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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [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: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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Amroun K, Brugel M, Rhaiem R, Teuma L, Vannieuwenhuyse G, Lipere A, Brenet E, Kianmanesh R, Bouché O. Assessing the time-to-removal of totally implantable venous access devices comparing valved-versus open-ended catheters in patients treated with chemotherapy. J Vasc Access 2024:11297298231223539. [PMID: 38205615 DOI: 10.1177/11297298231223539] [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: 01/12/2024] Open
Abstract
BACKGROUND Totally IntraVenous Acess Devices (TIVAD) are used to have long-term bloodstream access. The catheter connected to the subcutaneous chamber may be valved (TIVAD-V) or open-ended (TIVAD-O). Infectious and occlusion complications require the removal of the TIVAD. We compared the two types of catheters (TIVAD-V and TIVAD-O) in terms of time-to-removal and complication rates. METHODS A retrospective study of 636 patients treated for any malignancy using a TIVAD were included. TIVAD complication was defined as the occurrence of infection or occlusion requiring TIVAD removal. Risk factors of complications and time-to-removal of TIVAD were assessed by a Cox proportional hazard analysis. RESULTS A total of 55 TIVADs (8.7%) were removed including 47 for infection and eight for occlusion in 54 months. There was no significant difference in the frequency of complications between TIVAD-V and TIVAD-O. There was no significant difference in time-to-removal between TIVAD-V and TIVAD-O (17.0 months, IQR [10.5-25.0] and 18.4 months, IQR [11.5-22.9], p = 0.345, respectively). CONCLUSION There was no difference between TIVAD with valved and open catheter in terms of complications and time-to-removal in patients treated by chemotherapy.
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Affiliation(s)
- Koceila Amroun
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Mathias Brugel
- Department of Digestive Oncology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Rami Rhaiem
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Lugdivine Teuma
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Geoffrey Vannieuwenhuyse
- Department of Obstetrics and Gynaecology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Audrey Lipere
- Department of Obstetrics and Gynaecology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Esteban Brenet
- Department of Otorhinolaryngology, Head and Neck surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est France
| | - Reza Kianmanesh
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
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Nassereldine H, Hajj-Ali A, Hassanieh J, Hamideh D, Jaafar RF, Akel S, Zaghal A. Catheter-related atrial thrombosis: prevalence and risk factors in the pediatric age group—a retrospective study. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Catheter-related right atrial thrombosis (CRAT) is an under-studied complication of a long-term implantable venous access devices (IVAD), particularly in children with incidence rates extrapolated from the adult literature ranging between 2 and 29%. This is a single-center retrospective review of electronic medical records of children who underwent insertion of IVADs and had at least one echocardiogram performed prior to catheter removal between 2008 and 2018. Data collection included demographic information, development of CRAT, systemic infection, and administration of thrombogenic chemotherapeutic agents. We identified six patients who developed CRAT and compared them to 120 control patients. We also performed a detailed chart review for the patients who developed CRAT. Data was entered and analyzed using SPSS.
Results
A total of 764 patients underwent IVAD placement between 2008 and 2018. Six (0.79%) patients developed CRAT, and 120 patients were identified as controls that match the CRAT patients based on definitive criteria that include age, gender, chemotherapy type, steroid therapy, reason of line insertion, site of catheter insertion, tip-location at insertion, and history of systemic infections. In the CRAT group, 3 (50%) patients had their catheter tips placed in the superior vena cava-right atrial junction and 3 (50%) in the right atrium, whereas in the control group, all patients had their catheter tips placed in the superior vena cava-right atrial junction (p=0.000). Five (83.3%) patients in the CRAT group received L-asparaginase as compared to 75 (62.5%) patients in the control group (p=0.301). In the CRAT group, all patients had a history of systemic infection compared to 47 (39.2%) in the control group (p=0.180).
Conclusion
We identified 6 (0.79%) children with CRAT. Catheter-tip location within the right atrium is a potential risk factor for CRAT development in children.
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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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Liu S, Jiang L, Wang X. Intelligent Internet of Things Medical Technology in Implantable Intravenous Infusion Port in Children with Malignant Tumors. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8936820. [PMID: 34876968 PMCID: PMC8645386 DOI: 10.1155/2021/8936820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Due to the recent technological revolution that is centered around information technology, the Internet of Medical Things (IoMT) has become an important research domain. IoMT is a combination of Internet of Things (IoT), big data, cloud computing, ubiquitous network, and three-dimensional holographic technology, which is used to build a smart medical diagnosis and treatment system. Additionally, this system should automate various activities, such as the patient's health record and health monitoring, which is an important issue in the development of modern and smart healthcare system. In this paper, we have thoroughly examined the role of a smart healthcare system architecture and other key supporting technologies in improving the health status of both indoor and outdoor patients. The proposed system has the capacity to investigate and predict (if feasible) the clinical application and nursing effects of totally implantable intravenous port (TIVAP) in pediatric hematological tumors. For this purpose, seventy children with hematologic tumors were treated with TIVAP, and IoMT-enabled care was provided to them, where the occurrence of adverse events, specifically after the treatment, was observed. The experimental results collected after the 70 children were treated and cared for by TIVAP show that there were five cases of adverse events, whereas the incidence rate of the adverse events was 7.14%. Moreover, TIVAP has significant efficacy in the treatment of hematologic tumors in children, and it equally reduces the vascular injury caused by chemotherapy in younger patients. Likewise, targeted care reduces the incidence of adverse events in children with expected ratio.
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Affiliation(s)
- Shaohong Liu
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Luxing Jiang
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Xin Wang
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
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Singh T, Hook AL, Luckett J, Maitz MF, Sperling C, Werner C, Davies MC, Irvine DJ, Williams P, Alexander MR. Discovery of hemocompatible bacterial biofilm-resistant copolymers. Biomaterials 2020; 260:120312. [PMID: 32866726 PMCID: PMC7534038 DOI: 10.1016/j.biomaterials.2020.120312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
Blood-contacting medical devices play an important role within healthcare and are required to be biocompatible, hemocompatible and resistant to microbial colonization. Here we describe a high throughput screen for copolymers with these specific properties. A series of weakly amphiphilic monomers are combinatorially polymerized with acrylate glycol monomers of varying chain lengths to create a library of 645 multi-functional candidate materials containing multiple chemical moieties that impart anti-biofilm, hemo- and immuno-compatible properties. These materials are screened in over 15,000 individual biological assays, targeting two bacterial species, one Gram negative (Pseudomonas aeruginosa) and one Gram positive (Staphylococcus aureus) commonly associated with central venous catheter infections, using 5 different measures of hemocompatibility and 6 measures of immunocompatibililty. Selected copolymers reduce platelet activation, platelet loss and leukocyte activation compared with the standard comparator PTFE as well as reducing bacterial biofilm formation in vitro by more than 82% compared with silicone. Poly(isobornyl acrylate-co-triethylene glycol methacrylate) (75:25) is identified as the optimal material across all these measures reducing P. aeruginosa biofilm formation by up to 86% in vivo in a murine foreign body infection model compared with uncoated silicone.
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Affiliation(s)
- Taranjit Singh
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK; Biodiscovery Institute and School of Life Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Andrew L Hook
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Jeni Luckett
- Biodiscovery Institute and School of Life Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Manfred F Maitz
- Leibniz Institute of Polymer Research Dresden, Max Bergmann Centre for Biomaterials Dresden, Hohe Str. 6, D-01069, Dresden, Germany
| | - Claudia Sperling
- Leibniz Institute of Polymer Research Dresden, Max Bergmann Centre for Biomaterials Dresden, Hohe Str. 6, D-01069, Dresden, Germany
| | - Carsten Werner
- Leibniz Institute of Polymer Research Dresden, Max Bergmann Centre for Biomaterials Dresden, Hohe Str. 6, D-01069, Dresden, Germany
| | - Martyn C Davies
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Derek J Irvine
- Department of Chemical and Environmental Engineering, Faculty of Engineering, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Paul Williams
- Biodiscovery Institute and School of Life Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
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Chou PL, Fu JY, Cheng CH, Chu Y, Wu CF, Ko PJ, Liu YH, Wu CY. Current port maintenance strategies are insufficient: View based on actual presentations of implanted ports. Medicine (Baltimore) 2019; 98:e17757. [PMID: 31689833 PMCID: PMC6946320 DOI: 10.1097/md.0000000000017757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022] Open
Abstract
Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.
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Affiliation(s)
- Pin-Li Chou
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jui-Ying Fu
- Chang Gung University, Taiwan
- Division of Chest, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Hui Cheng
- Laboratory of Cardiovascular Physiology, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yen Chu
- Chang Gung University, Taiwan
- Laboratory of Cardiovascular Physiology, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Feng Wu
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Po-Jen Ko
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yun-Hen Liu
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yang Wu
- Chang Gung University, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Simultaneous delivery of paclitaxel and erlotinib from dual drug loaded PLGA nanoparticles: Formulation development, thorough optimization and in vitro release. J Mol Liq 2018. [DOI: 10.1016/j.molliq.2018.02.091] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Goossens GA, Vrebos M, De Wever I, Stas M. Vacutainer® filling time through subcutaneous venous access devices. J Vasc Access 2018; 5:154-60. [PMID: 16596559 DOI: 10.1177/112972980400500404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The functionality of subcutaneous venous access devices is evaluated at least every time the device is accessed. This evaluation is subjective and actions are only undertaken when blood withdrawal and/or fluid injection become problematic. The function of these devices has rarely been evaluated objectively. The present study tried to find an objective and standardized way to evaluate the withdrawal speed of a newly inserted port. Methods Between October 2001 and December 2002, a prospective randomized study of 3 types of ports was carried out. The ability to infuse heparinized normal saline and to withdraw blood was evaluated by recording the filling time of a 10 ml Vacutainer® tube in 876 newly inserted central venous ports at the end of the surgical procedure. Results The patient groups were comparable in age, gender and insertion procedure characteristics (vein used, position of the port on the body and length of the catheter). The median time needed to fill a 10 ml Vacutainer® tube in all ports was 17.00 sec (range 11.43–63.62 sec). The median filling time for BardPort™ was 16.36 sec (range 13.48–39.00 sec), for Celsite® 18.35 sec (range 12.03–40.00 sec) and for Port-a-cath® 16.43 sec (range 11.43–63–62 sec). A significant difference in filling time was found between the large bore catheters (BardPort™, Port-a-cath®) and the small bore catheter (Celsite®) of 2 seconds median value. Conclusion Measurement of withdrawal speed provides an objective criterion for the quality description of blood withdrawal immediately after insertion. A value of more than 20 seconds for filling a 10 ml Vacutainer® tube could therefore be suggested a useful trigger for further investigation.
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Affiliation(s)
- G A Goossens
- Nursing Department, University Hospitals Leuven, Belgium
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10
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Yildizeli B, Laçin T, Batirel HF, Yüksel M. Complications and management of long-term central venous access catheters and ports. J Vasc Access 2018; 5:174-8. [PMID: 16596562 DOI: 10.1177/112972980400500407] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Although prolonged venous access devices (PVADs) are used in case prolonged intravenous therapy is required, implantation and use of these devices is associated with complications. The purpose of this study was to evaluate perioperative and long-term complications associated with PVADs and the management of these complications. Methods A retrospective review was undertaken of 225 PVADs implanted in 217 patients from February 1993 to June 2004. This included 144 single-lumen port infusion systems, 49 single-lumen Hickman® catheters and 32 double-lumen Groshong® catheters. The PVADs were inserted using either the percutaneous Seldinger method (n=183) or cutdown access to the subclavian vein (n=42). Indications for placement were as follows: chemotherapy in 66.2% of patients, drug-infusion treatment in 31.6% of patients and total parenteral nutrition in 2.2% of patients. Results Perioperative complications occurred in 13 patients (5.7%): catheter malposition in seven patients (3.1%), pneumothorax in three patients (1.3%), hemorrhage in two patients (0.9%) and catheter embolization in one patient (0.4%). Long-term complications appeared in 15 patients (6.6%): infection in five patients (2.2%), thrombosis in three patients (1.3%), extravasation in three patients (1.3%), and catheter fracture in four patients (1.8%). The fractured fragments were removed by the Amplatz® snare device. In 10 patients (4.4%) only were PVADs removed prior to completion of the intended therapy. Indications for removal were catheter infection in five patients (2.2%) and catheter fracture in five patients (2.2%). Conclusions PVAD implantation is associated with some risk of serious perioperative and long-term complications. Care of the catheter and the patient should be maintained with the proper and immediate evaluation of the perioperative and long-term complications.
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Affiliation(s)
- B Yildizeli
- Department of Thoracic Surgery, Faculty of Medicine, Marmara University Hospital, Acibadem, Istanbul, Turkey
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Jonczyk M, Gebauer B, Rotzinger R, Schnapauff D, Hamm B, Collettini F. Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience. In Vivo 2018; 32:179-184. [PMID: 29275317 PMCID: PMC5892650 DOI: 10.21873/invivo.11222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Totally implantable central venous port systems provide a safe and effective, long-term means of access for administration of hyperosmolar, local irritant medication, such as chemotherapy, antibiotics and parenteral nutrition. AIM To evaluate the combination of access site and level of experience on fluoroscopy times (FT) and dose area products (DAP) during implantation of port catheters in a large patient population. MATERIALS AND METHODS A total of 1,870 patients (992 women, 878 men; age: 61±13.14 years) were reviewed investigating two groups of junior (≤50 implantations) and senior (>50) radiologists. RESULTS Senior radiologists required less FT/DAP (0.24 s/57.3 μGy m2 versus 0.43 s/68.2 μGy m2, respectively; p<0.001). Right jugular vein access required the least FT/DAP (0.25 s/56.15 μGy m2) and right-sided implantation lower FT/DAP (right: 0.26 s/56.4 μGy m2, left: 0.40 s/85.10 μGy m2, p<0.001). CONCLUSION Due to DAP/FT reductions, the right jugular vein seems to be the most favorable implantation side for port systems. For further dose reduction, residents should be well-trained.
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Affiliation(s)
- Martin Jonczyk
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Roman Rotzinger
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Dirk Schnapauff
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - University of Medicine, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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Zhang L, Xing X, Meng F, Wang Y, Zhong D. Oral fluoropyrimidine versus intravenous 5-fluorouracil for the treatment of advanced gastric and colorectal cancer: Meta-analysis. J Gastroenterol Hepatol 2018; 33:209-225. [PMID: 28608993 DOI: 10.1111/jgh.13845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM 5-Fluorouracil (5-Fu) is one of the most commonly prescribed antineoplastic agents against gastric and colorectal cancers. Continuous infusion would be the optimal way of its administration, however, may usually cause thrombosis, infection, and prolonged hospital stay. Oral fluoropyrimidines would be an attractive alternative, but their efficiency and toxicities for the treatment of gastric and colorectal cancer are still obscure as compared with infusion 5-Fu. METHODS Literature retrieval, trials selection and assessment, data collection, and statistic analysis were performed according to the Cochrane Handbook. The outcome measures were tumor response rate, progression-free survival, overall survival, and adverse effects. RESULTS Twenty-nine randomized controlled trials, comprising totally 15 154 patients, were included. Meta-analysis showed similar overall outcome in terms of response rate (1.01; 95% confidence interval [CI], 0.92-1.12), progression-free survival (hazard ratio 1.00; 95%CI, 0.94-1.06), and overall survival (hazard ratio 0.96; 95%CI, 0.92-1.01) between oral fluoropyrimidine-based and intravenous 5-Fu-based regimens in gastric and colorectal cancer patients. The risk of grade 3/4 neutropenia, thrombocytopenia, and stomatitis was more prominent in intravenous 5-Fu-based regimens; while more frequent grade 3/4 hand-foot syndrome, diarrhea, and anorexia were detected in oral fluoropyrimidine-based regimens. CONCLUSIONS Oral-fluoropyrimidines showed equivalent response and similar survival outcomes, but different toxicity profiles, as compared with intravenous 5-Fu. Thus, it would be a more convenient and adjustable alternative in treatment of advanced gastric and colorectal cancer.
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Affiliation(s)
- Linlin Zhang
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoli Xing
- Tianjin Fifth Central Hospital, Tianjin, China
| | - Fanlu Meng
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Wang
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Diansheng Zhong
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
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Vashi PG, Virginkar N, Popiel B, Edwin P, Gupta D. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis 2017; 17:372. [PMID: 28558699 PMCID: PMC5450397 DOI: 10.1186/s12879-017-2469-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/16/2017] [Indexed: 12/17/2022] Open
Abstract
Background Catheter-related bloodstream infections (CRBSIs) are associated with high morbidity and mortality as well as increased medical costs. Cancer patients, who are often immunocompromised, are susceptible to CRBSI while receiving home parenteral nutrition (HPN). We evaluated the incidence of and factors associated with CRBSIs in cancer patients undergoing HPN managed using a standardized catheter care protocol. Methods This is a retrospective cohort study of 335 cancer patients receiving HPN between January 2012 and July 2015. The primary outcome of interest was the incidence of CRBSI expressed as events per 1000 HPN days. HPN days were calculated from the start date with the home infusion provider until the discontinuation of HPN, or the removal of the venous access device (VAD), or the death of the patient. The VADs used were either peripherally inserted central catheters (PICCs) or a subcutaneous implanted port or tunneled central catheters (TCCs). Univariate Poisson regression analyses were used to determine the variables associated with CRBSIs. Results Of 335 patients, 193 were females and 142 were males. The most common cancer types were colorectal, pancreatic, ovarian and stomach. A total of 408 VADs in 335 patients were studied, covering a total of 29,403 HPN days. Of 408 VADs, 206 (50.5%) were ports, 191 (46.8%) were PICCs, and 7 (2.7%) were TCCs. The median duration of HPN was 54 days. A total of 16 CRBSI episodes were recorded (8 in ports, 7 in PICCs and 1 in TCCs). The median duration from the start of HPN to the development of CRBSI episodes was 43.5 days. The overall incidence of CRBSI per 1000 HPN days was 0.54 (95% confidence interval: 0.32–0.86). Upon univariate analysis, no variables were found to be statistically significantly associated with CRBSI incidence. Conclusions We found a low rate of CRBSI following a standardized catheter maintenance protocol in a high-risk oncology population undergoing HPN.
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Affiliation(s)
- Pankaj G Vashi
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, Illinois, 60099, USA
| | - Natasha Virginkar
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, Illinois, 60099, USA
| | - Brenten Popiel
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, Illinois, 60099, USA
| | - Persis Edwin
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, Illinois, 60099, USA
| | - Digant Gupta
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, Illinois, 60099, USA.
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Kakkos A, Bresson L, Hudry D, Cousin S, Lervat C, Bogart E, Meurant JP, El Bedoui S, Decanter G, Hannebicque K, Regis C, Hamdani A, Penel N, Tresch-Bruneel E, Narducci F. Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients. Eur J Surg Oncol 2016; 43:689-695. [PMID: 27889197 DOI: 10.1016/j.ejso.2016.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/05/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. PATIENTS AND METHODS Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10-20%), or high (>20%) risk for inducing neutropenia. RESULTS The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0-5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003). CONCLUSION An interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens.
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Affiliation(s)
- A Kakkos
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France.
| | - L Bresson
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - D Hudry
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - S Cousin
- Department of Medical Oncology, Centre Régional de Lutte Contre le Cancer Institut Bergonié, 229 Cours de l' Argonne, 33076 Bordeaux Cedex, France
| | - C Lervat
- Department of Pediatric Oncology, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - E Bogart
- Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - J P Meurant
- Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - S El Bedoui
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - G Decanter
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - K Hannebicque
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - C Regis
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - A Hamdani
- Department of Anesthesiology and Reanimation, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - N Penel
- Department of Medical Oncology, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - E Tresch-Bruneel
- Department of Methodology and Biostatistics, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
| | - F Narducci
- Department of Oncologic Surgery, Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 Rue Fréderic Combemale, BP 307, 59020 Lille Cedex, France
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Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus. Case Rep Surg 2016; 2016:9168154. [PMID: 27651974 PMCID: PMC5019894 DOI: 10.1155/2016/9168154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022] Open
Abstract
Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer.
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Ma LI, Liu Y, Wang J, Chang Y, Yu L, Geng C. Totally implantable venous access port systems and associated complications: A single-institution retrospective analysis of 2,996 breast cancer patients. Mol Clin Oncol 2016; 4:456-460. [PMID: 26998304 DOI: 10.3892/mco.2016.726] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022] Open
Abstract
Totally implantable venous access port systems (TIVAPS) are widely used in breast cancer patients. However, complications are frequent and may necessitate device replacement or removal, resulting in additional patient stress and treatment delays. The aim of this study was to investigate possible risk factors for complications. A total of 2,996 consecutive female breast cancer patients, with a median age of 50.2 years (range, 21.2-85.5 years) were enrolled in this observational, single-centre study between December, 2008 and April, 2014. TIVAPS implantation was principally performed using local anaesthesia and the blind puncture or Seldinger technique through internal jugular or subclavian vein access. A retrospective chart review was conducted to obtain information associated with TIVAPS and patient data. Insertion performed by blind puncture and Seldinger technique had a success ratio of 96.34 and 99.80%, respectively (χ2=29.905, P<0.001). However, the success ratio of the puncture technique group was 99.76% when the TIVAPS was implanted in the right internal jugular vein. The most common complications were late complications, with an overall incidence rate of 5.41% (162/2,996) during the entire device duration. The most common late complications included fibrin formation (1.84%, 55/2,996), port-related bacteraemia (1.44%, 43/2,996) and deep vein thrombosis (0.63%, 19/2,996). No patient died during the study. Our results demonstrated that insertion of TIVAPS by blind puncture or the Seldinger technique through internal jugular or subclavian vein access is convenient, and insertion by the Seldinger technique through the right internal jugular vein is the preferred method. Therefore, TIVAPS is safe for continuous infusional chemotherapy regimens for breast cancer patients.
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Affiliation(s)
- L I Ma
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Jianxin Wang
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yuan Chang
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Long Yu
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Cuizhi Geng
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
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Complications of Port A Cath implantation: A single institution experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Chemotherapy drug extravasation in totally implantable venous access port systems: how effective is early surgical lavage? J Vasc Access 2014; 16:31-7. [PMID: 25362986 DOI: 10.5301/jva.5000316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL). METHODS Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively. RESULTS Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft. CONCLUSIONS CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.
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Chauhan A, Bernardin A, Mussard W, Kriegel I, Estève M, Ghigo JM, Beloin C, Semetey V. Preventing Biofilm Formation and Associated Occlusion by Biomimetic Glycocalyxlike Polymer in Central Venous Catheters. J Infect Dis 2014; 210:1347-56. [DOI: 10.1093/infdis/jiu249] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Brédart A, Bottomley A. Treatment satisfaction as an outcome measure in cancer clinical treatment trials. Expert Rev Pharmacoecon Outcomes Res 2014; 2:597-606. [DOI: 10.1586/14737167.2.6.597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Implantable venous access device associated complications in patients with hereditary angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:524-5. [DOI: 10.1016/j.jaip.2013.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/27/2013] [Accepted: 04/05/2013] [Indexed: 11/20/2022]
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de Oliveira EB, Reis MA, Avelar TM, Vieira SC. Totally implantable central venous catheters for chemotherapy: experience with 793 patients. Rev Col Bras Cir 2013; 40:186-90. [PMID: 23912364 DOI: 10.1590/s0100-69912013000300004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/20/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To retrospectively study the results obtained with the implementation of totally implantable catheters in patients undergoing chemotherapy. METHODS 815 totally implantable catheters placed in 793 patients undergoing chemotherapy regimen, preferably using the right cephalic vein. We evaluated early and late complications. RESULTS The retrospective analysis showed an average duration of 339 days of the catheters. In 733 (90%) catheters there was no observe complication. Among early complications we observed one pneumothorax, one bad positioning of the catheter, one arterial puncture, one bleeding, one hemothorax and hemomediastinum and six hematomas in the implantation site. As for late complications, there were 35 catheter-related infections ten, infections in the surgical site, six obstructions and 20 thromboses. We removed 236 catheters, 35 due to complications and 201 by the end of treatment. CONCLUSION totally implantable catheters for chemotherapy are a safe means for the administration of substances, in view of the low number of complications observed in this study.
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Mastroianni CM, Viscomi C, Ceniti S, De Simone R, Filice A, Gadaleta Caldarola G, Infusino S, Manfredi C, Rea A, Sandomenico C, Turano S, Serranò F, Condemi G, Cortese C, Prantera T, Palazzo S. Preferences of patients with advanced colorectal cancer for treatment with oral or intravenous chemotherapy. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 1:181-7. [PMID: 22272925 DOI: 10.2165/1312067-200801030-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND In recent years, patient-reported outcomes such as health-related quality of life have become important areas of clinician focus in general cancer management. Patients' preferences for, and/or satisfaction with, oral versus intravenous (IV) chemotherapy schedules may have a major impact on such outcomes. OBJECTIVE To evaluate preferences for oral or IV chemotherapy in patients with advanced colorectal cancer. METHODS A multicenter, randomized, crossover trial was conducted in 12 hospitals in Southern Italy, in which 22 patients with advanced colorectal cancer received one cycle of oral capecitabine ± irinotecan or oxaliplatin, followed by one cycle of an IV de Gramont or similar regimen (arm A), or the same regimens in reverse order (arm B). Patients were aged 50-70 years and 21% had a higher level of education (graduate or similar). Patients received oral capecitabine 3500 mg/m/day for 7 days (± irinotecan 180 mg/m or oxaliplatin 85 mg/m on day 1 only), followed by an IV de Gramont regimen ± irinotecan (FOLFIRI) or oxaliplatin (FOLFOX); or the two schedules administered in reverse order.The main outcome measure was patients' preferences for oral versus IV chemotherapy, as determined by a pre- and post-treatment therapy preference questionnaire (TPQ). RESULTS Before treatment, 75% of patients preferred oral therapy. Characteristics that patients considered to be important were that treatment should not interfere with daily activities (100% of patients) and should not cause fatigue (95%), diarrhea (76%), or painful mouth ulcers (76%); other factors considered important were the risk of infection and nausea (90%), and that treatment could be administered at home (65%). After receiving both chemotherapy schedules, only 45% of patients preferred oral therapy, while 55% preferred IV therapy. Among the latter, the most important characteristics influencing treatment choice were less nausea (66%), fewer mood effects (65%), the safety of hospital IV treatment (62%), less interference with family relationships (55%), less vomiting (55%), less interference with daily activities (50%), and less diarrhea (50%). Although the order in which patients received therapy did not influence treatment preference, significantly fewer patients with a lower rather than higher educational level preferred oral therapy (47% vs 80%; chi-square test = 9.9; p = 0.002). CONCLUSION These results suggest that there may be a correlation between educational level and the preference of patients with advanced colorectal cancer for oral or IV chemotherapy.
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Affiliation(s)
- Candida M Mastroianni
- 1 Mariano Santo Hospital, Cosenza, Italy 2 Siderno Hospital, Siderno, Italy 3 San Giovanni di Dio Hospital, Crotone, Italy
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Craus W, Di Giacomo A, Tommasino U, Frezza A, Festa G, Cricrì AM. Totally Implantable Central Venous Access: 15 years' experience in a single unit. J Vasc Access 2012; 2:161-7. [PMID: 17638281 DOI: 10.1177/112972980100200406] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of Totally Implantable Central Venous Access Systems (T.I.C.V.A.S.) has become an essential aid for those patients requiring extended intravenous infusion treatments or complete parenteral nutrition, and for whom the peripheral venous system may be or may become inadequate for infusions. This paper describes fifteen years of experience in the use of totally implantable systems. It examines the application methods as well as the different systems, complications, patient satisfaction, quality of life, and cost/benefit ratio. We examined 261 patients observed during a period of approximately 15 years. A surgical team carried out the operations for these patients in an operating room under the strictest asepsis conditions. The Port-a-Cath central venous access systems were used in 221 cases (84.6%) and the Pas-Port peripheral venous access systems were used in 40 cases (15.3%). We observed no particular differences between the different types of systems implanted. The total rate of complications was 11.7%, 0.7% of which were positioning complications, 4.2% stability complications, and 6.1% management complications. There were 2 cases (0.76%) of defective performance of the implanted system. We found patient satisfaction with the method average in 19.85% of the cases, good in 70.23% and excellent in 11.9%. Quality of life improved because of reduced total hospitalization time and more convenient treatment management. Regarding the cost/benefit ratio we also found that the benefits outnumbered costs. In connection with the cost of the system the possibility of home management leads to a marked decrease in hospitalization expenditure. Today these systems should be considered as being essential in the correct management of the patient requiring medium-to-long-term infusion treatment. On the whole these treatments are well accepted by the patient and the possibility of home or day hospital management allows a marked reduction in hospitalization, which affects both social life and costs. The incidence of complications was found to be relatively low considering that most of them are the result of poor management of the system by the paramedical personnel or by the relatives of the patients. In this sense, better education in the management of the system would further optimize results. (The Journal of Vascular Access 2001; 2: 161-167).
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Affiliation(s)
- W Craus
- Department of General Surgery, Geriatrics, Oncology and Advanced Technologies, Federico II University, Naples - Italy
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25
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Massive fluidopneumothorax after implantation of a totally implantable venous access port: report of a case. Eur Surg 2012. [DOI: 10.1007/s10353-012-0086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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NAGEL S, TEICHGRÄBER U, KAUSCHE S, LEHMANN A. Satisfaction and quality of life: a survey-based assessment in patients with a totally implantable venous port system. Eur J Cancer Care (Engl) 2011; 21:197-204. [DOI: 10.1111/j.1365-2354.2011.01275.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Narducci F, Jean-Laurent M, Boulanger L, El Bédoui S, Mallet Y, Houpeau JL, Hamdani A, Penel N, Fournier C. Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. Eur J Surg Oncol 2011; 37:913-8. [PMID: 21831566 DOI: 10.1016/j.ejso.2011.06.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/25/2011] [Accepted: 06/28/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Totally Implantable Venous Access Port Systems (TIVAPS) are widely used in oncology, but complications are frequent, sometimes necessitating device removal and consequently delays in chemotherapy. The aim of this study was to investigate possible risk factors for morbidity. METHODS A total of 815 consecutive cancer patients (median age: 56.2 years [0.8-85.2]; 522 female) were enrolled in this observational, single-centre study between May 2nd 2006 and April 30th 2007. TIVAPS implantation involved principally cephalic or external jugular vein access. Patients were followed up for one year unless the device was removed earlier. RESULTS The overall morbidity rate was 16.1% (131/815). Complications necessitated device removal in 55 patients a mean of 3.7 months [0.2-12.0] after implantation. These comprised TIVAPS-related infection (19), port expulsion (14), catheter migration (6), venous thrombosis (5), mechanical problems (3), skin disorders (2), pain (2), drug extravasation (2) infection unrelated to TIVAPS (1) and inflammation (1). No patient died during the study. The factor most strongly predictive of complications was the interval between insertion and first use of the TIVAPS, ranging from 0 to 135 days (median: 8.0 days). The morbidity rate was 24.4% when this interval was 0-3 days, 17.1% when it was 4-7 days and 12.1% when it exceeded 7 days (p < 0.01; Chi(2) test). The median interval was 6 days (0-53) and 8 days (0-135), respectively, in patients with and without complications (p < 0.001). CONCLUSION To reduce complications, an interval of at least 8 days between placement of the TIVAPS and its first use may be advisable.
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Affiliation(s)
- F Narducci
- Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France.
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Goossens GA, Stas M, Jérôme M, Moons P. Systematic review: malfunction of totally implantable venous access devices in cancer patients. Support Care Cancer 2011; 19:883-98. [DOI: 10.1007/s00520-011-1171-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/18/2011] [Indexed: 11/25/2022]
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Teichgräber UK, Pfitzmann R, Hofmann HAF. Central venous port systems as an integral part of chemotherapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:147-53; quiz 154. [PMID: 21442071 DOI: 10.3238/arztebl.2011.0147] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 04/08/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Port systems are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access. They are used mainly for cancer patients. METHODS This article is based on a selective literature review, the guidelines of the German Society for Nutrition Medicine and of the European Society for Clinical Nutrition and Metabolism, and the recommendations of the German Society for Pediatric Oncology and Hematology. RESULTS In modern oncology, central venous port systems are increasingly replacing short-term and permanently tunneled central venous catheters. They are indicated for patients who need long-term intravenous treatment involving, e.g., the repeated administration of chemotherapeutic drugs, parenteral nutrition, transfusions, infusions, injections, and/or blood sample collection. Port systems can markedly alleviate the burden of intravenous therapy and thereby improve these patients' quality of life. The planning, preparation, and performance of port system implantation require meticulous attention to detail. The rate of implantation-associated complications is less than 2% in experienced hands; overall complication rates have been reported from 4.3% to as high as 46%. The proper postoperative use and care of the port system are of decisive importance to the outcome. Reported infection rates during port system use range from 0.8% to 7.5% in current clinical studies. CONCLUSION The treatment, follow-up care, and rehabilitation of cancer patients are interdisciplinary tasks. Optimal treatment and complication avoidance require a collaborative effort of all of the involved specialists-not just the physician implanting the port system, but also the oncologists, nutritionists, visiting nurses, and other home health care providers. Continuing medical education, too, plays a role in improving outcomes.
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Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011; 21:1224-32. [PMID: 21207035 DOI: 10.1007/s00330-010-2045-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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Explanation of Totally Implantable Venous Access Ports of the Forearm: Reasons for Removal and Observed Complications. J Vasc Access 2010; 12:45-51. [DOI: 10.5301/jva.2010.5849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2010] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate indications for, and complications during, explantation of interventionally placed totally implantable venous access ports (TIVAPs) of the forearm. Background Many studies analyze the explantation procedure of pectorally placed TIVAPs. The literature on TIVAPs in the forearm is limited, and the explantation procedure of these devices in the forearm has not been sufficiently evaluated yet. Methods We retrospectively reviewed the archives of our institute between May 2006 and May 2009 and identified 850 TIVAPs that had been implanted in the forearm. Of these TIVAPs, 145/850 (80 in women, 65 in men; mean age 52 years, range 15–82 years) were explanted during this period either by interventionists (n=109) or by general surgeons (n=36). Results Mean catheter survival was 322 days. Reasons for explantation were end of therapy (63.4%), infection (29.0%), thrombosis (3.4%), occlusion (1.4%), or dislocation (1.4%) of the TIVAP. Primary technical success rate was 97.2% for the surgical as well as for the interventional procedure. The overall success rate was 100%. The reasons for retrieval failure by interventionists (3/108) as well as by surgeons (1/36) were post-thrombotic adhesions of the port catheter to the blood vessel wall. Conclusions Removal of TIVAPs of the forearm shows a high technical success rate and a low complication rate. End of therapy is the most common indication for explantation. There is a low risk of interventional removal failure with a resulting need for open surgery to remove the device.
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Pardo I, Rager EL, Bowling MW, Fajardo A, Clare S, Goulet R. Central Venous Port Placement: A Comparison of Axillary Versus Anterior Chest Wall Placement. Ann Surg Oncol 2010; 18:468-71. [DOI: 10.1245/s10434-010-1353-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Indexed: 11/18/2022]
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Culp WTN, Mayhew PD, Reese MS, Duda L, Glassman MM, Brown DC. Complications associated with use of subcutaneous vascular access ports in cats and dogs undergoing fractionated radiotherapy: 172 cases (1996-2007). J Am Vet Med Assoc 2010; 236:1322-7. [PMID: 20550447 DOI: 10.2460/javma.236.12.1322] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe complications associated with use of a subcutaneous vascular access port (SVAP) in cats and dogs treated with fractionated radiotherapy and to determine predisposing factors for developing these complications. DESIGN Retrospective case series. ANIMALS 46 cats and 126 dogs. PROCEDURES The medical records of cats and dogs undergoing radiation therapy that received placement of an SVAP between March 1996 and August 2007 were reviewed. Data were recorded and analyzed to determine factors for development of complications associated with the use of an SVAP during treatment with fractionated radiotherapy. RESULTS 18 and 36 major and minor complications were identified, respectively. Sex and the lack of administration of propofol during anesthesia induction were significantly associated with development of major complications. Female cats and dogs were 5.00 times as likely as male cats and dogs to develop major complications associated with SVAP usage. Animals in which propofol was not administered were 19.15 times as likely as animals administered propofol to develop major complications. Placement of SVAP catheters in a femoral vein was 17.20 times as likely as placement in the jugular vein to result in minor complications. CONCLUSIONS AND CLINICAL RELEVANCE Factors associated with the development of complications included sex, propofol administration, and vein in which an SVAP catheter was inserted. The use of an SVAP may be a useful alternative to repeated catheterizations in cats and dogs.
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Affiliation(s)
- William T N Culp
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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McNulty NJ, Perrich KD, Silas AM, Linville RM, Forauer AR. Implantable Subcutaneous Venous Access Devices: Is Port Fixation Necessary? A Review of 534 Cases. Cardiovasc Intervent Radiol 2009; 33:751-5. [DOI: 10.1007/s00270-009-9758-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 11/06/2009] [Indexed: 10/20/2022]
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Beckers MMJ, Ruven HJT, Seldenrijk CA, Prins MH, Biesma DH. Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer. Thromb Res 2009; 125:318-21. [PMID: 19640573 DOI: 10.1016/j.thromres.2009.06.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/16/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Thrombosis and infections are well known complications of central venous catheters and totally implanted access ports. These complications lead to increased costs due to prolonged hospitalisation, increased antibiotics use and need for replacement. The objectives of the study were to document the occurrence of catheter related thrombosis and infections in patients with central venous catheters and totally implanted chest ports in cancer patients and to investigate whether factor V Leiden is a risk factor for catheter related thrombosis. MATERIALS AND METHODS Between February 2002 and November 2004, 43 patients with central venous catheter or totally implanted access port were followed up to document the occurrence of catheter related thrombosis and infections. Patients received chemotherapy either for haematological malignancy or for solid tumours. Factor V Leiden (R506Q) was determined by restriction fragment length polymorphism analysis. Follow-up period ended in April 2007. RESULTS Catheter related thrombosis occurred in 4 patients (4/43; 9.3%) with a totally implanted access port. None of the 3 patients with factor V Leiden had catheter related infection or thrombosis. Catheter related infections occurred in 15 patients: 10 patients (23.3%; 10/43) with central venous catheter and 5 patients (11.6%; 5/43) with totally implanted access ports. Time to infection was 32.5 days in the central venous catheter group compared to 88 days in the totally implanted access port group. CONCLUSION A higher incidence of catheter related infections was observed in patients with central venous catheters in contrast to patients with totally implanted access ports were venous thrombosis was more frequent.
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Affiliation(s)
- M M J Beckers
- Department of Internal Medicine, University of Maastricht, The Netherlands
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Complications d’un dispositif intraveineux implantable pour chimiothérapie dans les cancers des voies aérodigestives supérieures. ACTA ACUST UNITED AC 2009; 126:43-52. [DOI: 10.1016/j.aorl.2009.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 02/13/2009] [Indexed: 11/18/2022]
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Crisinel M, Mahy S, Ortega-Debalon P, Buisson M, Favre JP, Chavanet P, Piroth L. Incidence, prévalence et facteurs de risque de survenue d’une première complication infectieuse sur chambres à cathéter implantables. Med Mal Infect 2009; 39:252-8. [DOI: 10.1016/j.medmal.2008.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 10/02/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
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Adverse effects of parenteral antimicrobial therapy for chronic bone infections. Eur J Clin Microbiol Infect Dis 2008; 27:1227-32. [DOI: 10.1007/s10096-008-0570-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 05/29/2008] [Indexed: 10/21/2022]
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[Satisfaction and personal experience of subcutaneous vascular access in 50 oncological patients]. ENFERMERIA CLINICA 2008; 18:197-200. [PMID: 18724916 DOI: 10.1016/s1130-8621(08)72195-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the personal experience of patients with central venous access (CVA) devices: satisfaction, fears and concerns, the influence of the devices on their daily lives, and the healthcare received. METHOD We performed a descriptive, longitudinal, prospective study in a sample of 50 patients with CVA devices withdrawn in the Angiography Unit of the Hospital de Navarra between August 1, 2006 and March 1, 2007. A 26-item questionnaire (Likert-like 5-point scale) was used. The statistical analysis was performed using the SPSS 13.0 package. RESULTS Fifty patients were interviewed, 18 men and 32 women, with a mean age of 52.54 years. The most frequent disease was colon cancer. The mean catheter dwell time was 369.52 days and the most frequent complication was hematoma. CONCLUSIONS The patients were satisfied with the device and would be willing to have another inserted, if necessary. Patients tended not to worry about complications and perceived the catheter as a foreign body. Arm movement was hardly restricted. Nursing care of the device was deficient in some patients.
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Mayer MN, Grier CK, Yoshikawa H, Ringwood PB. Complications associated with the use of vascular access ports in dogs receiving external beam radiation therapy. J Am Vet Med Assoc 2008; 233:96-103. [PMID: 18593316 DOI: 10.2460/javma.233.1.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the perioperative and postoperative complications associated with use of vascular access ports (VAPs) in the jugular and lateral saphenous veins of dogs requiring frequent anesthetic episodes for radiation therapy. DESIGN Cohort study. ANIMALS 40 dogs referred to a veterinary teaching hospital. PROCEDURES VAPs were used in 23 dogs, and intravenous catheters inserted in a peripheral vein were used in 17 dogs. The frequency of perioperative and postoperative complications associated with VAP use and the frequency of infection associated with intravenous catheter use were recorded. Results of bacterial culture of VAP tips and amount of time required for VAP placement and removal and for anesthetic induction were also recorded. RESULTS VAP-associated perioperative complications included malposition of the catheter tip in 4 of 23 (17.4%) dogs. The VAP-associated postoperative complications included seroma formation in 7 (30.4%) dogs, breakage of port-anchoring sutures in 3 (13.0%) dogs, suspected fatal catheter-related septicemia in 1 (4.3%) dog, and temporary partial withdrawal occlusion in 18 of 255 (7.1%) anesthetic episodes. CONCLUSIONS AND CLINICAL RELEVANCE Placement of VAPs provided ready access in dogs receiving radiation therapy. Most complications were minor and self-limiting; however, a low risk of serious complications existed. Use of fluoroscopy to assess position of the catheter tip is recommended to decrease the risk of malposition. Immediate removal of a VAP is recommended when clinical signs of infection develop. Removal of a VAP at the completion of radiation therapy should be performed unless the benefit of continued vascular access outweighs the risks.
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Affiliation(s)
- Monique N Mayer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
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Kreis H, Loehberg CR, Lux MP, Ackermann S, Lang W, Beckmann MW, Fasching PA. Patients' attitudes to totally implantable venous access port systems for gynecological or breast malignancies. Eur J Surg Oncol 2006; 33:39-43. [PMID: 17029869 DOI: 10.1016/j.ejso.2006.08.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Accepted: 08/07/2006] [Indexed: 11/20/2022] Open
Abstract
AIMS The aim of this study was to analyze patients' port-related quality of life. PATIENTS AND METHODS 260 consecutive patients with gynecological or breast malignancies were asked to take part in a questionnaire-based survey including 26 questions, and 232 women agreed to participate in the study. The questionnaire inquired about port-related aspects of everyday life and the use of a central venous access port device for chemotherapy and supportive cancer care. Multivariate analysis was used to identify parameters associated with satisfaction and dissatisfaction in relation to the port. RESULTS Most of the women were very satisfied with the use of a port to provide venous access for chemotherapy and supportive cancer care. Faster hospital procedures, good cosmetic results, and the ability to cope with the social environment had a significant influence on the degree of satisfaction. Fear of port punctures, inconvenient heparinization of the port, and fear of complications were found to be negative variables associated with the method. CONCLUSIONS Port catheters are well accepted by patients for chemotherapy and supportive cancer care. Generally ports should be rapidly removed after the end of antineoplastic treatment in order to improve patients' satisfaction with the procedure.
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Affiliation(s)
- H Kreis
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Universitaetsstrasse 21-23, D-91054 Erlangen, Bavara, Germany
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Agnelli G, Verso M. Therapy Insight: venous-catheter-related thrombosis in cancer patients. ACTA ACUST UNITED AC 2006; 3:214-22. [PMID: 16596145 DOI: 10.1038/ncponc0458] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 02/08/2006] [Indexed: 11/09/2022]
Abstract
Central venous catheters (CVCs) have improved the management of patients with cancer substantially, by facilitating chemotherapy and supportive therapy. The use of CVCs is associated with complications such as infection and upper-limb deep vein thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to the use of CVCs ranges between 2% and 4%. In the most recent study, the incidence of CVC-related thrombosis, as screened by venography, was approximately 18% in the absence of prophylaxis. In cancer patients with CVC-related UL-DVT, the incidence of clinically overt pulmonary embolism was between 15% and 25%, and the incidence of autopsy-proven pulmonary embolism was up to 50%. Pathogenic factors for CVC-related thrombosis include vessel injury caused by the CVC insertion procedure, venous stasis because of the indwelling CVC, and hypercoagulability associated with cancer. Recent studies have not confirmed a benefit for prophylaxis with antithrombotic agents for CVC-related thrombosis. The recommended treatment for CVC-related thrombosis is based on long-term anticoagulant therapy, with or without catheter removal.
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Twelves C, Gollins S, Grieve R, Samuel L. A randomised cross-over trial comparing patient preference for oral capecitabine and 5-fluorouracil/leucovorin regimens in patients with advanced colorectal cancer. Ann Oncol 2005; 17:239-45. [PMID: 16344278 DOI: 10.1093/annonc/mdj023] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Traditionally, metastatic colorectal cancer (MCRC) has been treated with intravenous (i.v.) 5-fluorouracil/leucovorin (5-FU/LV). The tumour-activated, oral fluoropyrimidine capecitabine demonstrates superior activity and favourable safety compared with the Mayo regimen, while potentially avoiding the complications and inconvenience associated with i.v. regimens. PATIENTS AND METHODS Ninety-seven patients with previously untreated advanced/MCRC were randomised to receive capecitabine followed by i.v. 5-FU/LV [Mayo Clinic, in-patient de Gramont (IPdG) or out-patient modified de Gramont (OPdG) regimens], or i.v. 5-FU/LV followed by capecitabine. RESULTS Before treatment, of those patients for whom a preference was recorded, almost all (95%) preferred oral treatment (consistent across all treatment groups) and the majority retained this preference after treatment (64% overall; 86%, 63% and 50% in the Mayo, IPdG and OPdG groups, respectively). Following treatment, the principal reasons for oral treatment preference were increased convenience, home-based administration and tablet formulation. Treatment satisfaction was significantly higher with capecitabine compared with Mayo (P<0.05) and with OPdG compared with capecitabine (P<0.05). Quality of life (QoL) was largely constant across the regimens, although it appeared better with OPdG than capecitabine (P<0.05). Grade 3/4 adverse events were uncommon in all arms. CONCLUSIONS This study confirmed that the majority of patients with MCRC prefer oral to i.v. therapy, although the OPdG regimen appears to be the most popular i.v. option. Capecitabine clearly represents an effective, well-tolerated oral alternative to i.v. 5-FU/LV.
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Affiliation(s)
- C Twelves
- University of Leeds, Bradford NHS Trust & Beatson Oncology Centre, Glasgow, UK.
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Goossens GA, Vrebos M, Stas M, De Wever I, Frederickx L. Central vascular access devices in oncology and hematology considered from a different point of view: how do patients experience their vascular access ports? JOURNAL OF INFUSION NURSING 2005; 28:61-7. [PMID: 15684906 DOI: 10.1097/00129804-200501000-00008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oncology patients require long-term vascular access, but the subjective experience of having a port in daily life is not well studied. METHODS In a prospective study, patients at an outpatient clinic filled out a questionnaire. INSTRUMENT The questionnaire consisted of four questions. RESULTS The top three reported benefits of having a port were (1) no more peripheral venipunctures, (2) greater convenience, and (3) arms left free for activities of daily living. Patients disliked the visibility of ports and complained about site soreness. CONCLUSIONS Good nursing care includes the ability to provide optimal care and maintenance of the vascular access device, but understanding the patients' point of view is an added value.
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Affiliation(s)
- Godelieve A Goossens
- Surgical Oncology Department, University Hospitals, Herestraat 49, 3000 Leuven, Belgium
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Carlo JT, Lamont JP, McCarty TM, Livingston S, Kuhn JA. A prospective randomized trial demonstrating valved implantable ports have fewer complications and lower overall cost than nonvalved implantable ports. Am J Surg 2004; 188:722-7. [PMID: 15619490 DOI: 10.1016/j.amjsurg.2004.08.041] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 08/07/2004] [Accepted: 08/07/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the current study was to evaluate whether a totally implanted valved subcutaneous port system would have fewer complications as compared to a standard nonvalved port. METHODS Study subjects requiring port placement were randomized to receive a valved port (PASV; Boston Scientific, Natick, MA) or a nonvalved port (BardPort; Bard Accesss Systems, Salt Lake City, UT). Each port was placed with standard operative technique. Difficulty with blood return, excess time spent accessing the port, and required interventions were reported over the initial 180 days of port usage. RESULTS Seventy-three patients were randomized to receive either a valved port (n = 37) or a nonvalved port (n = 36). No major complications were identified from port placement, and there were no differences in rates of infection between the 2 ports. A reported inability to withdraw blood was noted in the valved port group on 21 of 364 (5.8%) port accessions and in the nonvalved port group on 37 of 341 (11%) accessions (P = 0.02). Significantly more total time was spent ensuring adequate blood draw from nonvalved ports as opposed to valved ports (750 minutes vs. 1545 minutes, respectively) (P <0.03). CONCLUSIONS This study revealed that the PASV valved port is associated with significantly fewer instances of poor blood return and less nursing access time, indicating that a port with a PASV valve may be superior to a nonvalved device.
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Affiliation(s)
- John T Carlo
- Department of Surgery, Baylor University Medical Center, 3409 Worth Street, Ste. 420, Dallas, TX 75246, USA
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Barbut F, Soukouna S, Lalande V, Garcia ML, Neyme D, de Gramont A, Petit JC. Cathéters à chambre implantable : épidémiologie des complications et étude microbiologique des dispositifs après ablation. ACTA ACUST UNITED AC 2004; 52:566-74. [PMID: 15596304 DOI: 10.1016/j.patbio.2004.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 07/07/2004] [Indexed: 11/16/2022]
Abstract
UNLABELLED Totally implantable venous access ports (TIVAP) are valuable medical devices for long-term intravenous treatment such as parenteral nutrition, cancer chemotherapy or antiviral therapy. Implantation and use of these devices are each associated with infectious or mechanical complications. AIMS OF THE STUDY To determine the frequency of complications and to analyze bacterial contamination of different parts of TIVAP (tip, septum, internal lumen of the port). MATERIAL AND METHODS Clinical charts of patients, which TIVAP was removed between April 20th to December 31st 2003, were retrospectively reviewed. Infectious complications (local and septicemic) and non-infectious complications (i.e. obstruction, thrombosis, drug extravasation...) were defined using clinical and/or microbiological criteria. Quantitative culture from different parts of the TIVAP was performed. RESULTS One hundred and ten patients (age 57 +/- 14-years-old, 94.3% cancers) were included, corresponding to 57,018 catheter-days: 39.1% had one or more non-infectious complications (density incidence: 0.86 for 1000 catheter-days). Among the 49 complications, obstruction, thrombosis, extravasations and malposition accounted for 30.6%, 30.6% 4.1% and 6% of cases. Twenty-one patients (19.1%) had an infectious complication: 11 were local and 14 were systemic (density incidence 0.43 for 1000 catheter-days). Bacteria responsible for TIVAP-associated bacteraemia were coagulase negative staphylococci (N = 2), Staphylococcus aureus susceptible to methicilline (N = 3), micrococci (N = 1), corynebacteria (N = 1) or Gram-negative bacilli (N = 8). Comparison of quantitative culture of the different parts of TIVAP with a threshold at 10(3) CFU/ml showed that culture of tip, septum and port has a sensitivity of 47.6% 57.1% and 61.9 %, respectively and a specificity of 100% 92.1% and 92.1%, respectively for the diagnosis of TIVAP infection. CONCLUSION Complications associated to TIVAP are frequent but incidence that we have reported is comparable with previous studies. Analysis of internal lumen of the port is the most sensitive method for the diagnosis of TIVAP-associated infections.
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Affiliation(s)
- F Barbut
- Unité d'hygiène et de lutte contre les infections nosocomiales, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Van Cutsem E, Hoff PM, Harper P, Bukowski RM, Cunningham D, Dufour P, Graeven U, Lokich J, Madajewicz S, Maroun JA, Marshall JL, Mitchell EP, Perez-Manga G, Rougier P, Schmiegel W, Schoelmerich J, Sobrero A, Schilsky RL. Oral capecitabine vs intravenous 5-fluorouracil and leucovorin: integrated efficacy data and novel analyses from two large, randomised, phase III trials. Br J Cancer 2004; 90:1190-7. [PMID: 15026800 PMCID: PMC2409640 DOI: 10.1038/sj.bjc.6601676] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study evaluates the efficacy of capecitabine using data from a large, well-characterised population of patients with metastatic colorectal cancer (mCRC) treated in two identically designed phase III studies. A total of 1207 patients with previously untreated mCRC were randomised to either oral capecitabine (1250 mg m−2 twice daily, days 1−14 every 21 days; n=603) or intravenous (i.v.) bolus 5-fluorouracil/leucovorin (5-FU/LV; Mayo Clinic regimen; n=604). Capecitabine demonstrated a statistically significant superior response rate compared with 5-FU/LV (26 vs 17%; P<0.0002). Subgroup analysis demonstrated that capecitabine consistently resulted in superior response rates (P<0.05), even in patient subgroups with poor prognostic indicators. The median time to response and duration of response were similar and time to progression (TTP) was equivalent in the two arms (hazard ratio (HR) 0.997, 95% confidence interval (CI) 0.885–1.123, P=0.95; median 4.6 vs 4.7 months with capecitabine and 5-FU/LV, respectively). Multivariate Cox regression analysis identified younger age, liver metastases, multiple metastases and poor Karnofsky Performance Status as independent prognostic indicators for poor TTP. Overall survival was equivalent in the two arms (HR 0.95, 95% CI 0.84–1.06, P=0.48; median 12.9 vs 12.8 months, respectively). Capecitabine results in superior response rate, equivalent TTP and overall survival, an improved safety profile and improved convenience compared with i.v. 5-FU/LV as first-line treatment for MCRC. For patients in whom fluoropyrimidine monotherapy is indicated, capecitabine should be strongly considered. Following encouraging results from phase I and II trials, randomised trials are evaluating capecitabine in combination with irinotecan, oxaliplatin and radiotherapy. Capecitabine is a suitable replacement for i.v. 5-FU as the backbone of colorectal cancer therapy.
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Affiliation(s)
- E Van Cutsem
- University Hospital Gasthuisberg, Leuven, Belgium.
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Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003; 21:3665-75. [PMID: 14512399 DOI: 10.1200/jco.2003.08.008] [Citation(s) in RCA: 397] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Long-term central venous catheters (CVCs) have considerably improved the management of cancer patients because they facilitate chemotherapy, transfusions, parenteral nutrition, and blood sampling. However, the use of long-term CVCs, especially for chemotherapy, has been associated with the occurrence of upper-limb deep venous thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to CVCs has been reported to vary between 0.3% and 28.3%. The incidence of CVC-related UL-DVT screened by venography reportedly varies between 27% and 66%. The incidence of clinically overt pulmonary embolism (PE) in patients with CVC-related UL-DVT ranges from 15% to 25%, but an autopsy-proven PE rate of up to 50% has been reported. Vessel injury caused by the procedure of CVC insertion, venous stasis caused by the indwelling CVC, and cancer-related hypercoagulability are the main pathogenetic factors for CVC-related venous thromboembolism (VTE). Several studies have assessed the benefit of the prophylaxis of UL-DVT after CVC insertion in cancer patients. According to the results of these studies, prophylaxis with low molecular weight heparin or a low fixed dose of warfarin has been recently proposed. However, the limitations of the experimental design of the prophylactic studies do not allow definitive recommendations. The recommended therapy for UL-DVT associated with CVC is based on anticoagulant therapy with or without catheter removal. This review focuses on the epidemiology, pathogenesis, diagnosis, prevention, and treatment of VTE in cancer patients with long-term CVC.
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Affiliation(s)
- Melina Verso
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy.
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Henry CJ, Russell LE, Tyler JW, Buss MS, Seguin B, Cambridge AJ, Moore ME. Comparison of hematologic and biochemical values for blood samples obtained via jugular venipuncture and via vascular access ports in cats. J Am Vet Med Assoc 2002; 220:482-5. [PMID: 11860243 DOI: 10.2460/javma.2002.220.482] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether hematologic and serum biochemical values for blood samples obtained from cats via vascular access ports (VAP) are comparable to those for samples obtained by direct venipuncture. DESIGN Prospective study. ANIMALS 14 healthy cats. PROCEDURE A VAP was surgically implanted in a jugular vein in each cat. Blood samples were obtained from the VAP and by direct venipuncture of the contralateral jugular vein 10 weeks after VAP placement. Results of hematologic and serum biochemical analyses were compared by use of a paired t-test. The Pvalue to reject the null hypothesis was adjusted to account for multiple comparisons by using the Bonferroni procedure in which the nominal P-to-reject value is divided by the number of comparisons (0.05/24 = 0.002). RESULTS Paired samples (VAP and venipuncture) obtained 10 weeks after VAP placement were evaluated for each cat. Of the 24 measured analytes, only potassium, total protein, and albumin concentrations differed significantly (P< 0.001 for all 3) between VAP and venipuncture samples. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that samples obtained from VAP are suitable for routine hematologic monitoring of feline cancer patients. Sample hemolysis may account for a slight increase in potassium, total protein, and albumin concentrations obtained from VAP samples. However, the values of variables most critical for monitoring of patients receiving chemotherapy (ie, mature neutrophil and platelet counts) are comparable. If proper techniques are used, VAP may be used for administration of chemotherapy as well as for blood collection in cats undergoing cancer treatment.
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Affiliation(s)
- Carolyn J Henry
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia 65211, USA
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