang
- Nephrology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, China
| | - Xiaojian Jia
- General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, China
| | - Yunchuan Mu
- General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, China
| | - Yanbo Lou
- General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, China.
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Nishizaki D, Eskander RN. Targeted Therapies, Biologics, and Immunotherapy in the Neoadjuvant and Adjuvant Settings: Perioperative Risks. Surg Oncol Clin N Am 2024; 33:279-291. [PMID: 38401910 DOI: 10.1016/j.soc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Cancer therapeutics has been revolutionized by the introduction of molecularly targeted therapies and immune checkpoint inhibitors (ICIs). The paradigm of neoadjuvant therapy is commonly employed across multiple solid tumors, exhibiting significant clinical benefit as exemplified with ICIs in melanoma and non-small-cell lung cancer. However, neoadjuvant therapy can be associated with treatment-related adverse events. As the incorporation of these novel therapies in the preoperative space expands, it is crucial for surgical oncologists to understand the potential perioperative implications of these treatments. This article focuses on surgical considerations tied to these treatments, highlighting potential drug-surgery interactions and complications.
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Affiliation(s)
- Daisuke Nishizaki
- Division of Hematology and Oncology, Department of Medicine, Center for Personalized Cancer Therapy, University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Personalized Cancer Therapy, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
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Sharma V, Pandey A. A Spectrum of Chemoport-Associated Complications and Their Management in Cancer Patients. Cureus 2024; 16:e58052. [PMID: 38738137 PMCID: PMC11088396 DOI: 10.7759/cureus.58052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly. METHODS We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records. RESULTS The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases. CONCLUSION Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.
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Affiliation(s)
- Vikas Sharma
- Surgical Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Arun Pandey
- Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, IND
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Guan X, Yan H, Zhang J, Li Y, Zhou Y. Risk factors of infection of totally implantable venous access port: A retrospective study. J Vasc Access 2023; 24:1340-1348. [PMID: 35389296 DOI: 10.1177/11297298221085230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Infection is the most frequent complication associated with the use of totally implantable venous access port (TIVAP). This retrospective study was conducted to determine the risk factors affecting TIVAP-related infection. METHODS A total of 1406 patients implanted with TIVAP at our center were included in this retrospective study. Incidence of perioperative infection, patient characteristics and bacteriologic data were retrieved and analyzed. Univariable analyses and multiple logistic regression analyses were used to determine the risk factors. RESULTS Overall, 72 (5.1%) patients had perioperative infection, and TIVAP was finally removed from 12 (0.85%) patients. There was significantly more hematologic malignancy in the infection group, compared to the non-infection group. Patients with chemotherapy and infection within 30 days before operation also had more infections. There were more inpatients in the infection group than in the non-infection group. The rate of hematoma was higher in the infected patients. Multivariate logistic analysis revealed that hematoma (OR 5.695, p < 0.001), preoperative hospital stay (⩾14d) (OR 2.945, p < 0.001), history of chemotherapy (OR 2.628, p = 0.002), history of infection (within 30 days) (OR 4.325, p < 0.001) were independent risk factor for infection. CONCLUSIONS This study demonstrated that hematoma, preoperative hospital stay (⩾14d), history of chemotherapy and history of infection (within 30 days) are independent risk factor for all patients.
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Affiliation(s)
- Xiaonan Guan
- Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - He Yan
- Center of Intervention Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zhang
- Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yanbing Li
- Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yiming Zhou
- Center of Intervention Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Bailleul A, Fulgencio JP, Vimont S, Mordelet C, Ray B, Lassel L, Lapidus N, Quesnel C, Garnier M. Risk factors and prognostic significance of infection of totally implantable vascular access port in solid tumor patients: A prospective cohort study. Infect Dis Now 2023; 53:104766. [PMID: 37543258 DOI: 10.1016/j.idnow.2023.104766] [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: 05/04/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Totally implantable venous access ports (TIVAP) are devices mainly used to deliver antineoplastic chemotherapies, of which the insertion may be complicated by TIVAP-related infection (TIVAP-RI). This study aims to provide data on the risk factors for TIVAP-RI and its influence on patient prognosis. PATIENTS AND METHODS Prospective observational study including adult patients with solid tumors, in whom a TIVAP was inserted to deliver antineoplastic chemotherapy between January 2018 and October 2019. Factors associated with TIVAP-RI and one-year mortality were determined using multiple logistic regressions. RESULTS More than a thousand (1014) patients were included, among whom 48 (4.7%) presented with TIVAP-RI. Gram-positive cocci and Gram-negative bacilli represented 51% and 41% of the pathogens isolated, respectively. Young age (odds ratio [OR] 0.67; 95% Confidence Interval [0.53-0.83] per 10-year increase), WHO performance status ≥ 1 (OR 3.24 [1.52-7.79]), chemotherapy administration in the month before TIVAP placement (OR 2.26 [1.17-4.26]), and radiation therapy of the homolateral chest wall (OR 3.28 [1.51-6.67]) were independently associated with TIVAP-RI occurrence. During the year following TIVAP insertion, 287 (28%) patients died. TIVAP-RI was not associated with one-year mortality (OR 1.56 [0.75-3.19]). CONCLUSION TIVAP insertion in adult patients with solid tumors is associated with a low infection rate, which did not influence one-year mortality. In addition to young age and impaired health status, TIVAP insertion in the month following initiation of the antineoplastic chemotherapy and TIVAP insertion in an irradiated area are two newly reported preventable TIVAP-RI risk factors.
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Affiliation(s)
- Amaury Bailleul
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Jean-Pierre Fulgencio
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Sophie Vimont
- Département de Bactériologie, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, - 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne Université, INSERM UMR S_1155, Hôpital Tenon, Paris, France
| | - Cécile Mordelet
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Benoit Ray
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Ludovic Lassel
- Sorbonne Université, AP-HP, DMU 3ID, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales - 4 rue de la Chine, 75020 Paris, France
| | - Nathanaël Lapidus
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, 75012 Paris, France
| | - Christophe Quesnel
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Hôpital Tenon, Service d'Anesthésie-Réanimation et Médecine Périopératoire - 4 rue de la Chine, 75020 Paris, France; Université Clermont-Auvergne, CHU de Clermont-Ferrand, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
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Takahashi K, Arai T, Asai T, Okuda Y. A fragmented segment of a central venous catheter caused delayed ventricular fibrillation: a case report. JA Clin Rep 2023; 9:27. [PMID: 37193904 DOI: 10.1186/s40981-023-00615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Central venous port systems may be safely used for chemotherapy of patients with cancer, but several complications may occur associated with their use. CASE PRESENTATION An 83-year-old man with heat stroke was transferred to our emergency department, where he was treated and became able to eat on the same day. He had been fit and healthy, except for colorectomy and chemotherapy using a central venous access port placed in the right upper jugular vein 8 years ago. The next day, he suddenly had ventricular fibrillation. Cardiopulmonary resuscitation was successful. Emergency coronary angiography showed a catheter-like foreign body in the coronary sinus. Physicians failed to remove the foreign body using catheter therapy, and ventricular fibrillation occurred repeatedly. After induction of general anesthesia, the fractured catheter was removed surgically. Postoperative course was uneventful. CONCLUSIONS A fragmented segment of a catheter may suddenly cause ventricular fibrillation years later.
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Affiliation(s)
- Kei Takahashi
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan.
| | - Takero Arai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Yasuhisa Okuda
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, 343-8555, Japan
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Lu X, Ren Y, Wan H, Xu Q, Duan S. Case report: Extravascular catheter migration in a child: A rare complication of the totally implantable venous access device. Medicine (Baltimore) 2023; 102:e32710. [PMID: 36827053 DOI: 10.1097/md.0000000000032710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Totally implantable venous access devices (TIVADs) are widely used to gain intermittent central venous access, such as in patients who need long-term chemotherapy, total parenteral nutrition, and long-term antibiotic treatment. At present, there are many complications associated with the use of these devices. Complete extravascular migration of TIVADs via the internal jugular vein is a very rare and potentially serious condition, especially in children. CASE PRESENTATION A 1-year-old girl needed palliative chemotherapy because of hepatoblastoma complicated by inferior vena cava thrombosis. A TIVAD was implanted through the right internal jugular vein with a routine heparin flushing tube. On the second day after the operation, a pale bloody liquid was drawn out from the device and the chest X-ray was checked to confirm that the position of the catheter was normal. On the third day after the operation, however, the patient's right respiratory sound was weakened on physical examination and auscultation. Fluoroscopy showed that the tip of the catheter was located in the right thoracic cavity, and there was a large amount of effusion in the right thoracic cavity. The pleural effusion was removed, the TIVAD was replaced again, and the child was discharged 2 days later. CONCLUSIONS Following TIVAD implantation, if abnormalities are found, in addition to chest X-ray, saline flush and echocardiography should be performed to determine the position of the catheter and rule out extravascular migration of the catheter to avoid irreparable consequences.
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Affiliation(s)
- Xuning Lu
- Heart Center, Dalian Municipal Women and Children's Medical Center (Group), Liaoning, China
| | - Yueyi Ren
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
| | - Hao Wan
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
| | - Qiteng Xu
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
| | - Shuhua Duan
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
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Zhang S, Xiao Z, Yang F. Analysis of related complications of totally implantable venous access ports in children's chemotherapy: Single center experience. Medicine (Baltimore) 2022; 101:e29899. [PMID: 35801731 PMCID: PMC9259173 DOI: 10.1097/md.0000000000029899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Totally implantable venous access port (TIVAP) has become an important infusion channel for children who need chemotherapy. With the popularization of TIVAP, its related complications have gradually received clinical attention. However, there are few studies on the complications of TIVAP in children. Therefore, this study intends to analyze the risk factors of complications in children's infusion port, so as to provide basis for guiding clinical prevention and intervention. This paper retrospectively analyzed 182 children who received TIVAP implantation in our hospital from January 2018 to January 2021. According to the demographic data, basic disease status and operation related data obtained through Hospital Information System and manual follow-up, the complications and related influencing factors after implantation and implantation were summarized and analyzed. SPSS software was used to analyze the influencing factors between the complication group and the control group. There were 182 cases of children implanted in intravenous infusion port, of which 71 cases had complications, infection was the most common complication in 50 cases, followed by catheter blockage in 23 cases. Among the infection factors, catheter-related blood stream infection accounted for the highest proportion in 31 cases (17.0%), and Staphylococcus epidermidis was the most common pathogen. A total of 19 cases were pulled out early, and the unplanned pullout rate of catheter-related blood stream infection was the highest. In the analysis of influencing factors, age had significant differences in catheter-related infection, all complications and no complications (P < .05). The overall incidence of complications in the use of TIVAP in children with chemotherapy is high, and infection is the most common complication, among which catheter-related blood stream infection is the most common cause of unplanned pullout. Lower age may be associated with a higher incidence of complications.
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Affiliation(s)
- Songze Zhang
- Department of General Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Songze Zhang, MD, Department of General Surgery, The Affiliated People’s Hospital of Ningbo University, 251 Baizhang Road, Ningbo, Zhejiang 315040, China (e-mail: )
| | - Zhangsheng Xiao
- Department of General Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Feibiao Yang
- Department of General Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
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Retrospective analysis: 5509 cases of "totally implantable venous access port systems implantation (TIVAPS) depth" assisted by digital radiography. Langenbecks Arch Surg 2022; 407:3123-3132. [PMID: 35660962 DOI: 10.1007/s00423-022-02573-x] [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: 09/11/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Modern oncological treatment in breast cancer patients requires the precise delivery of chemotherapy infusion into the central venous systems without toxicity. TIVAPS is the significant method of chemotherapy delivery although certain internal or external complications associated with their placement. However, the long-term use of TIVAPS is still a concern to minimize the complications such as venous thrombosis syndrome (VTS) and cardiac defects. The aim of this study is to investigate the potential disadvantages that may be avoided by digital radiography (DR)-assisted measurement of catheter depth pertinent to TIVAPS implanted system. METHODS Retrospective analysis related to 5509 TIVAPS recipients of 99% female breast cancer patients and 1% male blood disorder patients registered from April 2013 to November 2017 were included in the study. Patients with TIVAPS catheter tip depth into superior vena cava into upper (group A), middle (group B), and lower (group C) parts were stratified for evaluation during implantation; DR-assisted measurement of TIVAPS was performed to decipher "tip depth of catheter" and determined the relevance of tip depth to complications such as VTS and cardiac defects. RESULTS Incidence of VTS complications were significantly higher in TIVAPS recipients of group A (82.7%) than group B (16%) and group C (0.12%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). Defects in heart function are higher in group C (59.6%) than group A (15.8%) and group B (24.6%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). CONCLUSION DR-assisted measurement can more accurately determine the depth of TIVAPS catheter implantation, and avoid the incidence of related complications, and provide a better method for surgeons.
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Wang P, Soh KL, Ying Y, Liu Y, Huang X, Huang J. Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis. Thromb Res 2022; 213:34-42. [DOI: 10.1016/j.thromres.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022]
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Hernando J, Riera-Arnau J, Roca M, Garcia A, Capdevila J. Cervical dissecting extravasation of oxaliplatin: A case report. Mol Clin Oncol 2022; 16:60. [PMID: 35127085 DOI: 10.3892/mco.2022.2493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Oxaliplatin is a chemotherapy drug considered to be an irritant and vesicant. Peripheral extravasation could happen following oxaliplatin chemotherapy administration, but mediastinal or cervical events are rare. The present study focused on the case of a 64-year-old female patient with KRAS-mutated colorectal adenocarcinoma. The patient was prescribed folinic acid, fluorouracil and oxaliplatin chemotherapy via a subcutaneous pump or port-a-cath device, which was inserted into the right subclavian vein. The patient reported a sudden throbbing pain in the chest wall and anterior cervical region. After performing a computed tomography scan, anterior cervical collection and jugular-subclavian venous confluence at the distal end was observed at the venous access site of the subcutaneous port-a-cath device, which extended cranially, dissected cervical planes and forming a hydro-aerial collection in the submaxillary region. Subsequently, the port-a-cath device was removed and a warm dry compress was applied. After 2 weeks, the patient had fully recovered without any sequelae at the cervical level. To the best of the authors' knowledge, this is the first case of cervical extravasation of oxaliplatin reported in the literature to date and will help to manage similar situations.
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Affiliation(s)
- Jorge Hernando
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Judit Riera-Arnau
- Clinical Pharmacology Service, Department of Pharmacovigilance and Pharmacoepidemiology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Maria Roca
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Alejandro Garcia
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Jaume Capdevila
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
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Yong L, Jianxi G, Yanfang Z, Jian K. Complications from port-a-cath system implantation in adults with malignant tumors: A 10-year single-center retrospective study. J Interv Med 2021; 5:15-22. [PMID: 35586285 PMCID: PMC8947993 DOI: 10.1016/j.jimed.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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Lee J, Hur SM, Kim Z, Lim CW. Safety of immediate use of totally implantable venous access ports in adult patients with cancer: a retrospective single-center study. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:104-110. [PMID: 36945672 PMCID: PMC9942755 DOI: 10.14216/kjco.21016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023]
Abstract
Purpose Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications. Methods Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients' clinical data was performed to investigate catheter days and complications of TIVAPs. Results Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10-457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054-1.414; P=0.008). Conclusion This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.
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Affiliation(s)
- Jisu Lee
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Mo Hur
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Cheol Wan Lim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Tagashira H, Izushi Y, Ikuta T, Koike Y, Kitamura Y, Yamamoto H. Regimen of 5-Fluorouracil and Cisplatin Increases the Incidence of Extravasation in Patients Undergoing Chemotherapy. In Vivo 2021; 35:1147-1150. [PMID: 33622913 DOI: 10.21873/invivo.12361] [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: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Extravasation associated with chemotherapy can induce localised injury, necrosis, and nerve damage, resulting in discontinued chemotherapy and impaired quality of life; however, risk factors for extravasation remain unclear. The present study aimed to identify chemotherapy regimen-associated factors related to extravasation. PATIENTS AND METHODS Data on patient and chemotherapy protocol characteristics were extracted from our hospital's electronic database; the frequency of extravasation was compared among patients receiving different chemotherapy regimens. RESULTS Twenty-two patients with extravasation undergoing chemotherapy during the study period were enrolled in the present study. Patients undergoing treatment with 5-fluorouracil and cisplatin were most likely to develop extravasation in the present study. All patients presenting with extravasation during treatment with 5-fluorouracil and cisplatin developed swelling and many (40%) developed erythema within the first two cycles of treatment. CONCLUSION Treatment with 5-fluorouracil combined with cisplatin increases the incidence of extravasation. Ensuring suitable vascular access and increasing awareness regarding the symptoms and timing of extravasation among patients and medical staff can improve extravasation prevention and diagnosis.
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Affiliation(s)
- Hisashi Tagashira
- Department of Pharmacy, National Hospital Organization Okayama Medical Centre, Okayama, Japan;
| | - Yasuhisa Izushi
- Department of pharmacotherapy, School of Pharmacy, Shujitsu University, Okayama, Japan.,Division of Molecular and Cellular Medicine, Department of Clinical Science, National Hospital Organization Okayama Medical Centre, Okayama, Japan
| | - Tomoki Ikuta
- Department of Pharmacy, National Hospital Organization Shikoku Cancer Centre, Ehime, Japan
| | - Yasumasa Koike
- Department of Pharmacy, National Hospital Organization Shikoku Cancer Centre, Ehime, Japan
| | - Yoshihisa Kitamura
- Department of pharmacotherapy, School of Pharmacy, Shujitsu University, Okayama, Japan
| | - Hiroshi Yamamoto
- Department of Pharmacy, National Hospital Organization Okayama Medical Centre, Okayama, Japan
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Forty years after the first totally implantable venous access device (TIVAD) implant: the pure surgical cut-down technique only avoids immediate complications that can be fatal. Langenbecks Arch Surg 2021; 406:1739-1749. [PMID: 34109472 PMCID: PMC8481188 DOI: 10.1007/s00423-021-02225-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Aim Even though TIVADs have been implanted for a long time, immediate complications are still occurring. The aim of this work was to review different techniques of placing TIVAD implants to evaluate the aetiology of immediate complications. Methods A systematic literature review was performed using the PubMed, Cochrane and Google Scholar databases in accordance with the PRISMA guidelines. The patient numbers, number of implanted devices, specialists involved, implant techniques, implant sites and immediate complication onsets were studied. Results Of the 1256 manuscripts reviewed, 36 were eligible for inclusion in the study, for a total of 17,388 patients with equivalent TIVAD implantation. A total of 2745 patients (15.8%) were treated with a surgical technique and 14,643 patients (84.2%) were treated with a percutaneous technique. Of the 2745 devices (15.8%) implanted by a surgical technique, 1721 devices (62.7%) were placed in the cephalic vein (CFV). Of the 14,643 implants (84.2%) placed with a percutaneous technique, 5784 devices (39.5%) were placed in the internal jugular vein (IJV), and 5321 devices (36.3%) were placed in the subclavian vein (SCV). The number of immediate complications in patients undergoing surgical techniques was 32 (1.2%) HMMs. In patients treated with a percutaneous technique, the number of total complications were 333 (2.8%): 71 PNX (0.5%), 2 HMT (0.01%), 175 accidental artery punctures AAP (1.2%) and 85 HMM (0.6%). No mortality was reported with either technique. Conclusion The percutaneous approach is currently the most commonly used technique to implant a TIVAD, but despite specialist’s best efforts, immediate complications are still occurring. Surgical cut-down, 40 years after the first implant, is still the only technique that can avoid all of the immediate complications that can be fatal.
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Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients: A Meta-analysis. Cancer Nurs 2021; 43:455-467. [PMID: 31464692 DOI: 10.1097/ncc.0000000000000742] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) and implantable port catheters (IPCs) are 2 most common central venous access for cancer patients receiving chemotherapy. However, no specific evidence exists to guide practitioners on safety and less cost. OBJECTIVE To compare the differences of complications and costs of PICC and IPC in the treatment of cancer patients with chemotherapy and to provide a basis for better clinical decision making. METHODS All the cohort studies were searched in the Cochrane Library, JBI, PubMed, Elsevier, Web of Science, CINAHL, CBM, and CNKI from inception to July 2018. Two reviewers screened and selected trials, evaluated quality, and extracted data. Meta-analysis and description of the outcomes were performed by using the RevMan 5.3 software. RESULTS A total of 761 articles were retrieved, with 15 articles meeting eligibility criteria. Outcome analysis showed no difference in 1-puncture success rate. Peripherally inserted central catheter use was associated with higher complication rates than IPC, including occlusion, infection, malposition, catheter-related thrombosis, extravasation, phlebitis, and accidental removal rate. The life span of IPC was longer than that of PICC, and the costs of IPC were lower. CONCLUSIONS Implantable port catheter has advantages over PICC in reducing cancer patients' complications and less cost in terms of long-term cancer chemotherapy. IMPLICATIONS FOR PRACTICE In terms of safety, the results provide evidence for practitioners to choose which type of central venous catheters is better for cancer chemotherapy patients. In terms of costs, practitioners need to make decisions about which type of central venous catheters has less cost.
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Akhtar N, Lee L. Utilization and Complications of Central Venous Access Devices in Oncology Patients. Curr Oncol 2021; 28:367-377. [PMID: 33435136 PMCID: PMC7903275 DOI: 10.3390/curroncol28010039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.
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Affiliation(s)
- Narmeen Akhtar
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada;
- Department of Oncology, Niagara Health, St. Catharines, ON L2S 0A9, Canada
| | - Linda Lee
- Department of Oncology, Niagara Health, St. Catharines, ON L2S 0A9, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
- Correspondence: ; Tel.: +1-905-682-6451; Fax: +1-905-685-3391
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22
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Kaya E, Tollapi L, Pastore A, Aringhieri G, Maisetta G, Barnini S, Paolicchi A, Batoni G, Esin S. Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections. J Med Microbiol 2020; 69:1273-1284. [PMID: 33064069 DOI: 10.1099/jmm.0.001263] [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] [Indexed: 12/13/2022] Open
Abstract
Introduction. Totally implanted venous access ports (TIVAPs) are widely used in patients receiving long-term chemotherapy but may lead to serious complications such as catheter-related bloodstream infections (CRBSIs). Diagnosis of CRBSI requires catheter culture, but there is no consensus on microbiological culture methods to be adopted.Aim. To compare three different procedures to recover bacterial cells from colonized catheters and to determine which section of the TIVAP (i.e. tip, septum, reservoir) is the probable source of infection. To investigate the correlation between blood culture results and TIVAP culture in order to get further evidence about the utility of differential time to positivity (DTP) as a diagnostic tool before TIVAP removal.Hypothesis/Gap statement. Comparisons of different diagnostic procedures for catheter culture have been rarely reported for TIVAPs. We hypothesized that the optimization of methods to recover micro-organisms from different parts of TIVAPs may help to decrease the number of false-negative results in the diagnosis of TIVAP-related bloodstream infections.Methodology. A total of 53 TIVAPs removed because of suspected infection (n=36) or end of use (n=17) were evaluated. The reservoir, the septum and the catheter tip were separated and subjected to different treatments for the recovery of adherent micro-organisms: (a) flushing of the catheter lumen, (b) sonication and flushing, (c) treatment with dithiothreitol and flushing. The three methods were also evaluated in an in vitro catheter infection model with Staphylococcus epidermidis. Culture results were compared to those obtained from paired blood cultures drawn from TIVAP and peripheral vein and to the relative DTP.Results. The results obtained demonstrated that vigorous flushing/vortexing of the catheter lumen/septum, allows the recovery of a number of micro-organisms comparable to that of more complex procedures such as sonication or chemical treatment. Among 24 positive TIVAP-cultures, nine were tip-culture negative, whereas the corresponding reservoirs and septa were culture positive. A good correlation was observed between DTP and TIVAP cultures (P<0.001).Conclusions. The results support the evidence that sending the port reservoir in addition to the catheter tip to the microbiology laboratory may increase the sensitivity and the accuracy of CRBSI diagnosis. Moreover, when a TIVAP-related infection is suspected, DTP is a useful diagnostic tool to decide between device removal or a more conservative approach.
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Affiliation(s)
- Esingül Kaya
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Lara Tollapi
- Anesthesiology and Pain Therapy Unit, Pisa University Hospital, Pisa, Italy
| | - Alberto Pastore
- Anesthesiology and Pain Therapy Unit, Pisa University Hospital, Pisa, Italy
| | - Giacomo Aringhieri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giuseppantonio Maisetta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Pisa University Hospital, Pisa, Italy
| | - Adriana Paolicchi
- Anesthesiology and Pain Therapy Unit, Pisa University Hospital, Pisa, Italy
| | - Giovanna Batoni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Semih Esin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Krümpelmann U, Boseila A, Löhnert M, Kaup O, Clarenbach JJ, Görner M. An analysis of totally implantable central venous port system infections in an urban tertiary referral center. J Chemother 2020; 33:228-237. [PMID: 33030416 DOI: 10.1080/1120009x.2020.1829327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A frequent complication of central venous port systems (CVP) is infection (CVP-I), either local (CVP-LI) or a life-threatening blood stream infection (CVP-BSI). We examined the course of CVP-I including results of an antibiotic eradication attempt of CVP-BSI. We investigated adults with CVP-I from 2010 to 2018 who had to undergo port explantation or were treated by a combination of systemic antibiotics and antibiotic lock therapy (ALT). In nine years we diagnosed 206 CVP-I (CVP-LI: 52; CVP-BSI: 152). In 146 patients with CVP-I the port system was primary explanted, while 56 patients received antibiotics/ALT. 79% of Gram negative pathogens and 50% of coagulase negative staphylococci (CoNS) were eradicated. Failure of antibiotic treatment was more often associated with short time span since CVP implantation, neutropenia and polymicrobial infection. All patients with non-neoplastic disease survived, while 18/173 patients (10%) with underlying malignant disease had a fatal outcome in the same hospital stay.
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Affiliation(s)
| | - Ahmed Boseila
- Department of Thoracic Surgery, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Mathias Löhnert
- Department of Visceral Surgery, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Olaf Kaup
- Microbiologic Laboratory, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Jacob J Clarenbach
- Zentrum für Diabetes, Nieren- und Hochdruckkrankheiten MVZ GmbH, Bielefeld, Germany
| | - Martin Görner
- Department of Oncology, Klinikum Bielefeld Mitte, Bielefeld, Germany
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Vinchurkar KM, Maste P, Togale MD, Pattanshetti VM. Chemoport-associated Complications and Its Management. Indian J Surg Oncol 2020; 11:394-397. [PMID: 33013116 DOI: 10.1007/s13193-020-01067-w] [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: 01/27/2020] [Accepted: 04/01/2020] [Indexed: 12/21/2022] Open
Abstract
Chemoport is being routinely used to administer chemotherapy, blood, blood products, total parenteral nutrition, and also to draw blood for investigations. We started using chemoport in our institute. We use it exclusively to administer chemotherapy. We analyzed our results of chemoport usage and confirm that the rate of complications associated with chemoport usage is at par with the available literature. We also conclude that with regular use, the intra-op and post-op complications will reduce further.
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Affiliation(s)
- Kumar M Vinchurkar
- Department of Surgical Oncology, JNMC KAHER, Belagavi, India
- KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, India
| | - Preeti Maste
- Department of Microbiology, KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, India
| | - Manoj D Togale
- Department of General Surgery, JNMC KAHER, Belagavi, India
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McDevitt JL, Quadri RS, Sutphin PD, Zeikus E, Kwon JK, Browning T, Reddick M. Capacity Prioritization Initiative Reduced the Wait Time for Port Placement and Facilitated Increased Volume of Port Placements at a Large County Health System. Curr Probl Diagn Radiol 2020; 50:288-292. [PMID: 33010973 DOI: 10.1067/j.cpradiol.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022]
Abstract
DESCRIPTION OF THE PROBLEM Wait time from request to placement of ports in interventional radiology had increased from 14 to 27 days over a 4-month period. The goal of this project was to reduce the wait time by 15% within 4 months while accommodating additional volume. INSTITUIONAL APPROACH TO ADDRESS PROBLEM Capacity analysis revealed 2 bottlenecks: (1) inadequate provider capacity for preprocedural visits in interventional radiology clinic and (2) inadequate number of spots for port placement in the angiography schedule. The intervention consisted of: (1) 2 reserved slots in the attending physician's morning clinic schedule and (2) 3 daily guaranteed spots for port placement in the angiography suite. Both changes were integrated into the electronic medical record scheduling system. DESCRIPTION OF OUTCOMES After the intervention, per biweekly period, the number of port requests increased by 17% (Preintervention: 16.6 ± 3.1, Postintervention: 20.1 ± 4.1, P = 0.03), the number of completed clinic visits increased by 19% (Preintervention: 16.7 ± 5.1, Postintervention: 20.5 ± 3.6, P = 0.05), and the number of port placements increased by 19% (Preintervention: 16.9 ± 3.9, Postintervention: 21.0 ± 3.5, P = 0.02). The average wait time from request to placement decreased by 22% (Preintervention: 22.2 ± 4.4 days, Postintervention: 18.3 ± 3.4 days, P = 0.03), driven by a 49% decrease in wait time between request and clinic visit (Preintervention: 11.0 ± 2.3 days, Postintervention: 7.4 ± 1.0 days, P = 0.03). CONCLUSIONS Prioritization of clinic and angiography suite capacity, integrated into the electronic scheduling system, significantly reduced the wait time for port placement, even with significant increases in the volume of port requests.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX.
| | - Rehan S Quadri
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | | | - Eric Zeikus
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | - Jeannie K Kwon
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | - Travis Browning
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | - Mark Reddick
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
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Piredda A, Radice D, Zencovich C, Cerri M, Aventino L, Naccarato F, Magon G, Biffi R. Safe use of Peripherally Inserted Central Catheters for chemotherapy of solid malignancies in adult patients: A 1-year monocentric, prospectively-assessed, unselected cohort of 482 patients. J Vasc Access 2020; 22:873-881. [PMID: 33019880 DOI: 10.1177/1129729820962905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Aim of this study was to analyze the overall complication and failure rates of Peripherally Inserted Central Catheters (PICCs), in a 1-year consecutive unselected cohort of 482 adult patients, affected by non-hematological malignancies undergoing chemotherapy. METHODS Adult outpatients (aged 18-75 years), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, bearing solid tumors and candidates for intravenous chemotherapy were eligible for the study. Exclusion criteria were active infections, coagulopathy (defined as platelet count <50,000/μL and/or prothrombin time more than 18 s), life expectancy <6 months, or inability to give written informed consent. Devices were all implanted in an outpatients' hospital facility, following predefined evidence-based institutional guidelines and protocols by a PICC-dedicated team at the European Institute of Oncology in Milan, Italy, during the 12-month period from January 1 to December 31, 2019. RESULTS Five-hundred PICCs were implanted in a cohort of 482 patients during the time interval of this study. Thirty devices were overall removed (6.2%), 23 as a consequence of a complication occurred, and seven inadvertently. The inserted PICCs accounted for a total of 49,718 catheter days in situ, median duration was 85.5 days [interquartile range (IQR): 56-146]. Overall there were 42 (8.7%) complications, corresponding to 0.84 catheter-adverse events (CAE)/1000 PICC-days (95% CI: 0.61-1.14). There were N = 13 (2.7%) thromboses, N = 11 (2.3%) irreversible occlusions, N = 7 (1.5%) accidental removals, N = 5 (1.0%) infections [two Catheter Related Blood Stream Infection (CRBSI) and three exit site/local infection], N = 3 (0.6%) ruptures and N = 3 (0.6%) primary or secondary malpositions. CONCLUSION This large prospective study supports the increasing use of PICCs in adult oncology outpatients treated in specialized centers with chemotherapy for non-hematological malignancies. In this clinical setting, PICC failure occurred in 6% only of the inserted devices.
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Affiliation(s)
- Alessio Piredda
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, IRCCS, Milano, Italy
| | - Claudia Zencovich
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Martina Cerri
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Lucia Aventino
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Francesco Naccarato
- PICC Team/Vascular Access Service, Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Giorgio Magon
- Department of Nursing, European Institute of Oncology, IRCCS, Milano, Italy
| | - Roberto Biffi
- Division of G-I Surgery, and PICC Team/Vascular Access Service, European Institute of Oncology, IRCCS, Milano, Italy
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27
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Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost 2020; 18:2253-2273. [PMID: 32479699 DOI: 10.1111/jth.14930] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP-associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. METHODS Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. RESULTS In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24-3.28), and 0.08 (95 CI: 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95% CI: 2.94-4.76). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. CONCLUSIONS Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.
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Affiliation(s)
- Meng Jiang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, Wuhan, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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28
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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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Gowin E, Świątek-Kościelna B, Mańkowski P, Januszkiewicz-Lewandowska D. The Profile of Microorganisms Responsible for Port-Related Bacteremia in Pediatric Hemato-Oncological Patients. Cancer Control 2020; 27:1073274820904696. [PMID: 32157910 PMCID: PMC7092702 DOI: 10.1177/1073274820904696] [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] [Indexed: 11/16/2022] Open
Abstract
Patients with pediatric cancer face an increased risk of infections. In most cases, these infections are associated with the use of a long-term central venous catheter. This study describes the epidemiology of a port-associated bacteremia as well as a profile of microorganisms responsible for port-associated bloodstream infections (PABSIs) in pediatric patients with cancer treated in a single center. The retrospective analysis included patients with cancer who had implanted a port, hospitalized between 2010 and 2015 at the Department of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences. The medical records of patients were reviewed for demographic characteristics, diagnosis, port-related complications, and their management. Data were collected from patients' electronic medical records containing complete information on medical examinations and supplementary tests, diagnosis, timing, and type of port-associated complications. In a study period, 277 ports were inserted to 241 patients. A total of 183 094 catheter days were analyzed. Sixteen patients had more than 1 insertion of a port. The commonest observed complication was PABSI (40.07%) and the incidence density was 0.6 per 1000 port-days. Staphylococcus was the most commonly isolated organisms from patients with PABSI. From all port-associated complications, bloodstream infections and mechanical complications were the most often observed complications. The commonest pathogens responsible for PABSI were coagulase-negative staphylococci. Pathogens resistant to standard antibiotic treatment play an important role in PABSI, with methicillin-resistant Staphylococcus epidermidis being the predominant pathogen. Port-associated bloodstream infections are a common reason for preterm removal of a port.
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Affiliation(s)
- Ewelina Gowin
- Department of Health Promotion, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Przemysław Mańkowski
- Department of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
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31
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An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.594025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Rhu J, Jun KW, Song BJ, Sung K, Cho J. Cephalic vein approach for the implantable central venous access: A retrospective review of the single institution's experiences; Cohort Study. Medicine (Baltimore) 2019; 98:e18007. [PMID: 31725671 PMCID: PMC6867776 DOI: 10.1097/md.0000000000018007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.
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33
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Velioğlu Y, Yüksel A, Sınmaz E. Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:499-507. [PMID: 32082916 PMCID: PMC7018162 DOI: 10.5606/tgkdc.dergisi.2019.17972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/31/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to present clinical characteristics, peri-procedural outcomes, early and late complications, and management strategies in patients undergoing totally implantable venous access port insertion through percutaneous subclavian vein. METHODS A total of 2,084 port devices were inserted to 2,000 cancer patients (1,066 males, 934 females; mean age 58.4±12.7 years; range, 18 to 88 years) through subclavian vein using percutaneous landmark method between March 2012 and June 2018. Medical data including demographic features, primary diagnosis, technical success, procedural time, duration of device use, reasons for the device removal, and early and late complications were retrospectively analyzed. RESULTS The most common type of cancer was colon cancer in males and breast cancer in females. Technical success rate of the procedure was 98.5%. Right subclavian vein was accessed in the majority of patients (92.4%). Early complications including inadvertent arterial puncture, catheter malposition, superficial hematoma, and pneumothorax occurred in 143 patients (6.9%), while late complications including infection, catheter occlusion, venous thrombosis, wound problems, catheter migration and embolization and pinch-off syndrome was developed in 118 patients (5.7%). Inadvertent arterial puncture in 63 patients (3%) was the most common early complication, while infection in 44 patients (2.1%) was the most common late complication. A total of 192 devices were removed due to the completion of chemotherapy or development of complications. CONCLUSION Our study confirmed the safety and tolerability of totally implantable venous access port insertion through percutaneous subclavian vein with high technical success and low complication rates.
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Affiliation(s)
- Yusuf Velioğlu
- Department of Cardiovascular Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ahmet Yüksel
- Department of Cardiovascular Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Emrah Sınmaz
- Department of Thoracic Surgery, Bursa Ali Osman Sönmez Oncology Hospital
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34
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Zhang P, Du J, Fan C, Mo X, Dong J, Fan Z, Zhao Q. Utility of totally implantable venous access ports in patients with breast cancer. Breast J 2019; 26:333-334. [PMID: 31541507 PMCID: PMC7065211 DOI: 10.1111/tbj.13595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Peng Zhang
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
| | - Jun Du
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
| | - Changsheng Fan
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
| | - Xueli Mo
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
| | - Jie Dong
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
| | - Zhenhua Fan
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
| | - Qikang Zhao
- Department of Breast Diseases, Peking University Shougang Hospital, Beijing, China
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Wu CY, Fu JY, Wu CF, Hsieh MJ, Wen CT, Cheng CH, Liu YH, Ko PJ. Superior Vena Cava Port Catheter Tip Confirmation: Quantified Formula for Intravascular Catheter Length versus Anatomic Landmark Reference. Ann Vasc Surg 2019; 60:193-202. [PMID: 31075484 DOI: 10.1016/j.avsg.2019.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate tip location is crucial for intravenous port implantation because it can minimize catheter-related complications. Adequate tip location cannot be observed directly and needs to be confirmed by imaging tools. A quantified intravascular catheter length formula has been proposed and we attempt to compare its clinical effectiveness with anatomic landmark references. METHODS During the period from March 2012 to February 2013, 503 patients who received port implantation where implanted catheter length depended on carina level as confirmed by intraoperative fluoroscopy were assigned to Group A. From March 2013 to February 2014, 521 patients who received port implantation based on quantified intravascular catheter length formula were assigned to Group B. Clinical outcomes were compared. RESULTS Catheter tip location of Group A, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.18 ± 0.51 and 1.1 ± 1.3 cm below carina, respectively. Catheter tip location of Group B, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.25 ± 1.05 and 1.05 ± 1.32 cm below carina, respectively. Similar catheter tip location was identified in both groups. The functional period of implanted ports, complication rate (3.58% and 2.53%), and incidence (0.049 and 0.0506 episodes/1,000 catheter days) were similar in both groups. CONCLUSIONS The quantified intravascular catheter length formula can predict an adequate catheter length just as well as carina do and results in good catheter tip location. The formula could replace the clinical use of anatomic landmarks and serve as an easy tool for practitioners.
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Affiliation(s)
- Ching-Yang Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Jui-Ying Fu
- Chest Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Feng Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tsung Wen
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hui Cheng
- Cardiovascular Physiology Laboratory, Department of Medical Research and Development, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Skelton WP, Franke AJ, Welniak S, Bosse RC, Ayoub F, Murphy M, Starr JS. Investigation of Complications Following Port Insertion in a Cancer Patient Population: A Retrospective Analysis. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2019; 13:1179554919844770. [PMID: 31040735 PMCID: PMC6482646 DOI: 10.1177/1179554919844770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/27/2019] [Indexed: 11/24/2022]
Abstract
Central venous access devices, specifically implantable ports, play an essential role in the care of oncology patients; however, complications are prevalent. This retrospective single-institutional review was performed to identify rates of complications from port placement and potential factors associated with these events. A retrospective analysis of 539 cancer patients who underwent port insertion between March 2016 and March 2017 at our institution was conducted. Data examining 18 potentially predictive factors were collected, and multivariate analysis was conducted using logistic regression and odds ratios (ORs) with standard errors to determine predictive factors. Out of 539 patients, 100 patients (19%) experienced 1 complication, and 12 patients (2%) experienced 2 or more complications. An overall lower rate of complications was seen in patients on therapeutic anticoagulation (OR: 0.17, P < .001) or on antiplatelet agents (OR: 0.47, P = .02). No patients on therapeutic anticoagulation developed venous thromboembolism (VTE; 0%). Right-sided port insertion was associated with decreased rates of infection (OR: 0.44, P = .04). Insertion as inpatient was associated with an increased risk for mechanical failure (OR: 4.60, P < .01). This analysis identified multiple predictive factors that can potentially put patients at a higher risk of experiencing complications following port insertion. Our data show lower rates of VTE for patients on anticoagulation or antiplatelet therapy. Further analysis is also necessary to determine why port insertion as an inpatient places patients at a higher risk of complications. This study highlights the risks associated with port placement and prompts the clinician to have an informed discussion with the patient weighing the risks and benefits.
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Affiliation(s)
- William Paul Skelton
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aaron J Franke
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samantha Welniak
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Raphael C Bosse
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Fares Ayoub
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Martina Murphy
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jason S Starr
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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37
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Implanted vascular access device related deep vein thrombosis in oncology patients: A prospective cohort study. Thromb Res 2019; 177:117-121. [DOI: 10.1016/j.thromres.2019.02.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/17/2019] [Accepted: 02/28/2019] [Indexed: 01/13/2023]
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38
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Vlasenko SV, Agarkov MV, Khilchuk AA, Scherbak SG, Sarana AM, Karmazanashvili EG, Kalinina LP, Volkov VG. Endovascular management of the peripherally inserted central venous catheter iatrogenic pinch-off syndrome: A case report. Radiol Case Rep 2019; 14:381-384. [PMID: 30627295 PMCID: PMC6319189 DOI: 10.1016/j.radcr.2018.12.009] [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: 12/06/2018] [Revised: 12/16/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022] Open
Abstract
The recent increase in the number of patients with implanted peripherally inserted central catheters (PICCs) requires physicians to be familiar with rare and unusual complication–pinch-off syndrome (POS). We present a case of a 40-years-old female with human epidermal growth factor receptor type 2 (HER2)–positive breast cancer and implanted Groshong PICC (BARD). The patient was admitted for an elective chest and abdomen CT angiography control after finishing her trastuzumab and paclitaxel chemotherapy course a month earlier. Immediately after the contrast media power injection, the PICC line was embolized to the right segmental pulmonary artery. Due to the low complications rate and early patient ambulation percutaneous foreign body retrieval is a primary option for the pinch-off syndrome, especially in frail, and vulnerable cancer patients. This case underscores the feasibility and safety of percutaneous venous interventions in patients with embolized venous infusion devices.
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Affiliation(s)
- Sergey V Vlasenko
- Department of Interventional Radiology, City Hospital no.40, Borisova str. 9, Sestroretsk, Saint-Petersburg, 197706, Russian Federation.,Saint-Petersburg State University, Universitetskaya emb. 7-9, Saint-Petersburg, 199034, Russian Federation
| | - Maksim V Agarkov
- Department of Interventional Radiology, City Hospital no.40, Borisova str. 9, Sestroretsk, Saint-Petersburg, 197706, Russian Federation
| | - Anton A Khilchuk
- Department of Interventional Radiology, City Hospital no.40, Borisova str. 9, Sestroretsk, Saint-Petersburg, 197706, Russian Federation.,Department of Endovascular and Arrhythmology, Russian National Research Center of Surgery, Abrikosovsky 2, Moscow, 119991, Russian Federation
| | - Sergey G Scherbak
- Saint-Petersburg State University, Universitetskaya emb. 7-9, Saint-Petersburg, 199034, Russian Federation
| | - Andrey M Sarana
- Saint-Petersburg State University, Universitetskaya emb. 7-9, Saint-Petersburg, 199034, Russian Federation
| | - Evgeniy G Karmazanashvili
- Department of Postgraduate surgery, Medical-Military Academy named after S.M. Kirov, Academic Lebedev str. 6, Saint-Petersburg, 194044, Russian Federation
| | - Linda P Kalinina
- Department of Dental Medicine and Medical Technologies, Saint-Petersburg State University, Universitetskaya emb. 7-9, Saint-Petersburg, 199034, Russian Federation
| | - Vladislav G Volkov
- Department of Medicine, Pavlov First Saint Petersburg State Medical University, L'va Tolstogo str. 6-8, Saint-Petersburg, 197022, Russian Federation
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Blanco-Guzman MO. Implanted vascular access device options: a focused review on safety and outcomes. Transfusion 2018; 58 Suppl 1:558-568. [PMID: 29443407 DOI: 10.1111/trf.14503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports.
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Affiliation(s)
- Merilda O Blanco-Guzman
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
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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. Eur J Surg Oncol 2018; 45:275-278. [PMID: 30087070 DOI: 10.1016/j.ejso.2018.07.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/11/2018] [Accepted: 07/18/2018] [Indexed: 12/24/2022] Open
Abstract
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.
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Alzahrani K, Lejeune J, Lakhal W, Morel B, Cook AR, Braïk K, Lardy H, Binet A. Polyurethane versus silicone port a cath: What's going on at removal? J Pediatr Surg 2018; 53:1417-1419. [PMID: 28689888 DOI: 10.1016/j.jpedsurg.2017.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Port-a-cath (PAC) is an essential device in the management of the patients of chronic illness, but despite theirs benefits there are many complications either at the time of insertion or at time of removal. Our aim of this study is to evaluate the fracture rate of the catheter at removal time in comparison with catheter type either polyurethane or silicone. METHODS A retrospective monocentric study of all PACs which were removed at our university pediatric hospital between 1 January 2006 and 31 December 2016. Two groups were compared: polyurethane group and silicone group. RESULTS Total of 216 central lines were removed, the mean age at the time of extraction was 9.7±4.9years and the mean time for both catheter was 2.7±1.6years, fracture occurred in 11 catheter of the polyurethane group (n=119), with no fracture of silicone group (n=86), in the polyurethane group, the risk of catheter fracture is significantly related to the duration of the PAC in place. CONCLUSION We found that the polyurethane-based catheters are more vulnerable for rupture and retained fragment in the blood vessels, especially if left in place for long time, for this reason we have switched to silicone-based catheter and all catheters should be remove within duration maximal of 2years. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Khalid Alzahrani
- Pediatric Surgery Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Julien Lejeune
- Pediatric Onco-hematology Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Walid Lakhal
- Pediatric Surgery Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Baptiste Morel
- Pediatric Radiology Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Ann-Rose Cook
- Pediatric Surgery Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Karim Braïk
- Pediatric Surgery Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Hubert Lardy
- Pediatric Surgery Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Aurelien Binet
- Pediatric Surgery Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
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Zhang S, Kobayashi K, Faridnia M, Skummer P, Zhang D, Karmel MI. Clinical Predictors of Port Infections in Adult Patients with Hematologic Malignancies. J Vasc Interv Radiol 2018; 29:1148-1155. [PMID: 29960670 DOI: 10.1016/j.jvir.2018.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To identify clinical predictors of port infections in adult patients with hematologic malignancies. MATERIALS AND METHODS A retrospective chart review identified 223 adult patients (age ≥ 18 y) with hematologic malignancies, including lymphoma (n = 163), leukemia (n = 49), and others (n = 11), who had a port placed from 2012 to 2015. Early (< 30 d after port placement) and overall port infections (bloodstream and site infections) were recorded. To elucidate clinical predictors for early and overall port infections, proportional subdistribution hazard regression (PSHREG) analyses were conducted with variables including patients' demographics, medications used, laboratory data, and port characteristics. RESULTS Total duration of follow-up was 83,722 catheter-days (median per patient, 274 catheter-days). Early and overall port infections were identified in 8 (3.6%) and 26 (11.7%) patients, respectively. Early and overall infection rates were 1.2 and 0.3 infections/1,000 catheter-days, respectively. Backward stepwise multivariate PSHREG analyses identified hypoalbuminemia (< 3.5 mg/dL) at the time of port placement (hazard ratio = 5.03; 95% confidence interval, 1.14-22.16; P = .03) and steroid use (> 30 d cumulatively during follow-up period) (hazard ratio = 3.41; 95% confidence interval, 1.55-7.47; P = .002) as independent risk factors for early and overall port infections, respectively. CONCLUSIONS In adult patients with hematologic malignancies, hypoalbuminemia at the time of port placement was a clinical predictor for early port infections, whereas steroid use was a clinical predictor for overall port infections.
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Affiliation(s)
- Shunqing Zhang
- Division of Interventional Radiology, Department of Radiology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210
| | - Katsuhiro Kobayashi
- Division of Interventional Radiology, Department of Radiology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.
| | - Masoud Faridnia
- Division of Interventional Radiology, Department of Radiology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210
| | - Philip Skummer
- Division of Interventional Radiology, Department of Radiology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210
| | - Dianbo Zhang
- Division of Interventional Radiology, Department of Radiology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210
| | - Mitchel I Karmel
- Division of Interventional Radiology, Department of Radiology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210
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Hong S, Seo TS, Song MG, Seol HY, Suh SI, Ryoo IS. Clinical outcomes of totally implantable venous access port placement via the axillary vein in patients with head and neck malignancy. J Vasc Access 2018; 20:134-139. [PMID: 29923460 DOI: 10.1177/1129729818781270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE: To evaluate the clinical outcomes and complications of totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy. MATERIALS AND METHODS: A total of 176 totally implantable venous access ports were placed via the axillary vein in 171 patients with head and neck malignancy between May 2012 and June 2015. The patients included 133 men and 38 women, and the mean age was 58.8 years (range: 19-84 years). Medical records were retrospectively reviewed. RESULTS: This study included a total of 93,237 totally implantable venous access port catheter-days (median 478 catheter-days, range: 13-1380 catheter-days). Of the 176 implanted totally implantable venous access port, complications developed in nine cases (5.1%), with the overall incidence of 0.097 events/1000 catheter-days. The complications were three central line-associated blood-stream infection cases, one case of keloid scar at the needling access site, and five cases of central vein stenosis or thrombosis on neck computed tomography images. The 133 cases for which neck computed tomography images were available had a total of 59,777 totally implantable venous access port catheter-days (median 399 catheter-days, range: 38-1207 catheter-days). On neck computed tomography evaluation, the incidence of central vein stenosis or thrombosis was 0.083 events/1000 catheter-days. Thrombosis developed in four cases, yielding an incidence of 0.067 events/1000 catheter-days. All four patients presented with thrombus in the axillary or subclavian vein. Stenosis occurred in one case yielding an incidence of 0.017 events/1000 catheter-days. One case was catheter-related brachiocephalic vein stenosis, and the other case was subclavian vein stenosis due to extrinsic compression by tumor progression. Of the nine complication cases, six underwent port removal. CONCLUSION: These data indicate that totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy is safe and feasible, with a low axillary vein access-related complication rate.
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Affiliation(s)
- Sun Hong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Myung Gyu Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hae-Young Seol
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - In-Seon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Shen Y, Zhang XP, Ge F, Huang H, Li L. Maintenance of totally implantable ports in Zhongshan Hospital: a best practice implementation project. ACTA ACUST UNITED AC 2018; 14:257-66. [PMID: 27532318 DOI: 10.11124/jbisrir-2016-2517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The totally implantable port is a common central venous access device. The cost of implantation and maintenance however is very expensive. At present, the biggest problem regarding the promotion and the use of implantable ports in China is lack of well trained professional healthcare providers. Furthermore, maintenance of totally implantable ports by nurses is poor and patients may easily get complications. AIMS/OBJECTIVES This project aimed to reduce the incidence of complications among general surgery patients with implantable ports, and improve healthcare safety and the care process, strictly in compliance with current evidence-based criteria. METHODS A baseline audit on maintenance of totally implantable ports utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System program was undertaken from 1 April to 15 May 2015 that involved 25 nurses and 25 patients. An intervention including education, demonstration, clinical practice and assessment was conducted from 16 May to 15 July 2015. A post-implementation re-audit was completed from 16 July to 10 August 2015. RESULTS The results of the audit for the nine audit criteria for totally implantable port maintenance were as follows: the compliance rate for Criteria 2 and 3 increased from 0% to 100%, Criterion 1 from 80% to 100%, Criterion 4 from 92% to 100%, Criterion 5 from 68% to 100%, Criterion 6 remained as 100%, Criterion 7 from 12% to 100%, Criterion 8 from 0% to 96% and Criterion 9 from 88% to 100%. During implementation we found four barriers and undertook measures to address them. CONCLUSIONS This project achieved a significant improvement in establishing evidence-based practice regarding maintenance of totally implantable ports in the general surgery ward. Strategies in sustaining best practice should be developed in the future.
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Pinelli F, Cecero E, Degl'Innocenti D, Selmi V, Giua R, Villa G, Chelazzi C, Romagnoli S, Pittiruti M. Infection of totally implantable venous access devices: A review of the literature. J Vasc Access 2018; 19:230-242. [PMID: 29512430 DOI: 10.1177/1129729818758999] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient's quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients' morbidity and mortality-both in the hospital or outpatient setting-and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device-related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device-related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device-related infections.
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Affiliation(s)
- Fulvio Pinelli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elena Cecero
- 2 Department of Health Science, University of Florence, Florence, Italy
| | | | - Valentina Selmi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rosa Giua
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Gianluca Villa
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Cosimo Chelazzi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- 4 Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Antimicrobial therapy in palliative care: an overview. Support Care Cancer 2018; 26:1361-1367. [DOI: 10.1007/s00520-018-4090-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
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Imaoka Y, Kuranishi F, Ogawa Y. Usefulness of Totally Implantable Central Venous Access Devices in Elderly Patients: A Retrospective Study. ANNALS OF NUTRITION AND METABOLISM 2018; 72:112-116. [PMID: 29353284 DOI: 10.1159/000486534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 12/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The need for totally implantable central venous access devices (TICVADs) has increased with increased opportunities in the use of chemotherapy and parenteral nutrition. This study aimed to determine the outcomes of TICVAD implantation and use in patients aged ≥85 years. METHODS Between January 2010 and August 2016, 117 patients underwent TICVAD implantation and their records were retrospectively reviewed. RESULTS Participants were divided into 2 groups (plus-85 and sub-85 groups). Fifty-five patients (47.0%) had solid organ cancer alone; 35 patients (29.9%) had cerebrovascular or cranial nerve disease. The average follow-up period was 201 (2-1,620) days. Major complications were identified in 6 (14.6%) plus-85 patients and 11 (14.5%) sub-85 patients (p = 0.9813). Catheter-related infections developed in 3 plus-85 (7.3%) and 4 sub-85 patients (5.3%; p = 0.6549). There were no significant group differences in hematoma, pneumothorax, occlusion, and removal rates. In plus-85 patients examined just before surgery and a month after surgery, increased rates of serum albumin and Onodera's prognostic nutritional index were observed in 48% (14/39) and 41% (12/39), respectively. CONCLUSIONS The use of TICVADs in the plus-85 group resulted in effective outcomes. The results of this retrospective study support the wider use of TICVADs in patients aged ≥85 years.
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Affiliation(s)
- Yuki Imaoka
- Department of Surgery, Innoshima Ishikai Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumito Kuranishi
- Department of Surgery, Innoshima Ishikai Hospital, Hiroshima, Japan
| | - Yoshiteru Ogawa
- Department of Surgery, Innoshima Ishikai Hospital, Hiroshima, Japan
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Long-term clinical outcomes of the single-incision technique for implantation of implantable venous access ports via the axillary vein. J Vasc Access 2017; 18:345-351. [DOI: 10.5301/jva.5000751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate long-term clinical outcomes and complications of the single-incision technique for implantation of totally implantable venous access ports (TIVAPs) via the axillary vein. Materials and Methods A total of 932 TIVAPs were placed in 927 patients between May 2012 and October 2014 using a single-incision technique. Patients included 620 men and 307 women with a mean age of 60.0 years. TIVAPs were placed via the left (n = 475) and right (n = 457) axillary veins after making a single oblique vertical incision and medial side pocket without subcutaneous tunneling. We retrospectively reviewed medical records to evaluate status of the patients and TIVAPs, complications, and reasons for explantation. In patients who still had a TIVAP in place, we calculated the duration of TIVAP use from the cut-off day of November 1, 2015. Results Clinical follow-up was obtained for a total device service period of 311,069 days with a median indwelling time of 467 days (range: 3-1097 days). A total of 37 (4.0%) complications developed. Early complications (n = 4) were one case each of stenosis of the brachiocephalic vein by tumor growth, thrombosis of axillary vein, intravascular migration, and malfunction depending on patient's position. Late complications (n = 33) were suspected catheter-related blood stream infection (n = 23), local infection of the pocket (n = 4), symptomatic stenosis and thrombosis of central vein (n = 4), malfunction by fibrin sleeve (n = 1), and intravascular migration (n = 1). Conclusions A single-incision technique for TIVAP implantation via the axillary vein seems to be safe with a low risk of complication.
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Viana Taveira MR, Lima LS, de Araújo CC, de Mello MJG. Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study. Pediatr Blood Cancer 2017; 64:336-342. [PMID: 27666952 DOI: 10.1002/pbc.26225] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. PROCEDURE A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients. Sociodemographic, clinical, and TIVAP insertion-related variables were evaluated, with the endpoint being the first CLABSI. A Kaplan-Meier analysis was performed to determine CLABSI-free catheter survival. RESULTS Overall, 188 children were evaluated over 77,541 catheter days, with 94 being diagnosed with CLABSI (50%). Although coagulase-negative staphylococci were the pathogens most commonly isolated, Gram-negative microorganisms (46.8%) were also prevalent. In the multivariate analysis, factors that increased the risk for CLABSI were TIVAP insertion prior to chemotherapy (risk ratio [RR] = 1.56; P < 0.01), white blood cell count less than 1,000 mm-3 on the day of implantation (RR = 1.64; P < 0.01), and chronic malnutrition (RR = 1.41; P < 0.05). Median time without CLABSI following TIVAP insertion was 74.5 days. CONCLUSIONS Risk factors for CLABSI in pediatric cancer patients with a TIVAP may be related to the severity of the child's condition at catheter insertion. Insertion of the catheter before chemotherapy and unfavorable conditions such as malnutrition and bone marrow aplasia can increase the risk of CLABSI. Protocols must be revised and surveillance increased over the first 10 weeks of treatment.
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Affiliation(s)
| | - Luciana Santana Lima
- Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, Pernambuco, Brazil
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