1
|
Cheng W, Zhang J, Wang X, Liu G, Yao W, Wang C, Wu R, Li Z. Surgical procedures and complications in placement of totally implantable venous access port in pediatric hemophilia patients: A retrospective analysis. Blood Cells Mol Dis 2024; 108:102862. [PMID: 38889659 DOI: 10.1016/j.bcmd.2024.102862] [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: 02/26/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
This retrospective study at Beijing Children's Hospital (2020-2023) analyzed surgical procedures and complications in 24 pediatric hemophilia patients undergoing Totally Implantable Venous Access Port (TIVAP) insertion, primarily in the right jugular vein (RJV). We detailed the surgical process, including patient demographics and intraoperative imaging use. The choice of the RJV for TIVAP placement was influenced by its larger diameter and superficial anatomical position, potentially reducing risks like thrombosis and infection. Our findings support the RJV as a safer alternative for port placement in pediatric patients, aligning with current literature. Statistical analysis revealed no significant correlation between complications and baseline characteristics like weight and diagnosis type. However, the length of hospital stay and implant brand were significant risk factors for catheter or port displacement and removal. The limited patient number may introduce bias, suggesting a need for further studies with larger samples. Despite a 14.7 %-33 % complication rate and 5 port removals, the advantages of TIVAP, including reliable venous access, reduced discomfort, and treatment convenience, were evident. Most complications improved with symptomatic treatment, and there were no deaths due to port-related complications, underscoring the impact of TIVAP on improving pediatric hemophilia treatment.
Collapse
Affiliation(s)
- Wei Cheng
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jinrui Zhang
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xipeng Wang
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Guoqing Liu
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wanru Yao
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Chunli Wang
- Nursing Department, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - Runhui Wu
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zhiqiang Li
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| |
Collapse
|
2
|
Donadoni M, Calloni M, Romano ME, Mutti A, Bartoli A, La Cava L, Celano R, Urso F, Popescu Janu V, Foschi A, Casella F, Taino A, Cogliati C, Zappa P, Masseroli MM, Gidaro A. Long peripheral catheters for intravenous infusions of iloprost or alprostadil therapy in rheumatologic outpatients. J Vasc Access 2024:11297298241252896. [PMID: 38770673 DOI: 10.1177/11297298241252896] [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: 05/22/2024] Open
Abstract
BACKGROUND Long peripheral catheters (LPCs) role in Difficult IntraVenous Access (DIVA) patients admitted to the emergency department has already been studied, resulting in a rapid, safe, and cost-effective procedure. Although their use in outpatient settings is established, there is a lack of studies assessing their benefits. In particular, rheumatologic outpatients affected by scleroderma, especially those affected by digital ulcers, are often treated with intravenous infusions of prostaglandin I2 (PGI2) analog (IV-PGI2A). OBJECTIVE AND METHODS From 1 October 2021 to 31 March 2024, we conducted a prospective study enrolling DIVA outpatients affected by systemic sclerosis or undifferentiated connective tissue disease who needed IV-PGI2A therapy at L. Sacco Hospital in Milan (Italy). Each treatment cycle consisted of four consecutive days of infusion of iloprost or alprostadil. The primary aim was to assess the efficacy and potential complications associated with LPCs for IV-PGI2A. RESULTS Twenty-six patients were enrolled 23 were females (88.5%), and the median age was 72 years (IQR 56-78.7). In total, 97 LPCs were inserted, with a mean number of insertions per patient/year of 2.3. An increase in LPCs insertion during the 30 months of the enrollment period was observed. Eighteen patients required more than one LPC placement, and in 61% of them, the second venipuncture was executed at a different site. No procedural complications were registered (accidental puncture of the brachial artery, accidental median nerve puncture, bleeding) nor late complications (Catheter-Related Thrombosis, Catheter-Related Bloodstream Infections, Accidental Removal). CONCLUSIONS Our experience shows that LPCs could be valuable and safe for rheumatologic outpatients. The increased number of insertions and new and total patients enrolled each year defines the satisfaction of patients and health care professionals.
Collapse
Affiliation(s)
- Mattia Donadoni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Calloni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Eva Romano
- Department of Rheumatology, "Luigi Sacco" Hospital, Milan, Italy
| | - Alessandra Mutti
- Department of Rheumatology, "Luigi Sacco" Hospital, Milan, Italy
| | - Arianna Bartoli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Leyla La Cava
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Rosita Celano
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Urso
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Valentina Popescu Janu
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, "Luigi Sacco" Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Alba Taino
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Paolo Zappa
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Matteo Maria Masseroli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| |
Collapse
|
3
|
Sharma V, Pandey A. A Spectrum of Chemoport-Associated Complications and Their Management in Cancer Patients. Cureus 2024; 16:e58052. [PMID: 38738137 PMCID: PMC11088396 DOI: 10.7759/cureus.58052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly. METHODS We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records. RESULTS The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases. CONCLUSION Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.
Collapse
Affiliation(s)
- Vikas Sharma
- Surgical Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Arun Pandey
- Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, IND
| |
Collapse
|
4
|
Li H, Shan J. Risk Factors of the Totally Implantable Venous Access Device-Related Infection in Patients With Brain Tumors Undergoing Chemotherapy After Surgery. Surg Infect (Larchmt) 2024; 25:133-139. [PMID: 38265425 DOI: 10.1089/sur.2023.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: The complication of totally implantable venous access device (TIVAD) is an infection, which causes the death of patients. Therefore, it is critical to identify risk factors for TIVAD infection to prevent death. Patients and Methods: The enrolled patients were divided into two groups and subsequently divided into subgroups according to various factors in which the correlation between infection and risk factors was analyzed. Multivariable logistic analysis of odds ratios (ORs) for seven risk factors was performed, meanwhile, the receiver operating characteristic (ROC) curve analysis of neutrophil and serum albumin was conducted for the prediction of TIVAD infection occurrence. Results: Catheter-related blood stream infection was the common infection type, which was dominantly caused by Staphylococcus aureus. Removal of TIVAD and antibiotic therapy were the preferred approaches for the treatment of infection. Seven risk factors were closely associated with the TIVAD infection, however, two risk factors, including age and outpatient, were excluded according to the multivariate logistic analysis of ORs. Receiver operating characteristic curve analysis revealed neutrophil count and serum albumin could predict the occurrence of TIVAD infection. Conclusions: Five risk factors were positively related to TIVAD infection; neutrophil and serum albumin could be used to predict the occurrence of TIVAD infection.
Collapse
Affiliation(s)
- Haihong Li
- Department of Neurosurgery 1, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jing Shan
- Department of Orthopaedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
5
|
Lesens O, Forestier E, Botelho-Nevers E, Pavese P, David G, Nougarede B, Corbin V, Pereira B, Aumeran C, Sauvat L. Comparing ethanol lock therapy versus vancomycin lock in a salvation strategy for totally implantable vascular access device infections due to coagulase-negative staphylococci (the ETHALOCK study): a prospective double-blind randomized clinical trial. Eur J Clin Microbiol Infect Dis 2024; 43:223-232. [PMID: 37993679 DOI: 10.1007/s10096-023-04702-w] [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: 04/20/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Little is known about efficacy and safety of ethanol lock therapy (ELT) to treat totally implantable venous access device (TIVAD) infections. The objective of this trial was to evaluate the effectiveness and safety profile of a local treatment with ELT without removal for TIVAD infection due to coagulase-negative staphylococci. METHODS We performed a prospective, multicenter, double-blind, randomized clinical trial comparing the efficacy of 40% ELT versus vancomycin lock therapy (VLT) in TIVAD infections due to coagulase-negative staphylococci, complicated or not by bloodstream infection. RESULTS Thirty-one patients were assigned to the ELT group and 30 to the VLT arm. Concomitant bacteremia was present in 41 patients (67.2%). Treatment success was 58.1 % (18 of 31) for the ELT arm and 46.7% (14 of 30) for the VLT arm (p = 0.37). The overall treatment success was 52.5% (32). The risk of treatment failure due to uncontrolled infections, superinfections, and mechanical complications did not differ significantly between participants receiving ELT (13 out of 31 [42%]) and those receiving VLT (16 out of 30 [53%]) with a hazard ratio of 0.70 (p = 0.343; 95% CI [0.34-1.46], Cox model). Catheter malfunctions were significantly more frequent in the ELT arm (11 patients versus 2 in the VLT group, p = 0.01). CONCLUSIONS We found an overall high rate of treatment failure that did not differ between the ELT arm and the VLT arm. TIVAD removal must be prioritized to prevent complications (uncontrolled infections, superinfections, and catheter malfunctions) except in exceptional situations.
Collapse
Affiliation(s)
- Olivier Lesens
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
- Centre d'Investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.
- Infectious and Tropical Diseases Department, Clermont-Ferrand University Hospital Center, Reference Center for Osteoarticular Infections, Regional Reference Center for Tick-Based Vector Diseases, Genome and Environment Microorganisms Laboratory, Clermont Auvergne University, Clermont-Ferrand, France.
| | - Emmanuel Forestier
- Infectious Disease Department, Metropole Savoie Hospital Center, Chambery, France
| | | | - Patricia Pavese
- Infectious Disease Department, Grenoble University Hospital Center, Grenoble, France
| | - Gary David
- Infectious Disease Department, Villefranche sur Saône Hospital Center, Villefranche sur Saône, France
| | | | - Violaine Corbin
- Infectious and Tropical Diseases Department, Clermont-Ferrand University Hospital Center, Reference Center for Osteoarticular Infections, Regional Reference Center for Tick-Based Vector Diseases, Genome and Environment Microorganisms Laboratory, Clermont Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical Research Direction, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Claire Aumeran
- Infection Control Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Léo Sauvat
- Infection Control Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| |
Collapse
|
6
|
Órfão J, Melo M, Mendes N, Germano A, Soares M, Barbosa L, Freire F. Unilateral vocal fold paralysis as a port complication. J Vasc Access 2024; 25:331-335. [PMID: 35891580 DOI: 10.1177/11297298221113690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Unilateral vocal fold paralysis (UVFP) is a frequent finding in otorhinolaryngology practice, but its occurrence as a port complication was very rarely described in English Literature. The authors report a 55-year-old woman with a pancreatic adenocarcinoma who presented a left vocal fold paralysis that occurred concurrently with a venous thrombosis of the left subclavian vein, where a totally implantable venous-access had been previously placed. Although the patient's oncologic disease, that could mislead to a neoplastic cause of the UVFP, the authors came across with an unusual etiology and to their best knowledge, it is the first case of irreversible UVFP associated with onsite thrombosis of the vessel where a port was implanted. The objective of this article is to present and discuss this rare case of UVFP secondary to a port complication and to review the main mechanisms of iatrogenic vocal fold paralysis related to these devices.
Collapse
Affiliation(s)
- João Órfão
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Marta Melo
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Nuno Mendes
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Ana Germano
- Department of Radiology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Mafalda Soares
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Leonel Barbosa
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| | - Filipe Freire
- Department of Otorhinolaryngology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
| |
Collapse
|
7
|
Kaul P, Tiwari AR, Kaul P, Kumar R, Garg PK. Revisiting the Anatomical Landmark-Guided Central Venous Access Device Insertion: A Retrospective Cohort Study. World J Surg 2023; 47:2562-2567. [PMID: 37310439 DOI: 10.1007/s00268-023-07088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ultrasound (USG) guidance is superior to blind and open cut-down techniques for accurate puncture of the internal jugular vein (IJV) or subclavian vein, but it increases the cost and duration of the procedure. Here, we report our experience with the reliability and consistency of anatomic landmark-guided technique for Central Venous Access Device (CVAD) insertion in a low-resource setting. MATERIAL AND METHODS A retrospective analysis of the prospectively maintained database of patients undergoing CVAD insertion through one of the jugular veins was performed. Central venous access was achieved using a standardized anatomic insertion landmark (apex of Sedillot's triangle). Ultrasonography (USG) and/or fluoroscopy assistance was taken as and when required. RESULTS Over 12 months (October 2021 to September 2022), a total of 208 patients underwent CVAD insertion. Central venous access was successfully achieved using anatomic landmark-guided technique in all but 14 patients (6.7%), in whom USG guidance or C-arm was used. Eleven out of 14 patients who needed guidance for CVAD insertion had body mass index (BMI) of more than 25, one had thyromegaly while the remaining two had an arterial puncture during cannulation. CVAD insertion-related complications included deep vein thrombosis (DVT) in five, extravasation of chemotherapeutic agent in one, spontaneous extrusion related to a fall in one, and persistent withdrawal-related occlusion in seven patients. CONCLUSION Anatomical landmark-guided technique of CVAD insertion is safe and reliable, and can reduce the need for USG/C-arm in 93% of the patients.
Collapse
Affiliation(s)
- Pallvi Kaul
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, 248001, India
| | - Ajeet Ramamani Tiwari
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, 248001, India
| | - Priyanka Kaul
- Department of Surgery, Doon Medical College, Dehradun, India
| | - Rahul Kumar
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, 248001, India
| | - Pankaj Kumar Garg
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, Uttarakhand, 248001, India.
| |
Collapse
|
8
|
Zhu Y, Niu S, Zhang Y, Zhang H, Chang J, Ye L. Effect of lidocaine spray on reliving non-coring needle puncture-related pain in patients with totally implantable venous access port: a randomized controlled trial. Support Care Cancer 2023; 31:452. [PMID: 37421451 PMCID: PMC10329572 DOI: 10.1007/s00520-023-07910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Patients with the placement of a totally implantable venous access port (TIVAP) commonly suffer from pain caused by inserting a non-coring needle. At present, lidocaine cream and cold spray are extensively used for pain management, but they are complex to manage in busy medical environments and developing countries. The lidocaine spray combines the analgesic effect of lidocaine cream and the rapid onset of cold spray, which can effectively alleviate the pain related to non-coring needle puncture in patients with TIVAP. This randomized-controlled trial aimed to explore the effectiveness, acceptability, and safety of lidocaine spray in relieving the pain of non-coring needle puncture in patients with TIVAP. METHODS A total of 84 patients who were hospitalized in the oncology department of a Grade III Level-A hospital in Shanghai from January 2023 to March 2023 and were implanted with TIVAP and required non-coring needle puncture were selected as the study subjects. The recruited patients were randomly assigned to the intervention group and the control group (n=42). Before routine maintenance, the intervention group received lidocaine spray 5 min before disinfection, while the control group received water spray 5 min before disinfection. The main clinical outcome was pain, and the degree of puncture pain in both groups was evaluated using the visual analogue scale. RESULTS There were no significant differences between the two groups in age, gender, educational level, body mass index, port implantation time, and disease diagnosis (P>0.05). The pain score in the intervention and control groups was 15.12±6.61mm and 36.50±18.79mm, respectively (P<0.001). There were 2 (4.8%) patients with moderate pain in the intervention group and 18 (42.9%) patients with moderate pain in the control group (P<0.001). In the control group, 3 (7.1%) patients reported severe pain. The median comfortability score for the two groups of patients was 10, but there was a difference between the two groups (P<0.05) because the intervention group tilted to the right. The successful puncture rate of the first time puncture had no difference between the two groups, both being 100%. Moreover, 33 patients (78.6%) in the intervention group and 12 patients (28.6%) in the control group reported that they would choose the same spray for intervention in the future (P<0.001). During the 1 week of follow-up, 1 patient in the intervention group developed skin itching (P>0.05). CONCLUSIONS The local use of lidocaine spray in patients with TIVAP is effective, acceptable, and safe to alleviate the pain caused by non-coring needle puncture. TRIAL REGISTRATION Chinese Clinical Trial Registry (registration number: ChiCTR2300072976).
Collapse
Affiliation(s)
- Ying Zhu
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Sihua Niu
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Yejun Zhang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Huiyan Zhang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Jian Chang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Liqin Ye
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China.
| |
Collapse
|
9
|
Rolland S, Kassis-Chikhani N, Auclin E, Bensaid S, Bidaud AL, Gerlinger MP, Blez D, Mainardi JL, Lebeaux D, Dubert M. TIVAP-related infection due to Gram-negative aerobic bacilli: should TIVAP stay or should it go? Eur J Clin Microbiol Infect Dis 2023; 42:161-168. [PMID: 36472717 DOI: 10.1007/s10096-022-04537-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: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
We aimed to describe the outcome of totally implantable venous-access port (TIVAP)-related infections due to Gram-negative aerobic bacilli (Pseudomonas aeruginosa and other Pseudomonas spp., Acinetobacter spp., and Stenotrophomonas maltophilia), or GNAB, and assess the safety of conservative treatment. We conducted a retrospective study in a French teaching hospital, from January 2016 to December 2020, including adult patients treated for TIVAP-related infection due to GNAB. Success of conservative treatment was defined as a functional TIVAP 3 months after infection with no recurrence. We performed a bivariate analysis and analyzed causes for treatment failure. We included 68 patients (53 TIVAP-related bloodstream infections, 11 TIVAP-related infections, and 4 probable TIVAP-related infections) due to GNAB, mostly P. aeruginosa (50/68, 74%). TIVAP removal was initially decided for 49/68 patients (72%). Among the 19/68 (28%) patients with conservative treatment (all for infections caused by P. aeruginosa), 5/19 (26%) had successful treatment, 7/19 (37%) experienced failure (without sepsis or septic shock), 6/19 (32%) died within 3 months without TIVAP removal and no signs of infection recurrence, and 1 patient had TIVAP removal as it was no longer required. TIVAP-related infections caused by GNAB frequently require TIVAP removal. Conservative treatment can be performed in selected patients with a non-complicated infection caused by P. aeruginosa, who can benefit from the continuation of antineoplastic chemotherapy or palliative care. Treatment failures were not associated with sepsis or septic shock.
Collapse
Affiliation(s)
- Simon Rolland
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.,Service Des Maladies Infectieuses Et Tropicales, Hôpital de La Cavale Blanche, CHU de Brest, 29200, Brest, France
| | - Najiby Kassis-Chikhani
- Unité de Prévention du Risque Infectieux, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Edouard Auclin
- Service d'oncologie Thoracique, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Samuel Bensaid
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Anne-Laure Bidaud
- Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Marie-Paule Gerlinger
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Damien Blez
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Jean-Luc Mainardi
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.,Université Paris Cité, 75006, Paris, France
| | - David Lebeaux
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France. .,Université Paris Cité, 75006, Paris, France.
| | - Marie Dubert
- Unité Mobile d'Infectiologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France. .,Université Paris Cité, 75006, Paris, France.
| |
Collapse
|
10
|
Can AT, Hermens DF, Lagopoulos J. A unique case of very low‐dose subcutaneous ketamine use: Maintenance option of ketamine for treatment‐resistant depression. Clin Case Rep 2022; 10:e6675. [PMCID: PMC9748241 DOI: 10.1002/ccr3.6675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Adem T. Can
- Thompson Institute University of the Sunshine Coast Birtinya Queensland Australia
| | - Daniel F. Hermens
- Thompson Institute University of the Sunshine Coast Birtinya Queensland Australia
| | - Jim Lagopoulos
- Thompson Institute University of the Sunshine Coast Birtinya Queensland Australia
| |
Collapse
|
11
|
Shi L, Chen H, Yang Y, Li H, Zhang J. Application of intracavitary ECG for positioning the totally implantable venous access port in the upper arm of cancer patients. Exp Ther Med 2022; 24:477. [PMID: 35761811 PMCID: PMC9214596 DOI: 10.3892/etm.2022.11404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/20/2022] [Indexed: 11/09/2022] Open
Abstract
Accurate positioning of the catheter tip is one of the most critical procedures in central venous catheter insertion. The traditional surface measurement method frequently has a large deviation and increases the X-ray exposure of doctors and patients. In the present retrospective study, cancer patients who received a totally implantable venous access port (TIVAP) in the upper arm using intracavitary electrocardiogram (ECG) guidance were compared with those where the traditional surface measurement method was used in terms of the rate of correct placement of the catheter tip, the rate of achieving the best position, the operation time and the complications. The results indicated that the correct placement rate and the best position rate of the catheter tip at the first attempt were higher in the ECG-guided group than in the traditional surface measurement method group (95.65 vs. 82.91% and 90.58 vs. 68.38%, respectively). The mean operation time was shorter in the ECG-guided group than in the surface measurement group (46.28 vs. 63.26 min). The incidence of complications in the ECG-guided group was 6.52%, while that in the surface measurement group was 10.26%. This indicated that the intracavitary ECG-guided tip positioning technique may improve the accuracy of tip catheter placement and shorten the operation time, thus reducing ionizing radiation caused by repeated positioning. Therefore, the intracavitary ECG-guided tip positioning technique is able to effectively place the tip of the TIVAD in the upper arm, holding great promise as a clinical application.
Collapse
Affiliation(s)
- Lihua Shi
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| | - Huihui Chen
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| | - Yaping Yang
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| | - Huifen Li
- Nursing Department, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu 215153, P.R. China
| | - Jianfang Zhang
- Nursing Department, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China
| |
Collapse
|
12
|
Zhou Y, Lan Y, Zhang Q, Song J, He J, Peng N, Peng X, Yang X. Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures. Phlebology 2022; 37:279-288. [DOI: 10.1177/02683555211069772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method. Methods Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis. Results A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43–1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15–3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14–8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22–3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22–1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01–2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16–89.76, p = .41) between the two implantation paths. Conclusions There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.
Collapse
Affiliation(s)
- Ya Zhou
- Department of Oncology, Chongqing General Hospital, Chomgqing, China
| | - Yanqiu Lan
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Qiang Zhang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Jifang Song
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Juan He
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Na Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xingqiao Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xinxin Yang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| |
Collapse
|
13
|
Dastouri D, McSweeney WT, Leaning M, Hendahewa R. Outcome Comparison of Totally Implantable Venous Access Device Insertions Between Surgeons and Radiologists in Australia. Cureus 2022; 14:e23244. [PMID: 35449615 PMCID: PMC9012940 DOI: 10.7759/cureus.23244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background The need for chemotherapy treatment is increasing with the growing incidence of cancer worldwide. The insertion of totally implantable venous access devices (TIVADs) is commonly performed by surgeons and radiologists, but the procedures are not without complications. The primary outcome of this review outlines TIVAD insertion success and complication rates between general surgeons and radiologists. The secondary goal of this study is to help identify areas for improvement and consideration when performing TIVAD insertion. Methodology This was a descriptive, three-year, retrospective multicentre study of oncological patients who underwent TIVAD insertion by either general surgeons or radiologists at two peripheral Brisbane hospitals. Results Surgeons performed 61 percutaneous subclavian vein cannulations, 29 ultrasound-guided internal jugular veins, and seven open cephalic veins cut-down TIVAD insertions (n=97). Overall surgical success was 81.4%, with the internal jugular (89.7%) having the highest success rate followed by the open cut-down (85.7) and subclavian approaches (77.0%). The overall surgical complication rate was 16.4%, with five pneumothorax, five port malfunctions, three haemorrhages, two infections, one thrombus, and one mediastinal injury. Each pneumothorax was associated with subclavian cannulation attempts. Two haemorrhages were associated with both open cephalic and subclavian attempts. Radiologists performed 248 ultrasound-guided internal jugular vein TIVAD insertions (n=248) with 247 successful first attempts (99.5%). Within the radiology group, there was an overall complication rate of 15.3% with 22 infections, 14 port malfunctions, one haemorrhage, and 1 mediastinal injury. Conclusion Ultrasound-guided internal jugular vein TIVAD insertion had the highest first attempt success rate in both the surgical and radiology groups.
Collapse
|
14
|
Pinto E, Granziera E, Cagol M, Cappellato S, Alfieri R, Mari V, Meroni M, Zagonel V, Conte P, Pilati P, Castoro C, Cavallin F, Scarpa M. Totally Implantable Venous Access Devices: A Randomized Controlled Trial on the Effect of Psychological Support on Quality of Life and Body Image (BI-PORT). Front Psychol 2021; 12:703497. [PMID: 34867586 PMCID: PMC8632700 DOI: 10.3389/fpsyg.2021.703497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The presence of totally implantable venous access devices (TIVADs), as any permanent or semipermanent medical devices, has an impact on the quality of life (QoL) of patients. Therefore, the purpose of this trial was to evaluate the efficacy of psychological support for patients undergoing this procedure. Methods: This randomized controlled trial (RCT) aimed to compare the efficacy of a psychological intervention vs. standard care on QoL in patients receiving TIVAD for chemotherapy treatment (ClinicalTrials.gov NCT02075580). The trial was conducted at the Veneto Institute of Oncology IOV-IRCCS (Padua, Italy) between October 2013 and September 2018. Participants were neoplastic adults receiving TIVAD for chemotherapy treatment for any cancer, not undergoing visible demolitive interventions, without psychopathological diagnosis and language understanding. The exclusion criteria were patients without a diagnosis of cancer, with psychopathological diagnosis, or with language misunderstanding. Results: The variation of C30-QL2 and BR32-BI was not statistically different between intervention and control arms in men and women. However, the variation of C30-SF was statistically better in the intervention than control arm in men [mean difference (MD) 22.3, 95% CI 3.5 to 41.0] but not in women (MD −2.7, 95% CI −24.0 to 18.7). The variations of the other secondary outcome measures were not statistically different between intervention and control arms. Conclusion: Psychological support did not show any clear advantages on global QoL and body image perception in patients at 15 days after TIVAD insertion for chemotherapy. In contrast, male patients might benefit from even a very short psychological counseling before or during chemotherapy even if they do not seem to ask for it.
Collapse
Affiliation(s)
- Eleonora Pinto
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Matteo Cagol
- Breast Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Sandra Cappellato
- Anesthesiology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Rita Alfieri
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Valentina Mari
- General Surgery Unit 3, Azienda Ospedale University of Padua (AOUP), Padua, Italy
| | - Muzio Meroni
- Anesthesiology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Pierfranco Conte
- Medical Oncology Unit 2, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Pierluigi Pilati
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Carlo Castoro
- Department of Upper GI Surgery, Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | | | - Marco Scarpa
- General Surgery Unit 3, Azienda Ospedale University of Padua (AOUP), Padua, Italy
| |
Collapse
|
15
|
Lee J, Hur SM, Kim Z, Lim CW. Safety of immediate use of totally implantable venous access ports in adult patients with cancer: a retrospective single-center study. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:104-110. [PMID: 36945672 PMCID: PMC9942755 DOI: 10.14216/kjco.21016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023]
Abstract
Purpose Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications. Methods Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients' clinical data was performed to investigate catheter days and complications of TIVAPs. Results Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10-457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054-1.414; P=0.008). Conclusion This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.
Collapse
Affiliation(s)
- Jisu Lee
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Mo Hur
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Cheol Wan Lim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| |
Collapse
|
16
|
Doğduş M, Dindaş F, Türkyılmaz E, Dindar B, Tunçer B, Candan Ö. Successful percutaneous transvenous removal of a fractured port catheter via novel technique: Balloon-supported retrieval. Anatol J Cardiol 2021; 25:671-672. [PMID: 34498601 DOI: 10.5152/anatoljcardiol.2021.62186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mustafa Doğduş
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Ferhat Dindaş
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Erdem Türkyılmaz
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Barış Dindar
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Barış Tunçer
- Department of Cardiovascular Surgery, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Özkan Candan
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| |
Collapse
|
17
|
Jeon SB, Jeon Y, Han KW, Chun YS, Baek JH. An analysis of the outcomes of totally implantable access port implantation performed by surgical residents. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:15-22. [PMID: 36945206 PMCID: PMC9942736 DOI: 10.14216/kjco.21003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
Purpose This study aimed to investigate the clinical outcomes after totally implantable access port (TIAP) implantation performed by general surgery residents in patients with colorectal cancer. Methods A total of 291 consecutive patients who underwent TIAP implantations were evaluated. The patients were divided into three groups: second-, third-, and fourth-grade residents. Results The mean follow-up was 22.1 months (range, 1-87 months). The total times of operation, puncture, and cannulation decreased as the resident grade increased (P<0.001). Early complications significantly decreased with higher resident grades (P=0.039). The non-use of ultrasonography and non-use of C-arm were identified as independent risk factors for complications. Resident grades between second and third (P=0.005) and between second and fourth (P=0.041) were identified as independent risk factors for optimal tip position. Conclusion TIAP implantation can be safely and effectively performed by residents. Low-grade residents were associated with early complications.
Collapse
Affiliation(s)
- Se-Beom Jeon
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Youngbae Jeon
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyoung-Won Han
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yong-Soon Chun
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jeong-Heum Baek
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| |
Collapse
|
18
|
Yoon SY, Jeon GS, Jung S. Image-guided placement of totally implanted vascular access device: retrospective analysis of the clinical outcomes and associated risk factors. BMJ Support Palliat Care 2021:bmjspcare-2021-002917. [PMID: 33927012 DOI: 10.1136/bmjspcare-2021-002917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 04/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine risk factors for catheter survival and complications after image-guided implantation of a totally implanted vascular access device (TIVAD). METHODS A total of 2883 TIVADs (2735 patients, 63.5±13 years old, 1060 men, 1675 women) implanted under guidance by ultrasound and fluoroscopy in our institution from January 2010 to December 2019 were evaluated retrospectively. We used the log rank test and logistic regression to analyse risk factors associated with catheter survival and complications. RESULTS Female patients (n=1778; 61.7%; mean catheter survival days: 780.6 days) and those with a haematological malignancy (n=277; 10.1%; mean catheter survival days: 1019 days) had significantly better catheter survival than male patients (n=1105; 38.3%; mean catheter survival days: 645.9 days) and those with a solid organ malignancy (n=2447; 89.5%; mean catheter survival days: 701 days) (p<0.001 and p=0.003). Patients with haematological malignancies and benign vascular inflammatory disease (n=11; 0.4%) were vulnerable to infection (n=96; 3.3%) (p<0.001 and p=0.004). Thrombotic malfunction (n=38; 1.3%) was significantly more common in females than males (p=0.005). Non-thrombotic malfunction (n=16; 0.6%) showed a significant association with left positioning of the TIVAD (n=410; 14.2%) (p=0.043). Wound dehiscence (n=3; 0.1%) was significantly more frequent in punctured veins other (n=23; 0.8%) than the internal jugular vein (p<0.001). CONCLUSIONS Increased attention should be paid to patients with an underlying haematological malignancy, underlying vascular inflammatory disease, female patients, older patients, those accessed via a vein other than the IJV, those with left positioning of the TIVAD system or those with a prolonged TIVAD maintenance.
Collapse
Affiliation(s)
- So Yeon Yoon
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Gyeong Sik Jeon
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Sanghoon Jung
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| |
Collapse
|
19
|
Yu Z, Sun X, Bai X, Ding W, Wang W, Xu L, Qin W, Wen L, Jin Y. Perioperative and Postoperative Complications of Supraclavicular, Ultrasound-Guided, Totally Implantable Venous Access Port via the Brachiocephalic Vein in Adult Patients: A Retrospective Multicentre Study. Ther Clin Risk Manag 2021; 17:137-144. [PMID: 33568912 PMCID: PMC7869700 DOI: 10.2147/tcrm.s292230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/20/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The totally implantable venous access port (TIVAP) provides patients with safe, effective and long-term convenient venous access for the administration of medications such as chemotherapy drugs. The implantation and long-term use of TIVAP are related to thrombosis, infection and other complications. In this study, the medical records of multicentre patients were collected, and the perioperative and postoperative complications were retrospectively analysed to objectively evaluate the safety of the implantation of supraclavicular, ultrasound-guided TIVAP via the brachiocephalic vein (BCV). PATIENTS AND METHODS We retrospectively analysed the clinical data of 433 adult patients who had undergone ultrasound-guided TIVAP implantation via the BCV at four hospitals in China from March 2018 to May 2019. The success rates of the first puncture, operation time, and perioperative and postoperative complications were analysed. RESULTS All the TIVAPs were implanted successfully (100%). The average TIVAP carrying time was 318.15 ±44.22 days (range: 38-502 days) for a total of 197,694 catheter days. The success rate of the first puncture was 94.92% (411/433), and the average operation time was 29.66 ±7.45 min (range: 18-60 min). The perioperative complications included arterial puncture in 4 patients and pneumothorax in 1 patient. The incidence of postoperative complications was 5.08% (22/433), including poor incision healing (n = 2), catheter-related infection (n = 3), port infection (n = 6), thrombosis (n = 2) and fibrin sheath formation (n = 8). Another patient had infusion disturbance 2 days after the operation, and chest X-ray showed bending at the connection between the catheter and port. No other serious complications occurred, such as catheter rupture and drug leakage. The total incidence of complications was 6.24% (27/433). CONCLUSION This study showed excellent tolerance of supraclavicular, ultrasound-guided BCV puncture to implant TIVAP and a low incidence of complications. As a safe and effective method of TIVAP implantation, it can provide a new choice for clinicians.
Collapse
Affiliation(s)
- Zepeng Yu
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People’s Republic of China
| | - Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People’s Republic of China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People’s Republic of China
| | - Wei Ding
- Department of Intervention, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, 214023, Jiangsu Province, People’s Republic of China
| | - WeiDong Wang
- Department of Intervention, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, 214023, Jiangsu Province, People’s Republic of China
| | - Liang Xu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, Jiangsu, People’s Republic of China
| | - Wenming Qin
- Department of Anesthesiology, Bazhong Central Hospital, Bazhong, Sichuan, 636000, People’s Republic of China
| | - Ling Wen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People’s Republic of China
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, People’s Republic of China
| |
Collapse
|
20
|
Sun X, Bai X, Zhang Y, Xu L, Yu Z, Jin Y, Zhuang Z. Perioperative and Postoperative Complications of Ultrasound-Guided Totally Implantable Venous Access Ports via the Brachiocephalic Vein in Patients with Cancer: A Prospective Study. J Cancer 2021; 12:1379-1385. [PMID: 33531983 PMCID: PMC7847646 DOI: 10.7150/jca.55343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives: To evaluate the safety and efficacy of ultrasound (US)-guided totally implantable venous access ports (TIVAPs) via the right brachiocephalic vein (BCV) or the left BCV approach. Methods: Patients requiring TIVAP for chemotherapy were included in the study. US-guided TIVAPs via BCV were used for patients from July 2018 to December 2018. General information about the patients (sex, age, and diagnosis), side (right or left), surgical procedures and complications were recorded. Results: A total of 107 TIVAPs in 107 patients (ages 38-73 years) were included, 75 via the right BCV and 32 via the left BCV. All of the patients underwent successful surgery. The BCV was successfully punctured on the first attempt in 99 patients (92.52%). Two attempts were needed in 6 patients (5.61%), and three attempts were necessary in 2 patients (1.87%). The mean operation time was 29 ± 5 min (range: 24 to 38 min). No serious complications occurred during the surgery, except the formation of a local haematoma in 1 case after artery puncture. During the follow-up period of 12 months, the incidence of long-term complications was 3.74% (4/107), including 2 cases of catheter-related infection and 2 cases of fibrin sheath formation. No serious complications such as catheter malposition or rupture were found. Conclusion: US-guided TIVAP via the BCV offers an alternative for adults with good needle guidance and a low rate of perioperative and postoperative complications.
Collapse
Affiliation(s)
- Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Liang Xu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, Jiangsu, China
| | - Zepeng Yu
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Zhixiang Zhuang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| |
Collapse
|
21
|
Kondo T, Matsumoto S, Doi K, Nomura M, Muto M. Femoral placement of a totally implantable venous access port with spontaneous catheter fracture: case report. CVIR Endovasc 2020; 3:2. [PMID: 32027011 PMCID: PMC6966363 DOI: 10.1186/s42155-019-0094-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background The incidence of catheter fracture after standard positioning of a totally implantable venous access port (TIVAP) is reported to be 1.1%–5.0%; however, the incidence of catheter fracture after TIVAP implantation at a femoral site remains unclear. Case presentation In a 30-year-old man with angiosarcoma of the right atrium, tumor embolism was observed from the left brachiocephalic vein to the superior vena cava. A TIVAP was implanted in the right femur. A catheter fracture was spontaneously observed after 7 months. Conclusions To the best of our knowledge, this is the first case of catheter fracture in a TIVAP implantation at a femoral site.
Collapse
|
22
|
Kazakova V, Vanegas YAM, Torres TA, Kozyreva O. Delayed presentation of doxorubicin extravasation into pleural space: Case report and review of literature. J Oncol Pharm Pract 2020; 27:1520-1527. [PMID: 33241731 DOI: 10.1177/1078155220975848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intrathoracic extravasation of anthracyclines is a dangerous and very rare complication of chemotherapy administration. While management of extravasation into soft tissues has been established, the data on treatment of mediastinal and intrapleural anthracycline extravasation is limited. CASE REPORT We present a case of a 52-year-old woman with intrapleural doxorubicin extravasation who presented to the hospital 24-hrs after chemotherapy infusion with chest pain and shortness of breath. MANAGEMENT & OUTCOME The patient underwent urgent surgical intervention and received IV dexrazoxane 36-hrs after the event. Her pain improved, but she continued to have chest soreness and pleural effusion at the site of extravasation even 3 months later. DISCUSSION We conducted review of literature using Medline/PubMed and Google Scholar databases and identified 7 cases of intrapleural and mediastinal anthracycline extravasation. No data is currently available regarding the outcome of delayed management of intrapleural anthracycline extravasation with dexrazoxane. Prevention and confirmation of adequate port catheter placement is the most important step to avoid such cases. Catheter misplacement should be suspected in any patient presenting with post procedural chest pain and should trigger a thorough evaluation prior to any chemotherapy administration.
Collapse
Affiliation(s)
- Vera Kazakova
- Division of Internal Medicine, St Elizabeth's Medical Center, Boston, MA, USA
| | | | - Tyion A Torres
- Division of Hematology/Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Olga Kozyreva
- Division of Hematology/Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| |
Collapse
|
23
|
Arm mobilization provokes deformity of long-term indwelling ports implanted via the jugular vein. J Vasc Surg Venous Lymphat Disord 2020; 9:998-1006. [PMID: 33130283 DOI: 10.1016/j.jvsv.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The incidence of totally implantable catheter fracture ranges from 0.48% to 5.00%, and these fractures represent a potentially fatal complication. The fracture mechanism of catheters implanted via the jugular vein is unclear, and whether extreme arm movements represent an additional risk factor for repetitive stress of the material remains unknown. The aim of this study was to demonstrate and classify catheter deformations caused by extreme arm mobilization and associations with changes in catheter function and displacement. METHODS We analyzed the fluoroscopy images of 60 consecutive patients undergoing long-term indwelling port implantation via the jugular vein. Three images were taken: arm in maximal abduction, maximal frontal elevation, and maximal adduction. The images were compared with an image of the remainder of the arm. We analyzed three catheter regions to classify the deformity: A, connection between catheter and reservoir; B, the catheter's subcutaneous tunnel; and C, the catheter's entrance in the jugular vein. The deformations were classified in comparative manner as follows: 0 (no changes), 1 (minor changes, new slightly curvatures with an angle of >90°), and 2 (major changes, new severe curvatures with angles of ≤90°). In each position, catheter function (injection and aspiration) and displacement of the reservoir and tip were analyzed. RESULTS Only 15% of patients did not show a deformity; 33.3% had a deformity in only one position, 47.7% in two positions, and 10% in three positions. Minor deformities were observed in 70% of patients and major deformities in 40%. Moreover, 25% of patients presented both major and minor deformities. Major deformities were observed in 25.0% of patients on maximal frontal elevation, in 23.3% on maximal adduction and in none on maximal abduction. Region B was the most affected, with 57.8% of all minor deformities and 78.1% of all major deformities. No change in function was noted in 91.7% of the catheters. Maximal arm adduction resulted in greater vertical and horizontal displacement of the catheter tip and horizontal displacement of the reservoir. Higher body mass index values were associated with major deformities. CONCLUSIONS Maximal frontal elevation and maximal adduction were associated with major catheter deformities, and the subcutaneous tunnel region was the most deformed catheter region. An association between major catheter deformity and high body mass index was noted; in contrast, no association between the severity of catheter deformity, tip or reservoir displacement, or worsened functioning was observed.
Collapse
|
24
|
Yin L, Li J. <p>Central Venous Catheter Insertion in Colorectal Cancer Patients, PICC or PC?</p>. Cancer Manag Res 2020; 12:5813-5818. [PMID: 32765084 PMCID: PMC7368562 DOI: 10.2147/cmar.s250410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
Collapse
Affiliation(s)
- Lijuan Yin
- Center of Oncology, Jiangsu Province Hospital, Nanjing, People’s Republic of China
| | - Jinhua Li
- Center of Oncology, Jiangsu Province Hospital, Nanjing, People’s Republic of China
- Correspondence: Jinhua Li Email
| |
Collapse
|
25
|
Depboylu BC, Yazman S. Do 'Videos' sections of Internet search engines provide accurate and adequate information about totally implantable venous access ports? J Vasc Access 2020; 22:225-231. [PMID: 32597358 DOI: 10.1177/1129729820937094] [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: 11/16/2022] Open
Abstract
OBJECTIVE After cancer diagnosis, patients often look to Internet to learn more about totally implantable venous access ports which improve compliance with systemic anticancer therapy, as they do not get enough information from healthcare professionals. The aim of this study was to evaluate the video quality on Internet about totally implantable venous access ports using the most used three Internet search engines worldwide. METHODS 'Videos' sections of the most used three Internet search engines were queried using 'Chemotherapy Port', 'Port Catheter' and 'Totally Implantable Venous Access Ports' keywords. First, 50 results of each keyword in each search engine were analysed and evaluated according to a novel scoring system created by authors (totally implantable venous access port video evaluation score), Journal of the American Medical Association score and modified DISCERN score by independent reviewers. Obtained data were analysed by descriptive statistics, Kruskal-Wallis and chi-square tests. RESULTS Of the 450 videos, 229 were evaluated. The total video length was 1394.38 min. The mean video length was 6.08 ± 5.39 min, and the mean video view count was 32,553.71 ± 83,524.23. Mean Journal of the American Medical Association score, modified DISCERN score and totally implantable venous access port video evaluation score were 2.33 ± 0.90, 2.43 ± 1.59 and 3.54 ± 3.47, respectively. According to totally implantable venous access port video evaluation score, of the videos, 1.3% were remarkable, 5.2% were useful, 25.8% were poor and 67.7% were useless. Of the videos, 36.7% have been presented by healthcare professionals. Mean Journal of the American Medical Association score, modified DISCERN score and totally implantable venous access port video evaluation score of these videos were 3.11 ± 0.68, 3.97 ± 0.93 and 4.69 ± 4.25, respectively (p = 0.000, p = 0.000 and p = 0.003, respectively). CONCLUSION Internet search engines' 'Videos' sections have the potential of providing information about totally implantable venous access ports. However, they are vulnerable to providing unreliable information. This study has showed that videos about totally implantable venous access ports are insufficient in terms of reliability and integrity and may mislead patients.
Collapse
Affiliation(s)
- Burak Can Depboylu
- Department of Cardiovascular Surgery, Mugla Sıtkı Kocman University, Faculty of Medicine, Mugla, Turkey
| | - Serkan Yazman
- Department of Cardiovascular Surgery, Mugla Sıtkı Kocman University, Faculty of Medicine, Mugla, Turkey
| |
Collapse
|
26
|
Colucci N, Gregoris A, Meyer J, Naiken SP, Staszewicz W, Gialamas E, Toso C, Abbassi Z. Introduction of a specialized consultation prior to insertion of totally implantable access venous devices: Impact on cancellation rate and patient satisfaction. Vascular 2020; 28:816-820. [PMID: 32508290 DOI: 10.1177/1708538120930470] [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: 11/16/2022]
Abstract
OBJECTIVES Preoperative consultation is usually not performed before insertion of a totally implantable venous access device (TIVAD). In our experience, an incomplete preoperative assessment, a predictable medical condition contraindicating surgery, or no-show patients the day of surgery led to several surgery cancellations. Therefore, we introduced a specific preoperative surgical consultation for TIVAD that took place shortly before surgery. The aim of the present study is to evaluate the patients' satisfaction and to establish the rate of cancellation after the adoption of this strategy. METHODS Two-hundred and four patients who benefited from the preoperative consultation before TIVAD insertion from August 2014 to August 2016 were included. Satisfaction of patients and cancellation rate were documented. RESULTS With that strategy, no TIVAD insertion was either delayed or cancelled. The overall level of satisfaction was high (91.8%); 184 patients (90.2%) judged the consultation useful in preparation for the surgery. The surgical procedure met their expectations in 92.2% of cases. Patients known for a psychiatric comorbidity were more likely to express dissatisfaction. CONCLUSIONS The introduction of a specific preoperative surgical consultation for TIVAD insertion led to a high level of patients' satisfaction. After the preoperative consultation, no cancellation was recorded. Special approaches have to be considered for patients with a psychiatric comorbidity.
Collapse
Affiliation(s)
- Nicola Colucci
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy
| | - Adrien Gregoris
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Jeremy Meyer
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Surennaidoo Perumal Naiken
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Wojciech Staszewicz
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Christian Toso
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| |
Collapse
|
27
|
Li J, Chen W, Zhao W, Zhang H, Huang Z, Zhang S, Li Y. Surface measurement, intracardiac electrocardiogram and tracheal bifurcation techniques for locating the catheter tips of totally implantable venous access port. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105238. [PMID: 31862623 DOI: 10.1016/j.cmpb.2019.105238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The purpose of our study is to compare the reliability and consistency of three commonly used techniques, which are surface measurement, intracardiac electrocardiogram (IECG) and tracheal bifurcation methods in measuring the tip location of totally implantable venous access port (TIVAP) in the same patient. METHODS The thirty-five patients scheduled for implantation of TIVAP were included and right subclavian vein was selected for venous access. We used surface measurement method (Group L) to estimate the length and position of catheter before catheterization, and then we used IECG method (Group E) to confirm the position of catheter during catheterization and after catheterization used tracheal bifurcation method by CT (Group T) for measurement. The differences of catheter length measured by three methods were compared by non-parametric Kruskal-Wallis test. Intraclass correlation coefficient (ICC) was used to evaluate the reliability of three methods and Bland-Altman chart was used to evaluate consistency. RESULTS There are no difference in the length of TIVAP catheter between L and T groups (P > 0.05), but they have significant differences comparing with E group (P < 0.05). The three positioning methods have a good consistency (ICC = 0.886, P < 0.05).Through linear regression analysis, the regression equation are: catheter length (mm) = 77.32 + 0.66 × height (cm), 36.25 + 0.81 × height (cm) and 68.82 + 0.70 × height (cm). The distances from catheter tip to the junction of superior vena cava and right atrium measured by IECG (Group E) was closer to the target value. CONCLUSIONS All three methods can be used to measure the length of TIVAP catheter, and IECG method is the most accurate. And similar to most studies, returning the catheter 20 mm after positioning can avoid catheter entering the right atrium, but we found that 10 mm is a sufficient length to achieve this.
Collapse
Affiliation(s)
- Jun Li
- Department of Anesthesiology, Shulan Hospital, No. 848 Dongxin Road, Xiacheng District, Hangzhou 310022, China
| | - Wei Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Wenli Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Hu Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Zeyong Huang
- Department of Anesthesiology, Shulan Hospital, No. 848 Dongxin Road, Xiacheng District, Hangzhou 310022, China
| | - Shuping Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Yuebing Li
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China.
| |
Collapse
|
28
|
Hamdan AL, Dabbous H. Vocal Fold Paralysis Secondary to Subclavian Venous Thrombosis. J Voice 2020; 35:809.e11-809.e13. [PMID: 32089419 DOI: 10.1016/j.jvoice.2019.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
The etiology of vocal fold paralysis is multifaceted. One of the rare causes is internal jugular vein thrombosis secondary to central venous catheterization. The palsy is usually ipsilateral to the site of indwelled catheterization, self-limited and reversible. The authors of this manuscript report a rare case of contralateral recurrent laryngeal nerve palsy induced by subclavian vein thrombosis following central venous catheterization. The patient developed irreversible vocal fold paralysis that necessitated office-based injection laryngoplasty.
Collapse
Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Helene Dabbous
- Department of Otolaryngology - Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
29
|
An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.594025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Tsuruta S, Goto Y, Miyake H, Nagai H, Yoshioka Y, Yuasa N, Takamizawa J. Late complications associated with totally implantable venous access port implantation via the internal jugular vein. Support Care Cancer 2019; 28:2761-2768. [PMID: 31724073 DOI: 10.1007/s00520-019-05122-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/06/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Several studies have analyzed late complications associated with totally implantable venous access ports (TIVAP) implantation via the internal jugular vein (IJV); however, the reported results are inconclusive. The aim of the study is to elucidate the characteristics and risk factors of late complications associated with TIVAP implantation via the IJV. METHODS The study included 482 patients who underwent TIVAP implantation for long-term chemotherapy and/or nutritional support between April 2012 and December 2017. Most patients (95.2%) had malignant diseases. Events requiring TIVAP removal were defined as TIVAP-related complications. RESULTS The median TIVAP and global follow-ups were 319 days (IQR 152-661) and 218,971 catheter days, respectively. The 3-year cumulative TIVAP availability rate was 70%. There were 44 complications (incidence of 9.1%; 0.201 complications/1000 catheter days). Infectious, catheter-related, and port-related complications occurred in 21, 14, and 9 patients, respectively with infectious complications occurring earlier and more frequently than catheter- and port-related complications. Multivariate analysis revealed that age < 65 years and presence of non-gastrointestinal diseases were significant unfavorable factors for TIVAP-related complications. Patients with 1 and 2 of these factors had an elevated risk (2.2 and 5.4 times, respectively) compared with those without. CONCLUSIONS Among the late complications associated with TIVAP implantation via the IJV, infectious complications occur earlier and more frequently than catheter- and port-related complications. Patients with an age < 65 years and having non-gastrointestinal diseases have a significantly high risk of TIVAP-related complications.
Collapse
Affiliation(s)
- Shigeaki Tsuruta
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yasutomo Goto
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Surgery, Japanese Red cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Junichi Takamizawa
- Department of Laboratory Medicine, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| |
Collapse
|
31
|
Velioğlu Y, Yüksel A, Sınmaz E. Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:499-507. [PMID: 32082916 PMCID: PMC7018162 DOI: 10.5606/tgkdc.dergisi.2019.17972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/31/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to present clinical characteristics, peri-procedural outcomes, early and late complications, and management strategies in patients undergoing totally implantable venous access port insertion through percutaneous subclavian vein. METHODS A total of 2,084 port devices were inserted to 2,000 cancer patients (1,066 males, 934 females; mean age 58.4±12.7 years; range, 18 to 88 years) through subclavian vein using percutaneous landmark method between March 2012 and June 2018. Medical data including demographic features, primary diagnosis, technical success, procedural time, duration of device use, reasons for the device removal, and early and late complications were retrospectively analyzed. RESULTS The most common type of cancer was colon cancer in males and breast cancer in females. Technical success rate of the procedure was 98.5%. Right subclavian vein was accessed in the majority of patients (92.4%). Early complications including inadvertent arterial puncture, catheter malposition, superficial hematoma, and pneumothorax occurred in 143 patients (6.9%), while late complications including infection, catheter occlusion, venous thrombosis, wound problems, catheter migration and embolization and pinch-off syndrome was developed in 118 patients (5.7%). Inadvertent arterial puncture in 63 patients (3%) was the most common early complication, while infection in 44 patients (2.1%) was the most common late complication. A total of 192 devices were removed due to the completion of chemotherapy or development of complications. CONCLUSION Our study confirmed the safety and tolerability of totally implantable venous access port insertion through percutaneous subclavian vein with high technical success and low complication rates.
Collapse
Affiliation(s)
- Yusuf Velioğlu
- Department of Cardiovascular Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ahmet Yüksel
- Department of Cardiovascular Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Emrah Sınmaz
- Department of Thoracic Surgery, Bursa Ali Osman Sönmez Oncology Hospital
| |
Collapse
|
32
|
Jiang M, Li CL, Pan CQ, Yu L. The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis. Support Care Cancer 2019; 28:361-372. [PMID: 31044308 DOI: 10.1007/s00520-019-04809-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs). METHODS A systematic search of PubMed, Web of science, Embase, and the Cochrane Library was carried out from inception through Oct 2018, with no language restrictions. Trials examining the risk of CLABSI in cancer patients who received TIVAPs compared with those who received external CVCs were included. Two reviewers independently reviewed, extracted data, and assessed the risk of bias of each study. A random-effect model was used to estimate relative risks (RRs) with 95% CIs. RESULTS In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31-0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22-0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38-0.79]). CONCLUSIONS TIVAP can significantly reduce the risk of CLABSI compared with external CVCs.
Collapse
Affiliation(s)
- Meng Jiang
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, 11 Lingjiaohu Avenue, Wuhan, 430015, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Li Yu
- Department of Critical Care Medicine, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
33
|
Sun X, Zhang Y, Yang C, Zhou Y, Bai X, Zheng W, Jin Y. Ultrasound-guided totally implantable venous access device through the right innominate vein in older patients is safe and reliable. Geriatr Gerontol Int 2019; 19:218-221. [PMID: 30724007 DOI: 10.1111/ggi.13611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
Abstract
AIM Ultrasound guidance has become the routine method for catheterization, dramatically reducing failure and complication rates for totally implantable venous access devices (TIVAD) placement. The aim of the present study was to report the safety and efficacy of ultrasound-guided right innominate vein TIVAD placement in older patients. METHODS Between September 2015 and September 2017, 55 older patients underwent right innominate vein TIVAD placement under ultrasound guidance. Intraoperative fluoroscopy was always carried out. The technical success rate and complications were recorded and retrospectively analyzed. RESULTS The technical success rate was 100%. The success rate of the first puncture was 96.36% (53/55). The mean operation time was 28 ± 7 min (range 23-39 min), and the mean length of catheter introduction was 19.24 ± 2.65 cm (range 17-21 cm). The overall incidence of complications was 7.27% (4/55), including one arterial puncture with self-limiting hematoma, two cases of catheter-related infection and one case of fibrin sheath. No catheter malposition or catheter fracture was observed. At the time of this study, three TIVAD were pulled out unexpectedly, and 32 TIVAD are still in functional use. CONCLUSIONS Ultrasound-guided puncture of the right innominate vein is safe and reliable to implant TIVAD, which can provide new options for older patients. Geriatr Gerontol Int 2019; 19: 218-221.
Collapse
Affiliation(s)
- Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanlai Yang
- Department of Science and Education, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yubin Zhou
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiwei Zheng
- Department of Orthopedics, Suzhou Hospital affiliated to Nanjing Medical University, Suzhou, China
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
34
|
Uzunkaya F, Soylu Aİ, Belet Ü, Terzi Ö, Akan H. Santral venöz portların çıkarılma nedenleri: Ardışık 154 hastadan edinilen deneyim. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.417318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
35
|
Vermeulin T, Lucas M, Marini H, Di Fiore F, Loeb A, Lottin M, Daubert H, Gray C, Guisier F, Sefrioui D, Michel P, de Mil R, Czernichow P, Merle V. Totally implanted venous access-associated adverse events in oncology: Results from a prospective 1-year surveillance programme. Bull Cancer 2018; 105:1003-1011. [PMID: 30322697 DOI: 10.1016/j.bulcan.2018.09.005] [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: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION During the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer. METHODS Data from our routine surveillance of TIVA-AE were collected prospectively between October 2009 and January 2011 in two oncology referral centers in Northern France. The open cohort under surveillance during the same time period was reconstituted retrospectively using data from the hospital information systems. Incidences of first TIVA-AE per 1000 TIVA-days were calculated. Risk factors were identified using multivariate logistic regressions. RESULTS We included 2286 cancer patients, corresponding to 582,347 TIVA-days. Among the 133 first TIVA-AE observed (incidence 0.23 per 1000 TIVA-days [0.19-0.27]), there were 50 infectious AE (incidence 0.09 [0.06-0.11]) and 83 non-infectious AE (incidence 0.14 [0.11-0.17]). Compared to non-metastatic solid cancers, metastatic cancers (aOR=2.3 [0.9-6.0]), and hematologic malignancies (aOR=3.2 [1.1-8.8]) tended to be associated with a higher risk of infectious TIVA-AE (P=0.087). Solid cancer type was associated with non-infectious TIVA-AE (P=0.030), especially digestive cancers. DISCUSSION We report accurate estimations of TIVA-AE incidences in one of the largest populations among previously published studies. As in previous studies, metastatic cancers and hematologic malignancies tended to be associated with a higher risk of infectious TIVA-AE. Further studies are warranted to confirm the effect of digestive cancers.
Collapse
Affiliation(s)
- Thomas Vermeulin
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France.
| | - Mélodie Lucas
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Hélène Marini
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Frédéric Di Fiore
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Agnès Loeb
- Comprehensive Cancer Center Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - Marion Lottin
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Hervé Daubert
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Christian Gray
- Comprehensive Cancer Center Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - Florian Guisier
- Rouen University Hospital, Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care, CIC Inserm U 1404, 1, rue de Germont, 76031 Rouen cedex, France
| | - David Sefrioui
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Pierre Michel
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Rémy de Mil
- Normandie Université, UNICAEN, Inserm U 1086, 3, avenue Général-Harris, 14076 Caen, France
| | - Pierre Czernichow
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Véronique Merle
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| |
Collapse
|
36
|
Perioperative antibiotics should be used for placement of implanted central venous ports: A propensity analysis evaluating risk. Am J Surg 2018; 216:1135-1143. [PMID: 30268417 DOI: 10.1016/j.amjsurg.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/21/2018] [Accepted: 09/16/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To quantify risk for CRI based on PABX use in CVAP placement for cancer patients. SUMMARY BACKGROUND DATA Central venous access ports (CVAP) are totally implanted devices used for chemotherapy. There is a temporal risk for catheter related infection (CRI) to insertion and perioperative prophylactic antibiotics (PABX) use is a contested issue among practitioners. METHODS Data was collected from a single center, academic oncology center. Treatment with a perioperative PABX was compared to non-treatment, to examine the incidence of 14-day CRI. Propensity scores with matched weights controlled for confounding, using 15 demographic, procedural and clinical variables. RESULTS From 2007 to 2012, 1,091 CVAP were placed, where 59.7 % received PABX. The 14-day CRI rate was 0.82%, with 78% of those not receiving PABX. While results did not achieve statistical significance, use of PABX was associated with a 58% reduction in the odds of a 14-day CRI (OR = 0.42, 95% CI: 0.08-2.24, p = 0.31). CONCLUSION The findings suggest a reduction in early CRI with the use of PABX. Since CRI treatment can range from a course of oral antibiotics, port removal, to hospital admission, we suggest clinicians consider these data when considering PABX in this high-risk population.
Collapse
|
37
|
Yu XY, Xu JL, Li D, Jiang ZF. Late complications of totally implantable venous access ports in patients with cancer: Risk factors and related nursing strategies. Medicine (Baltimore) 2018; 97:e12427. [PMID: 30235721 PMCID: PMC6160048 DOI: 10.1097/md.0000000000012427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to assess the incidence rate and the risk factors for late complications associated with use of central totally implanted venous access devices (TIVAPs) in patients with cancer, and to devise nursing strategies to minimize late complications.This retrospective study included 500 patients with TIVAPs from 2012 to 2015. Multivariable logistic regression analysis was performed to assess the effect of sex, age, primary diagnosis, duration of surgery, and the length of hospital stay on the incidence of late complications of TIVAP.The cumulative maintenance period of TIVAP was 159,605 days. Late complications included catheter-related obstruction (n = 14; 2.8%), infection (n = 3; 0.6%), drug extravasation (n = 1; 0.2%), and catheter exposure (n = 1; 0.2%). Multivariate analyses revealed that age, breast cancer, lung cancer, and gastric cancer were risk factors for the late complications associated with TIVAP.There was a low incidence of late complications with TIVAP use. Catheter-related obstruction is the most frequent late complication of TIVAP. Risk factors for TIVAP-associated late complications include age and certain cancers, such as breast cancer, lung cancer, and gastric cancer.
Collapse
|
38
|
Tippit D, Siegel E, Ochoa D, Pennisi A, Hill E, Merrill A, Rowe M, Henry-Tillman R, Ananthula A, Makhoul I. Upper-Extremity Deep Vein Thrombosis in Patients With Breast Cancer With Chest Versus Arm Central Venous Port Catheters. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223418771909. [PMID: 29881287 PMCID: PMC5987887 DOI: 10.1177/1178223418771909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/29/2018] [Indexed: 12/31/2022]
Abstract
Most of the patients undergoing treatment for cancer require placement of a
totally implantable venous access device to facilitate safe delivery of
chemotherapy. However, implantable ports also increase the risk of deep vein
thrombosis and related complications in this high-risk population. The objective
of this study was to assess the incidence of upper-extremity deep vein
thrombosis (UEDVT) in patients with breast cancer to determine whether the risk
of UEDVT was higher with chest versus arm ports, as well as to determine the
importance of previously reported risk factors predisposing to UEDVT in the
setting of active cancer. We retrospectively reviewed the medical records of 297
women with breast cancer who had ports placed in our institution between the
dates of December 1, 2010, and December 31, 2016. The primary outcome was the
development of radiologically confirmed UEDVT ipsilateral to the implanted port.
Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1
documented case of associated pulmonary embolism. Fourteen (9.5%) of 147
subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150
subjects with chest ports (P = .0056). Thus, implantation of
arm ports as opposed to chest ports may be associated with a higher rate of
UEDVT in patients with breast cancer.
Collapse
Affiliation(s)
- Danielle Tippit
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric Siegel
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniella Ochoa
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Angela Pennisi
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Erica Hill
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amelia Merrill
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark Rowe
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronda Henry-Tillman
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aneesha Ananthula
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Issam Makhoul
- Division of Medical Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
39
|
Nas H, Bowe D, Soubani AO. An unusual complication after placement of an inferior vena cava filter via right internal jugular vein access. J Vasc Access 2018; 20:102-104. [PMID: 29855215 DOI: 10.1177/1129729818777967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION: Totally implantable venous access devices are used extensively worldwide in cancer patients for administration of venotoxic agents, blood sampling, and nutrition. Their tip is usually positioned at the junction of superior vena cava and right atrium. Inferior vena cava filters are usually used for deep venous thrombosis in cases where anticoagulation is contraindicated; they can be inserted either via internal jugular or femoral access depending on patient conditions and preference. CASE DESCRIPTION: We are describing here a case of totally implantable venous access device fracture following a right internal jugular approach for inferior vena cava filter placement as the patient had inferior vena cava thrombus below the renal veins, extending into the right common iliac vein prohibiting femoral approach. CONCLUSION: Iatrogenic fracture of totally implantable venous access device is a potential complication of accessing the internal jugular vein for other procedures such as insertion of inferior vena cava filter.
Collapse
Affiliation(s)
- Hala Nas
- 1 Detroit Medical Center, Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Dedrick Bowe
- 2 Division of Pulmonary & Critical Care and Sleep Medicine, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Ayman O Soubani
- 2 Division of Pulmonary & Critical Care and Sleep Medicine, School of Medicine, Wayne State University, Detroit, MI, USA
| |
Collapse
|
40
|
Odaman Al I, Bayram C, Ersoy G, Öztarhan K, Güzeltaş A, Kasar T, Uysalol E, Koç B, Ayçiçek A, Özdemir N. A Rare Late Complication of Port Catheter Implantation: Embolization of the Catheter. Turk J Haematol 2018; 35:142-143. [PMID: 28443819 PMCID: PMC5972342 DOI: 10.4274/tjh.2017.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Işık Odaman Al
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Cengiz Bayram
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Gizem Ersoy
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Kazım Öztarhan
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Cardiology, İstanbul, Turkey
| | - Alper Güzeltaş
- University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Clinic Pediatric Cardiology, İstanbul, Turkey
| | - Taner Kasar
- University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Clinic Pediatric Cardiology, İstanbul, Turkey
| | - Ezgi Uysalol
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Başak Koç
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Ali Ayçiçek
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| | - Nihal Özdemir
- University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, İstanbul, Turkey
| |
Collapse
|
41
|
Shen Y, Zhang XP, Ge F, Huang H, Li L. Maintenance of totally implantable ports in Zhongshan Hospital: a best practice implementation project. ACTA ACUST UNITED AC 2018; 14:257-66. [PMID: 27532318 DOI: 10.11124/jbisrir-2016-2517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The totally implantable port is a common central venous access device. The cost of implantation and maintenance however is very expensive. At present, the biggest problem regarding the promotion and the use of implantable ports in China is lack of well trained professional healthcare providers. Furthermore, maintenance of totally implantable ports by nurses is poor and patients may easily get complications. AIMS/OBJECTIVES This project aimed to reduce the incidence of complications among general surgery patients with implantable ports, and improve healthcare safety and the care process, strictly in compliance with current evidence-based criteria. METHODS A baseline audit on maintenance of totally implantable ports utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System program was undertaken from 1 April to 15 May 2015 that involved 25 nurses and 25 patients. An intervention including education, demonstration, clinical practice and assessment was conducted from 16 May to 15 July 2015. A post-implementation re-audit was completed from 16 July to 10 August 2015. RESULTS The results of the audit for the nine audit criteria for totally implantable port maintenance were as follows: the compliance rate for Criteria 2 and 3 increased from 0% to 100%, Criterion 1 from 80% to 100%, Criterion 4 from 92% to 100%, Criterion 5 from 68% to 100%, Criterion 6 remained as 100%, Criterion 7 from 12% to 100%, Criterion 8 from 0% to 96% and Criterion 9 from 88% to 100%. During implementation we found four barriers and undertook measures to address them. CONCLUSIONS This project achieved a significant improvement in establishing evidence-based practice regarding maintenance of totally implantable ports in the general surgery ward. Strategies in sustaining best practice should be developed in the future.
Collapse
|
42
|
Nishinari K, Wolosker N, Vinicius Bernardi C, Yazbek G. Totally Implantable Ports Connected to Valved Catheters for Chemotherapy: Experience from 350 Groshong Devices. J Vasc Access 2018; 11:17-22. [PMID: 20119917 DOI: 10.1177/112972981001100104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose There are few studies regarding the use of totally implantable valved ports for chemotherapy. The objective of this study was to analyze the results obtained from consecutive implantation of 350 devices. Methods Adult patients submitted to port insertion in veins of the superior vena cava system over a 17-month period (July 2006 to December 2007) were considered. The device used was composed of a titanium and silicone rubber port (Dome Port™; Bard Inc, Salt Lake City, UT) connected to an 8.0 Fr silastic Groshong™ catheter tube. Follow-up was conducted on outpatient data and during clinical readmissions, until the device was removed or the patient died. Results Three hundred and fifty devices, total of 74,691 days in situ, were inserted, with a median follow-up of 176 days. There were 11 early complications (3.1%) and 49 late complications (14%), 21 of these (6%) were considered major ones. Early complications comprised four instances of phlebitis of the external jugular, three of pocket infection, two of technical failure and two of ecchymosis. Late complications comprised 33 instances of withdrawal difficulty, 12 of port-related bacteremia, two of deep venous thrombosis, one of occlusion and one of catheter fracture. Out of the 350 catheters implanted, 258 (73.5%) were still being used, 73 (21%) remained in use until the patient died, five (1.5%) were removed at the end of the treatment and 14 (4%) were removed because of complications. Conclusions There was a low rate of major complications associated with this valved system justifying its use.
Collapse
Affiliation(s)
- Kenji Nishinari
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo - Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo - Brazil
| | | | - Guilherme Yazbek
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo - Brazil
| |
Collapse
|
43
|
Wang CS, Yang CJ, Chen SC, Chen HC, Huang M. Hepatic migration of a catheter fragment followed by disconnection of a totally implantable venous access port. Int J Artif Organs 2018; 31:1059-61. [DOI: 10.1177/039139880803101210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Totally implantable venous access ports (TIVAPs) are frequently used in oncology patients who require long-term courses of chemotherapy. We report a silent, but potentially hazardous complication of catheter fracture and hepatic migration in a 64-year-old male. The patient presented with a painful, rapid swelling of subcutaneous tissue around the port area during a saline flush. A chest radiograph showed that the disconnected catheter had separated from the port and was no longer in its original location. A chest CT scan revealed that the disconnected catheter was found to be embolized to the right atrium, inferior vena cava and right hepatic vein. The patient was treated successfully with percutaneous transfemoral retrieval of the catheter under fluoroscopic guidance. To our knowledge, there have been no previous reports of migration of the fractured catheter of a TIVAP into the right hepatic vein. This case highlights that the integrity of TIVAPs should be ascertained before chemotherapeutic drugs are administered.
Collapse
Affiliation(s)
- C.-S. Wang
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung - Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung - Taiwan
| | - C.-J. Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung - Taiwan
| | - S.-C. Chen
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung - Taiwan
| | - H.-C. Chen
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung - Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung - Taiwan
| | - M.S. Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung - Taiwan
| |
Collapse
|
44
|
Maurer M, Beck A, Hamm B, Gebauer B. Central Venous Port Catheters: Evaluation of Patients' Satisfaction with Implantation under Local Anesthesia. J Vasc Access 2018; 10:27-32. [DOI: 10.1177/112972980901000105] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Evaluation of pain perception and patient satisfaction after implantation of a central venous port catheter system under local anesthesia. Methods A total of 100 consecutive patients (25 outpatients, 75 inpatients) who underwent successful implantation of a port catheter into the internal jugular vein from May through August 2007 were given an 8-item questionnaire. The extent of information about the implantation, the pain perception during implantation and the friendliness of the physician and nurse were evaluated. Furthermore, the patients were asked to assess their degree of anxiety and the pain they experienced during the intervention and to give an appraisal of whether local anesthesia was adequate. Each question was assessed on a 10–point scale (10 = very true to 1 = not at all true). In addition, the overall duration of the intervention (including patient preparation, implantation, patient aftercare, disinfection of the room) was documented. Results Patients felt highly satisfied with the way they were informed (mean score of 9.65) and considered the treating physician (9.89) and nurse (9.9) extremely friendly. Local anesthesia was rated as nearly completely adequate (9.56) and the degree of pain experienced was low (9.05; 10 = no pain). The average anxiety score was 8.56 (10 = not afraid at all). Overall satisfaction with the treatment was very high (9.62; outpatients: 9.72) and patients would recommend port catheter implantation at our department to others (9.77). The mean overall duration of the intervention was 76 min (range 40–120 min). Conclusion Positive patient reactions indicate that radiologic port catheter implantation under local anesthesia is a minimally invasive intervention with high patient satisfaction that can be performed on an outpatient basis and is a valid alternative to surgical implantation.
Collapse
Affiliation(s)
- M.H. Maurer
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin, Berlin - Germany
| | - A. Beck
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin, Berlin - Germany
| | - B. Hamm
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin, Berlin - Germany
| | - B. Gebauer
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin, Berlin - Germany
| |
Collapse
|
45
|
Sarzo G, Finco C, Zustovich F, Parise P, Savastano S, Degregori S, Vecchiato M, Merigliano S. Early Rupture of Subclavian Vein Catheter: A Case Report and Literature Review. J Vasc Access 2018; 5:39-46. [PMID: 16596539 DOI: 10.1177/112972980400500109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prolonged venous access devices (PVADs) have become indispensable in antiblastic protocols for the treatment of cancer patients, in anti-infection protocols for acquired immunodeficiency syndrome (AIDS) patients and in the management of chronic malabsorption syndromes. Using these catheters carries the risk of several complications, and some are potentially lethal, for example, cardiac embolization of catheter fragments. Rupture is a complication almost exclusive to catheters positioned percutaneously: after using this technique, device malfunction can occur due to catheter kinking after its excessively medial introduction in the subclavian vein. The early recognition of any pinch-off sign (POS) is fundamental in preventing catheter rupture that frequently follows this complication. Other factors can be involved in early rupture, for example, excessive force on a syringe used to clear a catheter that shows early signs of malfunction, or a strength defect in the materials used in the catheter construction. This report describes an early rupture case of an initially correctly positioned catheter and reviews 20 such cases in the recent literature.
Collapse
Affiliation(s)
- G Sarzo
- Department of Medical and Surgical Sciences, 3rd General Surgery Clinic, S. Antonio Hospital, University of Padova, Padova, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Matiotti-neto M, Eskander MF, Tabatabaie O, Kasumova G, Bliss LA, Ng SC, Tawa NE, Murphy B, Critchlow JF, Tseng JF. Percutaneous versus Cut-Down Technique for Indwelling Port Placement. Am Surg 2017. [DOI: 10.1177/000313481708301214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The superiority of surgical cut-down of the cephalic vein versus percutaneous catheterization of the subclavian vein for the insertion of totally implantable venous access devices (TIVADs) is debated. To compare the safety and efficacy of surgical cut-down versus percutaneous placement of TIVADs. This is a single-institution retrospective cohort study of oncologic patients who had TIVADs implanted by 14 surgeons. Primary outcomes were inability to place TIVAD by the primary approach and postoperative complications within 30 days. Multivariate analysis was performed by logistic regression. Secondary outcomes included operative time. Two hundred and forty-seven (55.9%) percutaneous and 195 (44.1%) cephalic cut-down patients were identified. The 30-day complication rate was 5.2 per cent: 14 patients (5.7%) in the percutaneous and nine (4.6%) in the cut-down group. The technique was not a significant predictor of having a 30-day complication (odds ratio = 0.820; 95% confidence interval 0.342–1.879). Implantation failure was observed in 16 percutaneous patients (6.5%) and 28 cut-down patients (14.4%) (adjusted odds ratio for cephalic vs cut-down = 2.387; 95% confidence interval 1.275–4.606). The median operative time for percutaneous patients was 46 minutes (interquartile range = 35, 59) versus 37.5 minutes (interquartile range = 30, 49) for cut-down patients(P < 0.0001). Both the percutaneous and cut-down technique are safe and effective for TIVAD implantation. Operative times were shorter and the odds of implantation failure higher for cephalic cut-down. As implantation failure is common, surgeons should familiarize themselves with both techniques.
Collapse
Affiliation(s)
- Mario Matiotti-neto
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Mariam F. Eskander
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Omidreza Tabatabaie
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Gyulnara Kasumova
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Lindsay A. Bliss
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Sing Chau Ng
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Nicholas E. Tawa
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Blanche Murphy
- Central Line Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jonathan F. Critchlow
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Jennifer F. Tseng
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| |
Collapse
|
47
|
A colon targeted drug delivery system based on alginate modificated graphene oxide for colorectal liver metastasis. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017. [DOI: 10.1016/j.msec.2017.05.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
48
|
Long-term clinical outcomes of the single-incision technique for implantation of implantable venous access ports via the axillary vein. J Vasc Access 2017; 18:345-351. [DOI: 10.5301/jva.5000751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate long-term clinical outcomes and complications of the single-incision technique for implantation of totally implantable venous access ports (TIVAPs) via the axillary vein. Materials and Methods A total of 932 TIVAPs were placed in 927 patients between May 2012 and October 2014 using a single-incision technique. Patients included 620 men and 307 women with a mean age of 60.0 years. TIVAPs were placed via the left (n = 475) and right (n = 457) axillary veins after making a single oblique vertical incision and medial side pocket without subcutaneous tunneling. We retrospectively reviewed medical records to evaluate status of the patients and TIVAPs, complications, and reasons for explantation. In patients who still had a TIVAP in place, we calculated the duration of TIVAP use from the cut-off day of November 1, 2015. Results Clinical follow-up was obtained for a total device service period of 311,069 days with a median indwelling time of 467 days (range: 3-1097 days). A total of 37 (4.0%) complications developed. Early complications (n = 4) were one case each of stenosis of the brachiocephalic vein by tumor growth, thrombosis of axillary vein, intravascular migration, and malfunction depending on patient's position. Late complications (n = 33) were suspected catheter-related blood stream infection (n = 23), local infection of the pocket (n = 4), symptomatic stenosis and thrombosis of central vein (n = 4), malfunction by fibrin sleeve (n = 1), and intravascular migration (n = 1). Conclusions A single-incision technique for TIVAP implantation via the axillary vein seems to be safe with a low risk of complication.
Collapse
|
49
|
Matsushima H, Adachi T, Iwata T, Hamada T, Moriuchi H, Yamashita M, Kitajima T, Okubo H, Eguchi S. Analysis of the Outcomes in Central Venous Access Port Implantation Performed by Residents via the Internal Jugular Vein and Subclavian Vein. JOURNAL OF SURGICAL EDUCATION 2017; 74:443-449. [PMID: 27932306 DOI: 10.1016/j.jsurg.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The central venous access port (CVAP) has played an important role in the safe administration of chemotherapy and parenteral nutrition. The aim of the present study was to clarify the optimal access vein for CVAP implantation when performed by residents rather than attending surgeons. METHODS A consecutive cases of CVAP implantation via the subclavian vein (SV) using a landmark-guided technique or via the internal jugular vein (JV) using an ultrasound-guided technique were divided into 2 groups according to whether the intervention was performed by a resident or an attending surgeon. Early and late complications were compared retrospectively between the 2 groups, and the outcomes of the CVAPs were compared between those implanted via the SV and those implanted via the JV in resident group. RESULTS A total of 207 cases of CVAP implantation were performed. Overall, 114 implantations were performed by residents, and another 93 implantations were performed by attending surgeons. Early complications were seen more frequently in the resident group (6.1%) than in the attending-surgeon group (1.1%), but the difference was not significant. No differences in operating time or late complications were observed between the 2 groups. In the resident group, CVAP implantations via the JV using the ultrasound-guided technique were associated with a shorter operating time compared with the SV approach. CONCLUSIONS Residents can perform CVAP implantations safely using both the SV and JV approaches. However, the JV approach using an ultrasound-guided technique can be performed in less time than the SV approach.
Collapse
Affiliation(s)
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Toru Iwata
- Department of Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Takashi Hamada
- Department of Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Hiroki Moriuchi
- Department of Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | | | - Tomoo Kitajima
- Department of Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Hitoshi Okubo
- Department of Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
50
|
Spontaneous Fracture and Migration of a Totally Implanted Port Device to Pulmonary Artery in Acute Leukemia Child. J Pediatr Hematol Oncol 2017; 39:e103-e105. [PMID: 28060112 DOI: 10.1097/mph.0000000000000734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Totally implanted port devices are important for the administration of fluid and chemotherapeutic agents. However, their use may be associated with serious complications, such as catheter fracture and embolism. Most data on port catheter embolization consist of isolated case reports. We report a 6-year-old boy with relapse of an acute lymphoblastic leukemia. He presented with dysfunction of his totally implanted port device. Radiologic examination revealed a catheter fracture. Echocardiography showed the catheter embolized into the right ventricle. The catheter was successfully removed from the right ventricle by percutaneous endovascular intervention. During the procedure, it was observed that the catheter fragment was located in the pulmonary artery. Catheter embolism may go undiagnosed for a prolonged period; however, severe systemic clinical signs may develop. Any implanted catheter should be removed after completion of treatment, or should be checked regularly for this complication by periodic standard chest x-ray monitoring.
Collapse
|