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Kehagias E, Galanakis N, Tsetis D. Central venous catheters: Which, when and how. Br J Radiol 2023; 96:20220894. [PMID: 37191031 PMCID: PMC10607393 DOI: 10.1259/bjr.20220894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Short-term or long-term CVCs are now considered the standard of practice for the administration of chemotherapy, fluid therapy, antibiotic therapy, and parenteral nutrition. Central venous access catheters are broadly divided into tunneled or non-tunneled catheters. Tunneled catheters can be further subdivided into totally implanted and totally not implanted devices. Device selection generally depends on various factors such as availability of peripheral veins, expected duration of therapy, and desired flow rate. Ultrasound-guided access is the safest technique for central venous access compared to the landmark technique and departments should strive to for a 100% ultrasound guided access. This review gives a basic overview of the differences of CVC catheters including PICCs, Hickman-catheters and port-catheters along with the criteria for CVC selection. It will also describe technical tips on placement of CVCs. Finally, it aims to highlight complications which are associated with CVC placement and options to treat or prevent them.
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Affiliation(s)
- Elias Kehagias
- Department of Medical Imaging, Heraklion University Hospital, University of Crete Medical School, Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Department of Medical Imaging, Heraklion University Hospital, University of Crete Medical School, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, Heraklion University Hospital, University of Crete Medical School, Heraklion, Crete, Greece
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Rieger MJ, Schenkel X, Dedic I, Brunn T, Gnannt R, Hofmann M, de Rougemont O, Stolz SM, Rösler W, Studt JD, Balabanov S, Wicki A, Lorch A, Manz MG, Schwotzer R. Complication rates of peripherally inserted central catheters vs implanted ports in patients receiving systemic anticancer therapy: A retrospective cohort study. Int J Cancer 2023; 153:1397-1405. [PMID: 37254629 DOI: 10.1002/ijc.34612] [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: 01/22/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023]
Abstract
While implanted port catheters ("PORTs") have historically been the standard device for intravenous systemic anticancer therapy, the use of peripherally inserted central catheters (PICCs) has increased continuously and reliable catheter selection guidelines are lacking. We compare complication rates of PORTs and PICCs in cancer treatment in a retrospective study of 3365 patients with both solid organ (n = 2612) and hematologic (n = 753) malignancies, between 2001 and 2021. 26.4% (n = 890) of all patients were treated via PICCs and 73.6% (2475) via PORTs. 20.7% (578) experienced a major catheter-related complication with a higher rate in PICCs than in PORTs (23.5% vs 14.9%, P < .001). Among major complications, infections and mechanical complications were more common in PICCs than in PORTs (11.9% vs 6.4%, P = .001, 7.3% vs 4.2%, P = .002), whereas the rate of thrombosis was similar (3.4% vs 3.0%, P = .9). While PORTs had a higher rate of periprocedural complications (2.7% vs 1.1%, P < .05), PICCs overall complication rate exceeded PORTs within 3 days from implantation. Median follow-up was 49 (PICC) and 60 weeks (PORT). PORTs are safer and therefore should be preferred in this setting regardless of catheter dwell time.
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Affiliation(s)
- Max J Rieger
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Xenia Schenkel
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Ivona Dedic
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Tadeusz Brunn
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ralph Gnannt
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Hofmann
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian M Stolz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Wiebke Rösler
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Jan-Dirk Studt
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Balabanov
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
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Sugawara S, Sone M, Sakamoto N, Sofue K, Hashimoto K, Arai Y, Tokue H, Takigawa M, Mimura H, Yamanishi T, Yamagami T. Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version). INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:105-117. [PMID: 37485481 PMCID: PMC10359169 DOI: 10.22575/interventionalradiology.2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/22/2022] [Indexed: 07/25/2023]
Abstract
The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | | | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Japan
| | | | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
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Shan J, Lv S, Li H, Wang D, Zhang X, Liu W. A comparative study between two methods of delivery of chemotherapeutic agent in patients with bone and soft tissue sarcoma of lower extremity. BMC Musculoskelet Disord 2023; 24:317. [PMID: 37087416 PMCID: PMC10122285 DOI: 10.1186/s12891-023-06417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/10/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND We aimed to compare the effects of peripherally inserted central catheters (PICC) and implantable venous access devices (TIVADs) in terms of complications and shoulder function in patients with malignant bone and soft tissue tumors of the lower extremities. METHODS We analyzed 65 cases of TIVADs (chest wall) and 65 cases of PICC at the orthopedic department of the Fourth Hospital of Hebei Medical University between June 2019 and December 2021, which were diagnosed with malignant bone tumors or soft tissue tumors of the lower extremities (tumors had to be relatively sensitive to chemotherapy), received regular chemotherapy, with ≥ 14 cycles (42 weeks). The two groups were compared in terms of catheter indwelling time, catheter-related complications, Constant-Murley shoulder function score, and displacement of the position of the catheter end on the catheterization side. RESULTS Compared to the PICC group, at six months after catheterization, the TIVADs group reported better outcomes for catheter indwelling time, catheter-related complications, and Constant-Murley score for the catheterization-side shoulder joint (p < 0.05). The TIVADs group also reported less displacement of the catheter end position after 180° abduction of the catheterization-side shoulder joint (p < 0.05). CONCLUSIONS Compared with PICC, TIVADs can prolong catheter indwelling time, reduce catheter-related complications, and maintain shoulder joint function, which makes it an ideal venous-access approach when providing chemotherapy to patients with malignant bone and soft tissue tumors of the lower extremities.
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Affiliation(s)
- Jing Shan
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China.
| | - Sumei Lv
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
| | - Haihong Li
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Donglai Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
| | - Xiaoyu Zhang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
| | - Wei Liu
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Provincial Cancer Institute, Shijiazhuang, Hebei, China
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Pugalenthi LS, Ahmad M, Reddy S, Barkhane Z, Elmadi J, Satish Kumar L. Malignancy and Endocarditis: Divulging Into the Intertwined Association. Cureus 2022; 14:e24089. [PMID: 35573527 PMCID: PMC9098766 DOI: 10.7759/cureus.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
Cancer is an immunosuppressive disorder with characteristic features of unchecked cell growth, invasion, and sometimes thromboembolism leading to multiple systemic sequelae, including infective endocarditis. This article has compiled some of the crucial mechanisms by which infective endocarditis occurs in cancer patients, its risk factors, and the existing treatment interventions. It has focused on the necessity of being aware that these multiple pathogeneses are involved in the development of infective endocarditis (IE) in cancer patients, which would help delineate the risk factors associated with the condition and help physicians screen better for specific red flags. Identifying these risk factors and patient-oriented therapy, targeting the necessary elements such as causative organism, patient immune status, type of cancer, choosing evidence-based treatment modalities, and to improve the outcome of the disease in an already exasperating condition called cancer.
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Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients. Pediatr Infect Dis J 2022; 41:133-139. [PMID: 34596627 DOI: 10.1097/inf.0000000000003315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship of early catheter-related bloodstream infections (CRBSIs) with perioperative neutropenia and antibiotic prophylaxis is not well established. We sought to evaluate perioperative factors associated with early CRBSIs in newly diagnosed pediatric cancer patients, particularly hematologic indices and antibiotic use. METHODS We retrospectively reviewed national registry records of newly diagnosed pediatric cancer patients with port-a-caths inserted using standardized perioperative protocols where only antibiotic use was not regulated. Thirty-day postoperative CRBSI incidence was correlated with preoperative factors using logistic regression and with postoperative blood counts using linear trend analysis. RESULTS Among 243 patients, 17 CRBSIs (7.0%) occurred at median 14 (range, 8-28) postoperative days. Early CRBSIs were significantly associated with cancer type [acute myeloid leukemia and other leukemias (AML/OLs) vs. solid tumors and lymphomas (STLs): odds ratio (OR), 5.09; P = 0.0036; acute lymphoblastic leukemia vs. STL: OR 0.83; P = 0.0446] but not preoperative antibiotics, absolute neutrophil counts and white blood cell counts. Thirty-day postoperative absolute neutrophil counts and white blood cell trends differed significantly between patients with acute lymphoblastic leukemia and STLs (OR 0.83, P < 0.05) and between AML/OLs and STLs (OR 5.09, P < 0.005), with AML/OL patients having the most protracted neutropenia during this period. CONCLUSIONS Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates. Instead, AML/OL patients, particularly those with prolonged neutropenia during the first 30 postoperative days, were at increased risk. Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropenia as a major contributing factor for early CRBSI.
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Augustin AM, Kertels O, Wiegering V, Thurner A, Kickuth R. Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients. Pediatr Radiol 2022; 52:1550-1558. [PMID: 35368211 PMCID: PMC9271099 DOI: 10.1007/s00247-022-05321-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. OBJECTIVE To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. MATERIALS AND METHODS Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. RESULTS Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. CONCLUSION Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080, Würzburg, Germany.
| | - Olivia Kertels
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| | - Verena Wiegering
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Strasse 6, DE 97080 Würzburg, Germany
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Grable C, Yusuf S, Song J, Viola GM, Ulhaq O, Banchs J, Jensen CT, Goel H, Hassan S. Characteristics of infective endocarditis in a cancer population. Open Heart 2021; 8:openhrt-2021-001664. [PMID: 34344722 PMCID: PMC8336187 DOI: 10.1136/openhrt-2021-001664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background Infective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE. Objectives Limited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality. Methods A retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed. Results Following the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis. Conclusions Overall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.
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Affiliation(s)
- Cullen Grable
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed Yusuf
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, Houston, Texas, USA
| | - Owais Ulhaq
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Banchs
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Corey T Jensen
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harsh Goel
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saamir Hassan
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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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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Kao CY, Fu CH, Cheng YC, Chen JL, Cheng YC, Chen CCC, Chai JW. Outcome analysis in 270 radiologically guided implantations of totally implantable venous access ports via basilic vein. J Chin Med Assoc 2020; 83:295-301. [PMID: 31990818 DOI: 10.1097/jcma.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) are widely applied in patients who require chemotherapy, parenteral nutrition, or frequent intravenous drug infusion. Although various venous access routes are possible for TIVAP insertion, the best method remains a topic of controversy. We present a single-center retrospective study of radiologically guided placement of TIVAPs through the basilic vein, with analysis of technical feasibility, patient safety, and device-related complications. METHODS We retrospectively reviewed 270 patients who received TIVAP implantation through the basilic vein from November 2013 to July 2016, under imaging guidance by an interventional radiology team at our institution. Fluoroscopic images, chest radiographs, computed tomography scans, and medical records were reviewed after port implantation. Catheter maintenance days were calculated and catheter-related complications were recorded. RESULTS The procedural success rate was 99.3%. In total, 270 TIVAPs were implanted in 270 patients, of which 150 remained functional at the end of the study period. The total catheter maintenance days was 77 543 days, and the mean catheter indwelling duration was 287 ± 207 days. In 20 (7.4%) patients, TIVAP-related complications occurred during the follow-up period, resulting in a postprocedural complication rate of 0.26 incidences per 1000 catheter days. No significant relationship was observed between complications and gender (p = 0.188), age (p = 0.528), body mass index (p = 0.547), the type of primary malignancy (p = 0.914), or between the left and right basilic veins (p = 0.319). CONCLUSION Real-time ultrasound and fluoroscopic guidance provides a safe method for TIVAP implantation through the basilic vein, with a high technical success rate and few device-related complications.
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Affiliation(s)
- Chia-Yu Kao
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chien-Hua Fu
- Division of Radiology, Everan Hospital, Taichung, Taiwan, ROC
| | - Yun-Chung Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jian-Ling Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Chi Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | | | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Tang L, Kim CY, Martin JG, Pabon-Ramos WM, Sag AA, Suhocki PV, Smith TP, Ronald J. Length of Stay Predicts Risk of Early Infection for Hospitalized Patients Undergoing Central Venous Port Placement. J Vasc Interv Radiol 2020; 31:454-461. [PMID: 32007408 DOI: 10.1016/j.jvir.2019.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare early totally implantable central venous port catheter-related infection rates after inpatient vs outpatient placement and to determine whether the risk associated with inpatient placement is influenced by length of hospital stay. MATERIALS AND METHODS In this single-institution retrospective study, 5,301 patients (3,618 women; mean age 57 y) underwent port placement by interventional radiologists between October 2004 and January 2018. The 30-day infection rate was compared between inpatients and outpatients using survival analysis. Among inpatients, the effect of time from admission to port placement and from placement to discharge was analyzed using a survival regression tree. RESULTS The 30-day infection rate was 3.6% (95% confidence interval [CI] = 1.9%-6.1%) among 386 inpatients and 1.0% (95% CI = 0.7%-1.3%) among 4,915 outpatients (hazard ratio [HR] = 3.6, 95% CI = 2.0-6.6, P < .001). Inpatient placement was a significant risk factor after accounting for covariates in multivariate analysis (HR = 2.2, 95% CI = 1.0-4.7, P = .05) and controlling for demographic differences by propensity score matching (HR = 2.8, 95% CI = 1.0-7.8, P = .04). Infection rate was 11% (95% CI = 4.7%-22%) among 65 inpatients in whom time from admission to placement was ≥ 7 days, 5.1% (95% CI = 1.9%-11%) among 129 inpatients in whom admission to placement was < 7 days and time to discharge was > 3 days, and 0% (95% CI = 0%-2.1%) among 192 inpatients in whom admission to placement was < 7 days and time to discharge was ≤ 3 days (P < .001). CONCLUSIONS Inpatient port placement was associated with a higher risk of early infection. However, a clinical decision tree based on shorter length of stay before and after placement may identify a subset of hospitalized patients not at increased risk for infection.
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Affiliation(s)
- Linnan Tang
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Jonathan G Martin
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Waleska M Pabon-Ramos
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Paul V Suhocki
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Tony P Smith
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - James Ronald
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710.
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Choksi A, Finnegan K, Etezadi V. Does systemic antibiotic prophylaxis prior to the placement of totally implantable venous access devices reduce early infection? A retrospective study of 1,485 cases at a large academic institution. Am J Infect Control 2020; 48:95-99. [PMID: 31439370 DOI: 10.1016/j.ajic.2019.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To determine if ending the practice of administering prophylactic antibiotics prior to the placement of totally implantable venous access devices (TIVADs) is correlated with an increase in 30-day bloodstream infection-related TIVADs removals. METHODS The practice of administering prophylactic antibiotics prior to the placement of TIVADs ended in July 2013 at our institution. We compiled a list of patients who had TIVADs placed between July 2010 and July 2016 and cross-referenced this list to a list of patients who had TIVADs removed between July 2010 and August 2016 to evaluate the 30-day bloodstream infection-related TIVAD removals. Retrospective chart review of all patients was performed to collect demographic information, indication for placement, and type of antibiotic administered, if applicable. RESULTS Over the study period of 6 years, a total of 1,513 TIVADs were placed, of which 28 cases were excluded because of death within 30 days unrelated to TIVAD placement. Of the remaining 1,485 cases, 733 TIVADs were placed in 709 unique patients with prophylactic antibiotic treatment and 752 TIVADs were placed in 709 unique patients without treatment. A total of 8 patients were identified to have TIVADs removed within 30 days owing to infection, of which 4 patients were treated with prophylactic antibiotics. The odds of infection-related removals without prophylactic treatment compared with prophylactic treatment was 0.97 (95% confidence interval, 0.24-3.91; P = .97). CONCLUSIONS Ending the practice of administrating systemic antibiotic prophylaxis prior to the placement of TIVADs had no effect on the 30-day bloodstream infection-related TIVAD removals rate at our institution. We do not recommend the use of prophylactic antibiotics for the placement of TIVAD.
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Affiliation(s)
- Ankur Choksi
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD
| | - Karen Finnegan
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD
| | - Vahid Etezadi
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD.
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Risk Factors of Infection and Role of Antibiotic Prophylaxis in Totally Implantable Venous Access Port Placement: Propensity Score Matching. Cardiovasc Intervent Radiol 2019; 42:1302-1310. [PMID: 31187229 DOI: 10.1007/s00270-019-02255-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate risk factors of infection and effectiveness of preprocedural single-dose intravenous prophylactic antibiotic (PABX) during totally implantable venous access port (TIVAP) placement in preventing procedure-related infections. METHODS This was a retrospective single-institution multicenter study evaluating short-term (30-day) infection outcomes after TIVAP placement. Correlation between infection rates and clinical factors, including hematologic versus non-hematologic malignancy, inpatient versus outpatient status, single versus double lumen and PABX, was investigated using univariate and multivariable analysis in the overall study population as well as the propensity-score-matched cohort. RESULTS Overall, 5967 patients underwent TIVAP placement from 2005 to 2016, of which 3978 (67%) patients received PABX. On propensity score matching, 1952 patients with PABX were matched to the same number of patients without PABX. TIVAP was removed due to infection concern in 48 patients in unmatched and 30 patients in matched population. There was no difference in the rate of infection between those who received PABX and those who did not in both unmatched and matched population (p = 0.5387 and 0.9999). Although infection rate was significantly higher in patients who had TIVAP placement in inpatient setting (p < 0.0001), who received a double-lumen TIVAP (p < 0.0001), or who had hematologic malignancy (p = 0.0004) on univariate analysis, inpatient status was the sole factor associated with higher rate of TIVAP infection on multivariable analysis of both overall (odds ratio 2.31, p < 0.0001) and matched populations (odds ratio 4.36, p = 0.0004). CONCLUSION Placement of TIVAP in inpatient setting increases the risk of TIVAP infection. PABX before TIVAP placement does not prevent short-term procedure-related infections.
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Johnson EJ. Is It Appropriate to Place Subcutaneous Chest Ports in Patients with Neutropenia? Radiology 2019; 291:519-520. [DOI: 10.1148/radiol.2019190095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Evan J. Johnson
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Mutch LA, Klinker ST, Janecek JJ, Niewinski MN, M Z Lee R, Graham ML. Long-Term Management of Vascular Access Ports in Nonhuman Primates Used in Preclinical Efficacy and Tolerability Studies. J INVEST SURG 2018; 33:493-504. [PMID: 30543131 DOI: 10.1080/08941939.2018.1536178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Vascular access ports (VAPs) are an essential tool for long-term vascular access in preclinical studies and disease modeling in non-human primates (NHPs). We retrospectively reviewed central (inferior vena cava, IVC) and portal VAP implantation with the maintenance at our center from 15 January 2010 to 31 January 2018. In total, 209 VAPs were implanted for long-term drug administration and sampling. Patency was >95% at 6 months and >80% at 1 year for IVC VAPs and >90% at 6 months and >85% at 1 year for portal VAPs. The majority of animals had no complications and access was generally durable with device use ranging up to 7 years. In IVC, VAPs loss of patency occurred in 13% (0.035/100 d), surgical site infection in 2.9% (0.097/100 d), port pocket infection in 2.2% (0.004/100 d), erosion in 2.9%, 0.008/100 d), and mechanical failure in 4.3% (0.012/100 d). In portal, VAPs loss of patency occurred in 11.3% (0.028/100 d) and port pocket infection in 1.4% (0.003/100 d). About 12% of VAPs were removed as a result of complications.This study confirms VAP implant and maintenance is a beneficial and safe practice in NHPs resulting in favorable outcomes. High patency rates and low complication rates are comparable to the clinical setting. In addition to enabling comprehensive data collection, VAPs increase satisfaction and well-being by minimizing interference with daily routines and fostering cooperation. VAP implantation, together with an effective maintenance regimen and co-operative handling, is a reliable and convenient refined method for drug administration and blood sampling.Keywords: Vascular access port; nonhuman primates; refinement; central vascular access; portal vascular access; surgical technique; experimental surgery; animal model.
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Affiliation(s)
- Lucas A Mutch
- Department of Surgery, Preclinical Research Center, University of Minnesota, Saint Paul, MN, USA
| | - Samuel T Klinker
- Department of Surgery, Preclinical Research Center, University of Minnesota, Saint Paul, MN, USA
| | - Jody J Janecek
- Department of Surgery, Preclinical Research Center, University of Minnesota, Saint Paul, MN, USA
| | - Melanie N Niewinski
- Department of Surgery, Preclinical Research Center, University of Minnesota, Saint Paul, MN, USA
| | - Rachael M Z Lee
- Department of Surgery, Preclinical Research Center, University of Minnesota, Saint Paul, MN, USA
| | - Melanie L Graham
- Department of Surgery, Preclinical Research Center, University of Minnesota, Saint Paul, MN, USA.,Department of Veterinary Population Medicine, University of Minnesota, Saint Paul, MN, USA
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Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29:1483-1501.e2. [DOI: 10.1016/j.jvir.2018.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
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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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Perioperative antibiotics should be used for placement of implanted central venous ports: A propensity analysis evaluating risk. Am J Surg 2018; 216:1135-1143. [PMID: 30268417 DOI: 10.1016/j.amjsurg.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/21/2018] [Accepted: 09/16/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To quantify risk for CRI based on PABX use in CVAP placement for cancer patients. SUMMARY BACKGROUND DATA Central venous access ports (CVAP) are totally implanted devices used for chemotherapy. There is a temporal risk for catheter related infection (CRI) to insertion and perioperative prophylactic antibiotics (PABX) use is a contested issue among practitioners. METHODS Data was collected from a single center, academic oncology center. Treatment with a perioperative PABX was compared to non-treatment, to examine the incidence of 14-day CRI. Propensity scores with matched weights controlled for confounding, using 15 demographic, procedural and clinical variables. RESULTS From 2007 to 2012, 1,091 CVAP were placed, where 59.7 % received PABX. The 14-day CRI rate was 0.82%, with 78% of those not receiving PABX. While results did not achieve statistical significance, use of PABX was associated with a 58% reduction in the odds of a 14-day CRI (OR = 0.42, 95% CI: 0.08-2.24, p = 0.31). CONCLUSION The findings suggest a reduction in early CRI with the use of PABX. Since CRI treatment can range from a course of oral antibiotics, port removal, to hospital admission, we suggest clinicians consider these data when considering PABX in this high-risk population.
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Experience in totally implantable venous port catheter: Analysis of 3,000 patients in 12 years. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:422-428. [PMID: 32082773 DOI: 10.5606/tgkdc.dergisi.2018.15299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/05/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to present our experience with patients who were performed totally implantable venous port catheter. Methods Demographics-clinical features, surgical results and complications of 3,000 patients (1,824 males, 1,176 females; mean age 61.04±11.5 years; range, 18 to 88 years) who were performed totally implantable venous port catheter between March 2005 and March 2017 were evaluated retrospectively. Totally implantable venous port catheter indications, complications, catheter duration of stay, reasons for catheter removal and statistical analysis information were reported in detail by reviewing patient records. Results Of the cases, the Seldinger method was used in 98%, 1% (n=36) had the catheter inserted with superficial Doppler ultrasonography, while the veins were not found in 1% (n=29) and these patients were excluded from the study. Totally implantable venous port catheter was inserted via right internal jugular vein in 2,095 patients (70%), via right subclavian vein in 470 patients (16%), via left internal jugular vein in 290 patients (10%), and via left subclavian vein in 106 patients (3%). Mean duration of stay for totally implantable venous port catheter was 46.7 months (range, 1 to 78 months). Complications were detected in a total of 288 patients (9.6%), 153 (5.1%) being early and 135 (4.5%) being late. The most common oncologic indication was colorectal cancer. The rate of port removal was 298/3,000 (9.9%) and the main reasons were infection, thrombosis, pain, and end of treatment. Totally implantable venous port catheter was required to be inserted twice in 33 patients (1%) and thrice in 14 patients (0.5%). Totally implantable venous port catheter had malposition in eight patients and all were revised successfully with over the guide method. Conclusion Totally implantable venous port catheter may increase the quality of life in cancer patients. Despite possible complications, totally implantable venous port catheter is safe and comfortable for long-term intravenous treatment. Possible complications may be prevented or managed when totally implantable venous port catheter is performed by surgeons with adequate experience.
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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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Jo JE, Tang EY, Pua BB. The role of antibiotics in preventing totally implantable venous access device (TIVAD) infections; is there a population that would benefit? Clin Imaging 2018; 51:213-216. [PMID: 29864730 DOI: 10.1016/j.clinimag.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/02/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the role for prophylactic antibiotics in preventing totally implantable venous access device (TIVAD) infections and identify populations that may benefit from antibiotics. METHODS 1284 patients undergoing TIVAD placement were retrospectively reviewed to determine association between infection rate, prophylactic antibiotics, and clinical data including white blood cell (WBC) count, platelets, and coagulation profile. Patients were further sub-categorized based on hospital admission status and leukopenia. Patients who received antibiotics were compared to those who did not using chi-square test or Fisher's exact tests and Student's t-tests. Additionally, multivariable logistic regression analysis was used to determine factors associated with infections. RESULTS A total of 7 infections were identified with an infection rate of 0.5%. 1010 patients received antibiotics (78.7%), and infection rate in these patients was 0.7% compared to 0% in patients who did not receive antibiotics. 21 patients were under the age of 18, eight of which received antibiotics. No infections occurred in the pediatric group. Upon multivariate analysis, developing TIVAD infection was significantly associated with inpatient placement (p < 0.0001, OR 29.1, 95% CI 3.1-272.1), while utilization of double lumen ports was not (OR 3.0, 95% CI 0.5-17.4). There were no significant associations between infections and antibiotic use (p = 0.36), leukopenia (p = 0.47), pediatric patients (p = 1) or other demographic or laboratory data. CONCLUSION Routine use of prophylactic antibiotics with TIVAD placement should be avoided. Antibiotics may not benefit even those with greater risk for infection.
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Affiliation(s)
- Jonathan E Jo
- Department of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, 1305 York Avenue, 3rd Floor, New York, NY 10021, United States.
| | - Eve Y Tang
- Department of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, 1305 York Avenue, 3rd Floor, New York, NY 10021, United States.
| | - Bradley B Pua
- Division of Interventional Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, Payson 521, New York, NY 10065, United States.
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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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