Expanding our interventional skills: placement of totally implantable injection ports by internists/intensivists

Totally implantable venous access devices via subclavian vein: a retrospective study of 368 oncology patients

Totally implantable catheters and totally implantable venous access devices (TIVADs) represent a valid method of administering long-term chemotherapy. TIVADs have several advantages over other methods of venous access: they are easy to implant under local anesthesia, they cause less discomfort for patients, and they can be implanted and managed on an outpatient basis. A total of 368 oncology patients were scheduled for percutaneous venous access devices. The purpose of this study was to examine the early and late complication rates of TIVADs used to deliver long-term chemotherapy. From June 2001 to January 2006, we placed 368 TIVADs, under x-ray guidance, for long-term chemotherapy in general oncology patients under local anesthesia (95% solid, 5% hematologic tumors). Percutaneous venous access devices were inserted into the subclavian vein, and adequate follow-up was provided in all cases (median, 145 d; range, 1-348 d). A total of 112 devices lpar;30%) remained in situ at the end of the study. Early complications of TIVADs included 9 (2.4%) arterial punctures, 2 (0.5%) malpositions, and 1 (0.3%) pneumothorax, which required no thoracic aspiration. Late complications included 3 cases (0.8%) of venous thrombosis, 2 cases (0.5%) of pocket infection, and 1 case (0.3%) of port-related bacteremia. This study describes a series of patients with subcutaneous infusion ports connected to various catheters. This device is a good option for long-term access to the subclavian vein; major complications related to implantation are rare, and ongoing management of these devices supports their increased use in oncology patients.

Central venous catheter pinch-off and fracture: recognition, prevention and management

The so-called pinch-off syndrome is observed in up to 1% of all central venous catheters (CVCs), and is a valuable warning prior to fragmentation, which occurs in approximately 40% of the respective cases. As long-term indwelling CVCs are used with increasing frequency, this paper describes the necessity of pinch-off monitoring following the experiences of a case study and a review of the current literature on this specific topic in order to point out preventive practice guidelines. Besides easy preventive practices such as a high level of suspicion and adequate X-ray controls, findings give strong evidence that the most important specific factor might be the adequate approach. In our hands, the supraclavicular technique has provided the best results with regards to percutaneous introduction of large bore CVCs.