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Wang Y, Zhao J, Wan GM. Prolong the flushing and locking interval of TIVAD is feasible in COVID-19: An overview of systematic reviews. J Vasc Access 2023; 24:1253-1259. [PMID: 35430915 DOI: 10.1177/11297298221086129] [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: 12/17/2023] Open
Abstract
The aim of the overview was to synthesize existing systematic reviews (SRs) of flushing interval for patients who inserted totally implanted venous catheter devices (TIVAD). Regular flushing is indispensable for catheter patency, the recommended flushing interval of TIVAD is 4 weeks, however, there is an argument for prolonging the maintenance interval, which has been proved by many SRs. However, the flushing interval range from 4-week to 3-month. The discrepancy in maintenance period could puzzle health professionals and hinder best practice into the clinic. So, we performed the overview by following the PRISMA statement. The PubMed, Ovid, Wan Fang database, Web of Science, CINAHL, CNKI, EMBASE, Cochrane Library were searched from inception to November 2021. The AMSTAR-2, the PRISMA statement, and ROBIS tool were used to assess SRs' method, report quality, and risk of bias, respectively. Then all results were synthesized, the quality of SRs' results was evaluated with GRADE. Finally, five SRs were included. However, non-randomized and small sample size of original studies result in the limitation of SRs. The evidence grade of conclusions is low, bias of mixed factors in included studies, further large sample sizes, RCTs need to be conducted in the future. Prolonged flushing interval was feasible based on the recent evidence, especially during the COVID-19 pandemic because the overwhelming healthcare system and inconvenience of transportation made maintenance not as easy as it used to be. There is no difference of complication between prolonged flushing interval (⩾4-week) and 4-week period, and it can also reduce healthcare cost with no harm to patients.
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Affiliation(s)
- Yan Wang
- RN School of nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Zhao
- RN School of nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Guang-Ming Wan
- RN Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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2
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Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Front Oncol 2022; 12:1021488. [DOI: 10.3389/fonc.2022.1021488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
AimTo investigate the safety and feasibility of extending the flushing interval for the totally implantable venous access port (TIVAP) during the non-treatment stage in patients with breast cancer (BC) by retrospectively analyzing the patients’ clinical data, including the incidence of TIVAP-related complications.MethodsThis single-center retrospective study included patients with BC who underwent TIVAP implantation at our hospital between January 2018 and March 2021 during their non-treatment phase and visited the hospital regularly for TIVAP flushing. Among the 1013 patients with BC who received TIVAP implantation, 617 patients were finally included on the basis of the inclusion and exclusion criteria and divided into three groups according to the length of the flushing interval: group 1 (≤30 days, n = 79), group 2 (31–90 days, n = 66), and group 3 (91–120 days, n = 472). The basic characteristics of patients in each group and the incidence of TIVAP-related complications (catheter obstruction, infection, and thrombosis) were analyzed.ResultsNo significant intergroup differences were observed in age, body mass index (BMI), tumor stage, pathological staging, implantation approach, chemotherapy regimen, duration of treatment, and TIVAP-related blood return rate (P > 0.05). Among patients from all three groups, 11 cases of catheter pump-back without blood and eight cases of TIVAP-related complications such as infection, thrombosis, and catheter obstruction were recorded. However, no significant differences in TIVAP-related complications were observed among the three groups (P > 0.05).ConclusionExtending the TIVAP flushing interval beyond three months during the non-treatment stage in BC patients is safe and feasible and did not increase the incidence of TIVAP-related complications.
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Jdidia IB, Zribi K, Daldoul A, Toumi O, Cherif A. Complications of catheters with an implantable chamber: about 26 cases. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:803-809. [DOI: 10.1016/j.pharma.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/18/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
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Chang TC, Yen MH, Kiu KT. Incidence and risk factor for infection of totally implantable venous access port. Langenbecks Arch Surg 2021; 407:343-351. [PMID: 34550464 DOI: 10.1007/s00423-021-02328-0] [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: 01/04/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAP) have been widely used in cancer patients for many years. The early infection (within 30 days after TIVAP implantation) rate of TIVAP accounts for about one-third of all TIVAP infections, and early infection often causes port removal and affects subsequent cancer treatment. This study investigated the incidence and risk factors for early and late infection after TIVAP implantation. METHODS From January 2013 to December 2018, all adult cancer patients who received TIVAP implantation in Taipei Medical University Shuang-Ho Hospital were reviewed. We evaluated the incidence of TIVAP-related infection, patient characteristics, and bacteriologic data. Univariable analysis and multiple logistic regression analysis were used to evaluate the risk factors of TIVAP-related infection. RESULTS A total of 3001 TIVAPs were implanted in 2897 patients, and the median follow-up time was 424 days (range: 1-2492 days), achieving a combined total of 1,648,731 catheter days. Thirty-one patients (1.0%) had early infection and 167 (5.6%) patients had late infection. In multivariate analysis, TIVAP combined with other surgeries (p = 0.03) and inpatient setting (p < 0.001) was the risk factor of early infection, and TIVAP combined with other surgeries (p = 0.007), hematological cancer (p = 0.03), and inpatient setting (p < 0.001) was the risk factor of late infection. CONCLUSION Inpatient TIVAP implantation and TIVAP implantation combined with other surgeries are associated with high rates of TIVAP-related early and late infections.
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Affiliation(s)
- Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, Taipei City, 235, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Min-Hsuan Yen
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, Taipei City, 235, Taiwan
| | - Kee-Thai Kiu
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291, Zhongzheng Road, Zhonghe District, Taipei City, 235, Taiwan
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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.
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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)
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Xiong ZY, Zhou HM, Li SY. Prolonged flushing and locking interval for totally implantable vascular access device: A systematic review and meta-analysis. J Vasc Access 2021; 22:969-978. [PMID: 33752495 DOI: 10.1177/11297298211003003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of this systematic review is to evaluate the safety ad feasibility of the totally implantable vascular access devices (TIVADs) flushed more than 4 weeks. We searched the following electronic databases from the date their build-up to February 2020: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The final selection resulted in 14 trials fulfilling the inclusion criteria and being included in our review. A pooled frequency of port-related late complications with longer flushing intervals (>4 weeks) was 8.0%, and the pooled frequency of occlusions, infections, and mechanical complications was 5.0%, 2.0%, and 3.0%, respectively. Then, we compared the frequency of port-related complications between standard and longer flushing intervals. There were no differences between the group's changes in the frequency of total late complications, occlusions, infections, and mechanical complications. This systematic review and meta-analysis demonstrates that longer flushing intervals for ports are safe. However, more prospective, power appropriated randomized trials are needed to explore the specific flushing time for ports.
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Affiliation(s)
- Zhao-Yu Xiong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui-Min Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Su-Yun Li
- Department of Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost 2020; 18:2253-2273. [PMID: 32479699 DOI: 10.1111/jth.14930] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP-associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. METHODS Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP-related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE. RESULTS In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24-3.28), and 0.08 (95 CI: 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95% CI: 2.94-4.76). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. CONCLUSIONS Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.
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Affiliation(s)
- Meng Jiang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, Wuhan, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Taxbro K, Mernelius S, Hammarskjöld F, Hanberger H, Berg S. CE Article: Transfer Rate of Pathogens Through In Vitro Contaminated Venous Port Membranes Varies With Species, Concentration, and Injection Technique. ACTA ACUST UNITED AC 2020. [DOI: 10.2309/j.java.2019.003.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Highlights
Local SVP infection is a common and potentially avoidable complication. Local SVP infection is usually verified by cultures. The transfer rate of pathogens across the SVP membrane may be reduced by applying a positive-pressure flow technique when puncturing the membrane.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sara Mernelius
- Microbiology Laboratory, Division of Medical Diagnosis, Jönköping County, Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Sweden
| | - Håkan Hanberger
- Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Sören Berg
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Rhu J, Jun KW, Song BJ, Sung K, Cho J. Cephalic vein approach for the implantable central venous access: A retrospective review of the single institution's experiences; Cohort Study. Medicine (Baltimore) 2019; 98:e18007. [PMID: 31725671 PMCID: PMC6867776 DOI: 10.1097/md.0000000000018007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.
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Tan L, Sun Y, Zhu L, Lei X, Liang D, Rao N, Su F, Chen K, Li S. Risk factors of catheter-related thrombosis in early-stage breast cancer patients: a single-center retrospective study. Cancer Manag Res 2019; 11:8379-8389. [PMID: 31571994 PMCID: PMC6750851 DOI: 10.2147/cmar.s212375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/19/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Totally implantable venous access devices (TIVADs) are widely used in cancer patients. The main purpose of our study is to observe the incidence and identified risk factors of catheter-related thrombosis (CRT) in breast cancer patients with TIVAD. Patients and methods We performed a retrospective cohort study of consecutive breast cancer patients who received the ultrasound-guided TIVAD implantation for the administration of chemotherapy from 2013 to 2016. The primary outcome was CRT (both symptomatic and asymptomatic detected by ultrasound). Univariable and multivariable logistic regression analyses were used to identify the risk factors for breast cancer TIVAD-related CRT. Results A total of 209 breast cancer patients with a newly implanted TIVAD for chemotherapy were included in this study. The average time of port duration was 7 months. Of the enrolled 209 patients, 33 patients (15.8%) had CRT, 2 of the 33 cases were symptomatic (1 pulmonary embolism, 1 deep-venous thrombosis [DVT]), the other 31 cases were asymptomatic detected by routine ultrasound examination of the catheter-associated vein before TIVAD removal with all cycles of chemotherapy completed. In total, 19 (57.6%) of CRT patients underwent directly TIVAD removal without any further treatments, 14 patients received anticoagulation treatments for 3–30 days followed by TIVAD removal. No DVT event was observed within at least 1.5 years of follow-up. In the multiple-variable analysis, tumor size >2 cm (OR 2.735, 95% CI 1.042–7.177; P=0.032), positive HbsAg (OR 2.803 95% CI 1.027–7.856; P=0.047) and low-density lipoprotein (LDL) >3.6 mmol/L (OR 2.360, 95% CI 1.059–5.351; P=0.040) were the significant independent risk factors of breast cancer TIVAD-related CRT. Conclusion CRT is a common complication in breast cancer patients with TIVAD for chemotherapy. Tumor size, HbsAg status and LDL level were independent predictors of breast cancer for TIVAD-related CRT. Removal of the port without anticoagulation treatments might be a feasible choice for asymptomatic TIVAD-related CRT.
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Affiliation(s)
- Luyuan Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Ya Sun
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xin Lei
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Dongya Liang
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Nanyan Rao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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11
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Singh P, Vardhan V, Chopra M, Mathur A. Rare cause of pulmonary consolidation in a malignancy case. Lung India 2019; 36:447-448. [PMID: 31464220 PMCID: PMC6710959 DOI: 10.4103/lungindia.lungindia_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Priyanka Singh
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Vasu Vardhan
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Manu Chopra
- Department of Pulmonary Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Ankit Mathur
- Department of Radiology, Army Hospital Research and Referral, New Delhi, India
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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.
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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
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McLoughlin M, Stepien KM, McNelly B, Thompson L, Gorton J, Hendriksz CJ. The use of port-a-caths in adult patients with Lysosomal Storage Disorders receiving Enzyme Replacement Therapy-one centre experience. Mol Genet Metab Rep 2017; 13:111-114. [PMID: 29071212 PMCID: PMC5651539 DOI: 10.1016/j.ymgmr.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/27/2022] Open
Abstract
Port-a-cath is a widely used device in patients with long-term venous access demand such as frequent or continuous administration of medications such as Enzyme Replacement Therapy (ERT), chemotherapy delivery, blood transfusions, blood products, and fluids. Patients with Lysosomal Storage Diseases (LSDs) often require recurrent courses of ERT. We reviewed our experience of using port-a-caths in patients with LSDs with the focus on challenges and complications associated with these catheters. Among 245 adult patients who were treated with ERT, twenty patients (8.2%) had a port-a-cath inserted due to poor venous access. Six patients were using their first port whereas five other patients had their port-a-caths replaced at least once. The remaining six patients had inactive port-a-caths. The majority of patients with active port-a-caths never missed more than one consecutive infusion, although one patient missed 2 consecutive infusions whilst on holiday. We identified significant gaps in patients' and their families' understanding of the management of port-a-caths and risks associated with them. It resulted in producing a leaflet and designing an educational program for our LSD patients.
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Affiliation(s)
- Mairead McLoughlin
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Karolina M Stepien
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Briony McNelly
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Lorraine Thompson
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Janet Gorton
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom
| | - Christian J Hendriksz
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Stott Lane, M6 8HD Salford, United Kingdom.,Paediatrics and Child Health, University of Pretoria, Steve Biko Academic Unit, Pretoria, South Africa
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Baumann Kreuziger L, Jaffray J, Carrier M. Epidemiology, diagnosis, prevention and treatment of catheter-related thrombosis in children and adults. Thromb Res 2017; 157:64-71. [DOI: 10.1016/j.thromres.2017.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022]
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15
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Voog E, Campion L, du Rusquec P, Bourgeois H, Domont J, Denis F, Emmanuel E, Dupuis O, Ganem G, Lafont C, Le Du K, Pavluc E, Pointreau Y, Roche S, Juhel-Voog L, Zinger M, Solal-Celigny P. Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer. Support Care Cancer 2017; 26:81-89. [DOI: 10.1007/s00520-017-3816-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
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16
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Madabhavi I, Patel A, Sarkar M, Anand A, Panchal H, Parikh S. A Study of Use of "PORT" Catheter in Patients with Cancer: A Single-Center Experience. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917691031. [PMID: 28469510 PMCID: PMC5395272 DOI: 10.1177/1179554917691031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/06/2017] [Indexed: 11/15/2022]
Abstract
Background: Effective and reliable venous access is one of the cornerstones of modern medical therapy in oncology. Materials and methods: This is a prospective observational study, which collected data of patients who require “PORT” catheter insertion for any cancer, at a tertiary care oncology hospital in Ahmadabad, Gujarat, India, during a 2-year period. Aims and objectives: The main objective of this study was to study the various complications and outcomes related to “PORT” catheters. Results: “PORT” catheter was inserted in 100 patients and was most commonly used in solid malignancies (n = 86, 86%), followed by hematologic malignancies (n = 14, 14%). Among the solid malignancies, breast cancer (38, 38%) was the most common underlying disease, whereas among the hematologic malignancies, acute lymphoblastic leukemia (6, 6%) was the most common underlying disease for “PORT” catheter insertion. Chemotherapy was started on the first day of “PORT” catheter in 74% of patients in the “PORT” study group. The various complications developed in the “PORT” study group in the descending order are as follows: 4 patients (4%) developed early infection (⩽30 days after “PORT” placement), 4 (4%) late infection (⩾30 days after “PORT” placement), 4 (4%) bloodstream infection, 2 (2%) local skin infection at the “PORT” insertion site, 2 (2%) dislodgment of the “PORT” catheter, 2 (2%) fracture of the “PORT” catheter, and 1 recurrent pleural effusion. One patient (1%) developed thrombosis as the complication of “PORT” catheter insertion. Conclusions: The most disturbing aspect of treatment for a patient with cancer is multiple painful venipunctures made for administration of cytotoxic agents, antibiotics, blood products, and nutritional supplements. The focus of this prospective observational research is to study the various underlying diseases for which “PORT” catheter is needed in different solid and hematologic malignancies and the various complications and outcomes in pediatric and adult patients with cancer.
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Affiliation(s)
- Irappa Madabhavi
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Apurva Patel
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, India
| | - Asha Anand
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Harsha Panchal
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
| | - Sonia Parikh
- Department of Medical & Pediatric Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, India
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Diaz JA, Rai SN, Wu X, Chao JH, Dias AL, Kloecker GH. Phase II Trial on Extending the Maintenance Flushing Interval of Implanted Ports. J Oncol Pract 2016; 13:e22-e28. [PMID: 28084883 DOI: 10.1200/jop.2016.010843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retrospective studies suggest that it may be safe to extend the maintenance flushing interval of implanted ports from once every month, as recommended by the manufacturer, to once every 3 months, but no prospective cohort studies have been done specifically assessing the safety and feasibility of this intervention. METHODS This was a phase II study in oncologic patients who retained a functional port after completion of systemic chemotherapy. Patients enrolled in the study had their port flushed once every 3 months and were observed until completion of five scheduled flushes (one on enrollment and four additional flushes, one every 3 months) or development of any port-related complication, including infections, thrombosis, and occlusions. The primary end points were frequency of port-related complications and port failure requiring removal. RESULTS A total of 87 patients were enrolled in the study. The median follow-up time was 308 days, accounting for a total of 24,202 catheter-days. There were 10 port-related complications (11.49%; 95% CI, 4.85% to 18.14%). No infection or symptomatic thrombosis occurred. The mean time to port-related complication was 184 days. No patients developed port failure while on protocol, but on subsequent medical record review, four patients developed a complication that required port removal or port revision within 30 days of being removed from the trial (4.6%; 95% CI, 0.4% to 8.8%; 0.17/1,000 catheter-days). CONCLUSION Extending the maintenance flushes of implanted ports in adult oncologic patients to once every 3 months is safe, effective, and likely to increase patient adherence and satisfaction while decreasing the associated cost.
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Affiliation(s)
- Jorge A Diaz
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Shesh N Rai
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Xiaoyoung Wu
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Ju-Hsien Chao
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Ajoy L Dias
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Goetz H Kloecker
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
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Minichsdorfer C, Füreder T, Mähr B, Berghoff A, Heynar H, Dressler A, Gnant M, Zielinski C, Bartsch R. A Cross-Sectional Study of Patients’ Satisfaction With Totally Implanted Access Ports. Clin J Oncol Nurs 2016; 20:175-80. [DOI: 10.1188/16.cjon.175-180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Morbidity-mortality conference for adverse events associated with totally implanted venous access for cancer chemotherapy. Support Care Cancer 2015; 24:1857-63. [PMID: 26454864 DOI: 10.1007/s00520-015-2969-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Although considered safer than central venous catheters for administration of cancer chemotherapy, totally implanted venous access (TIVA) is associated with adverse events that may impair prognosis and quality of life of patients receiving chemotherapy. Our aim was to assess the feasibility and interest of surveillance of cancer chemotherapy TIVA-adverse events (AE), associated with morbidity-mortality conferences (MMCs) on TIVA-AE. METHODS We performed a prospective interventional study in two hospitals (a university hospital and a comprehensive care center). For each cancer chemotherapy care pathway within each hospital, we set up surveillance of TIVA-AE and MMC on these events. Patients included in surveillance were those with a TIVA either placed or used for chemotherapy cycles in one of the participating wards. Feasibility of MMC was assessed by the number of MMC meetings that actually took place and the number of participants at each meeting. The interest of MMC was assessed by the number of TIVA-AE identified and analyzed, and the number and type of improvement actions selected and actually implemented. RESULTS We recorded 0.41 adverse events per 1000 TIVA-day. MMCs were implemented in all care pathways, with sustained pluriprofessional attendance throughout the survey; 39 improvement actions were identified during meetings, and 18 were actually implemented. CONCLUSIONS Surveillance of TIVA-AE associated with MMC is feasible and helps change practices. It could be useful for improving care of patients undergoing cancer chemotherapy.
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Hsu JF, Chang HL, Tsai MJ, Tsai YM, Lee YL, Chen PH, Fan WC, Su YC, Yang CJ. Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli. World J Surg Oncol 2015; 13:288. [PMID: 26420628 PMCID: PMC4588233 DOI: 10.1186/s12957-015-0707-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantable venous access port (IVAP)-related blood stream infections (BSIs) are one of the most common complications of implantable venous ports. The risk factors and pathogens for IVAP-related BSIs are still controversial. METHODS We retrospectively reviewed all patients who received IVAPs at a Hospital in Taiwan from January 1, 2011 to June 31, 2014. Two types of venous port, BardPort® 6.6 fr (Bard port) and Autosuture Chemosite® 7.5 fr (TYCO port) were used. All patients with clinically proven venous port-related BSIs were enrolled. RESULTS A total of 552 patients were enrolled. There were 34 episodes of IVAP-related BSIs during the study period for a total incidence of 0.177 events/1000 catheter days. Port type (TYCO vs. Bard, HR = 7.105 (95% confidence interval (CI), 1.688-29.904), p = 0.0075), age > 65 years (HR = 2.320 (95 % CI, 1.179-4.564), p = 0.0148), and lung cancer (HR = 5.807 (95% CI, 2.946-11.447), p < 0.001) were risk factors for port infections. We also found that no local sign of infection was significantly associated with the growth of gram-negative bacilli (p = 0.031). CONCLUSIONS TYCO venous ports, age > 65 years, and lung cancer were all significant risk factors for IVAP-related BSIs, and no sign of infection was significantly associated with the growth of gram-negative bacilli.
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Affiliation(s)
- Jui-Feng Hsu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Hsu-Liang Chang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Ying-Ming Tsai
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Yen-Lung Lee
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Pei-Huan Chen
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wen-Chieh Fan
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yu-Chung Su
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan.
| | - Chih-Jen Yang
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68 Chunghwa 3rd Road, Cianjin District, 80145, Kaohsiung City, Taiwan. .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Curto-García N, García-Suárez J, Callejas Chavarria M, Gil Fernández JJ, Martín Guerrero Y, Magro Mazo E, Marcellini Antonio S, Juárez LM, Gutierrez I, Arranz JJ, Montalvo I, Elvira C, Domínguez P, Díaz MT, Burgaleta C. A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study. Support Care Cancer 2015; 24:93-101. [PMID: 25935657 DOI: 10.1007/s00520-015-2754-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/06/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Use of peripherally inserted central catheters (PICCs) has markedly increased during the last decade. However, there are few studies on use of PICCs in patients with haematological malignancies (HM) receiving intensive chemotherapy. Preliminary data suggest a higher rate of PICC-related complications in these high-risk patients. This prospective observational single-centre study aimed to investigate PICC-related complications after implementation of a multidisciplinary approach to PICC care and compared it with previous literature. METHODS A total of 44 PICCs were inserted in 36 patients (27.3%, thrombocytopenia <50 × 10(9)/L at insertion) over 5045 PICC days (median duration, 114.5 days). RESULTS No major insertion-related complications were observed. Major late complications were obstruction in 13.6% (1.19/1000 PICC days) of patients, catheter-related bloodstream infection in 6.8% (0.59/1000 PICC days), and catheter-related thrombosis in 4.5% (0.39/1000 PICC days). Premature PICC removal occurred in 34% (2.97/1000 PICC days) of patients. The overall rate of potentially major dangerous complications was particularly low (11.36%, 0.99/1000 PICC days) compared with previous studies. CONCLUSIONS This study highlights the utility of a multidisciplinary approach for PICC care in adults with HM receiving intensive chemotherapy. We provide further data to support use of PICCs in such patient populations.
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Affiliation(s)
- Natalia Curto-García
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain.
| | - Julio García-Suárez
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Marta Callejas Chavarria
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Juan José Gil Fernández
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Yolanda Martín Guerrero
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Elena Magro Mazo
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Shelly Marcellini Antonio
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Luis Miguel Juárez
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Isabel Gutierrez
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Juan José Arranz
- Nursing Staff of the Haematology Unit, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Irene Montalvo
- Nursing Staff of the Haematology Unit, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Carmen Elvira
- Nursing Staff of the Haematology Unit, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Pilar Domínguez
- Nursing Staff of the Haematology Unit, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - María Teresa Díaz
- Nursing Staff of the Haematology Unit, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
| | - Carmen Burgaleta
- Department of Haematology, University Hospital Príncipe de Asturias, Carretera Alcalá- Meco s/n, Alcalá de Henares, Madrid, Spain
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Dal Molin A, Clerico M, Baccini M, Guerretta L, Sartorello B, Rasero L. Normal saline versus heparin solution to lock totally implanted venous access devices: Results from a multicenter randomized trial. Eur J Oncol Nurs 2015; 19:638-43. [PMID: 25933709 DOI: 10.1016/j.ejon.2015.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Our aim was to determine the non-inferiority of normal saline flushing compared to heparin flushing in maintaining the patency of totally implanted venous access devices (TIVADs). METHOD Four hundred and thirty patients were recruited from 14 Italian centres. Patients were randomized to heparin group or to normal saline group. The primary outcome of the study was TIVAD occlusion. RESULTS After randomisation, 203 patients were assigned to normal saline group and 212 to heparin group. Median follow up time was 204 days in normal saline group and 294 in the heparin group. We observed 24 withdrawal occlusions (5.78%): 10 in the heparin group and 14 in the normal saline group. One total occlusion was observed in the normal saline group. Taking as reference the arm treated with heparin, the absolute risk difference was 2.67 with the 90% CI including the non - inferiority margin of 4%. No significant difference between hazards of occlusion was found. CONCLUSIONS This study failed to demonstrate that normal saline flushing is not inferior to heparin flushing, even if a significant difference between the two treatments was not found. The use of heparin is controversial and other prospective trials are necessary in this field. TRIAL REGISTRATION EudraCT number: 2009-013620-22.
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Affiliation(s)
- Alberto Dal Molin
- Nursing School, Biella Hospital, University of Eastern Piedmont, Biella, Italy.
| | | | - Michela Baccini
- Department of Statistics, Informatics and Applications, University of Florence, Florence, Italy; Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
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Port-a-Cath extravasation of vesicant cytotoxics: surgical options for a rare complication of cancer chemotherapy. Eur J Surg Oncol 2014; 41:378-85. [PMID: 25515823 DOI: 10.1016/j.ejso.2014.11.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/03/2014] [Accepted: 11/10/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although implantation of a central venous device such as a Port-a-Cath was initially considered safe, extravasation rates up to 4.7% have been reported. Therefore, the objective of this study was to propose a structured procedure for the management of extravasation of a cytotoxic treatment. METHODS A total of eight patients were evaluated after port extravasation of epirubicin (n = 3), platinum compounds (n = 3), paclitaxel (n = 1), or trabectedin (n = 1) into the subcutaneous space. Immediate explantation of the port was performed in combination with a "Subcutaneous Wash-Out Procedure" (SWOP). When removal of the port was delayed, débridement and flap coverage were performed as necessary. Epirubicin concentrations present in the samples obtained during surgical intervention were subsequently analysed using high-performance liquid chromatography (HPLC). Patients were followed for at least six months and were examined for sequelae such as pain, induration, redness, and limited movement. RESULTS All three patients whose extravasation event was detected during chemotherapy administration benefited from SWOP with acceptable side effects (e.g., erythema). The analysis of epirubicin concentrations demonstrated the active removal of relevant amounts of the compound by wound rinsing. In contrast, late detection of extravasation led to major débridement and flap coverage in four out of five patients. A high body mass index (BMI) value was associated with all of the patients that experienced port extravasation. CONCLUSION Depending on when Port-a-Cath extravasations into subcutaneous tissue are detected, different treatments are appropriate. When extravasation is detected early, the SWOP was found to be beneficial.
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Doyle H, McNaughton A. Novice research: central venous access device care infections. ACTA ACUST UNITED AC 2014; 23:S35-41. [PMID: 24763274 DOI: 10.12968/bjon.2014.23.sup8.s35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes a literature review of published evidence on infection prevention and control in central venous access device (CVAD) care conducted by a novice researcher (lead author) under the supervision of her lecturer (second author). It includes details of the search as well as of the analysis which led to the selection and critical appraisal of a selected article identified and, importantly, discussion of the limitations and lessons learned by the novice researcher with her experimental approach. Infection control is paramount within nursing practice as a result of the number of healthcare-associated infections, which are preventable if evidence-based practice is followed and when trust protocols are informed by evidence. The question posed by the author prior to undertaking the literature search related to whether the use of sterile gloves for CVADs reduces infections in the oncology patient population compared with the use of non-sterile gloves. The question was formulated using the PICO (Population, Intervention, Comparison, Outcome) process and relevant literature was located using CINAHL and MEDLINE databases. The results of the review demonstrated no significant difference in infection rates using sterile or non-sterile gloves when handling CVADs but further research in this area is needed to validate the findings.
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Zottele Bomfim GA, Wolosker N, Yazbek G, Bernardi CV, Valentim LA, De Castro TM, Pignataro BS, Benitti DA, Nishinari K. Comparative Study of Valved and Nonvalved Fully Implantable Catheters Inserted Via Ultrasound-Guided Puncture for Chemotherapy. Ann Vasc Surg 2014; 28:351-7. [DOI: 10.1016/j.avsg.2013.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/12/2013] [Accepted: 01/15/2013] [Indexed: 10/26/2022]
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Piran S, Ngo V, McDiarmid S, Le Gal G, Petrcich W, Carrier M. Incidence and risk factors of symptomatic venous thromboembolism related to implanted ports in cancer patients. Thromb Res 2014; 133:30-3. [DOI: 10.1016/j.thromres.2013.10.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/18/2013] [Accepted: 10/17/2013] [Indexed: 12/21/2022]
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Implanted central venous access ports for therapeutic phlebotomy in patients with HFE hemochromatosis and other non-thalassemia iron overload disorders. J Vasc Access 2013; 15:67. [PMID: 24043326 DOI: 10.5301/jva.5000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Goossens GA, Jérôme M, Janssens C, Peetermans WE, Fieuws S, Moons P, Verschakelen J, Peerlinck K, Jacquemin M, Stas M. Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial. Ann Oncol 2013; 24:1892-1899. [PMID: 23553060 DOI: 10.1093/annonc/mdt114] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Heparin has been used for years as a locking solution in totally implantable venous access devices. Normal saline (NS) might be a safe alternative for heparin. However, evidence of non-inferiority of NS versus heparin is lacking. PATIENTS AND METHODS We randomly allocated 802 cancer patients with a newly inserted port either to heparin lock (300 U/3 ml) or to NS lock groups in a 1:1 assignment ratio. The primary outcome was the number of functional complications, which was defined as 'easy injection, impossible aspiration' at port access. Secondary outcomes included all functional problems and catheter-related bacteraemia. We hypothesised that NS locks do not cause more functional problems and catheter-related bacteraemia than heparin locks. Non-inferiority is established if the upper limit of the confidence interval (CI) for the relative risk of NS versus heparin is <1.4. RESULTS Three hundred and eighty-two patients from the NS group and 383 from the heparin lock group were included in the analysis. The incidence rate of our primary outcome (easy injection, impossible aspiration) was 3.70% (95% CI 2.91%-4.69%) and 3.92% (95% CI 3.09%-4.96%) of accesses in the NS and heparin groups, respectively. The relative risk was 0.94% (95% CI 0.67%-1.32%). Catheter-related bloodstream infection was 0.03 per 1000 catheter days in the NS group and 0.10 per 1000 catheter days in the heparin group. CONCLUSION NS is a safe and effective locking solution in implantable ports if combined with a strict protocol for device insertion and maintenance.
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Affiliation(s)
- G A Goossens
- Nursing Centre of Excellence, University Hospitals Leuven, Leuven; Department of Public Health and Primary Care, KU Leuven, Leuven.
| | - M Jérôme
- Nursing Centre of Excellence, University Hospitals Leuven, Leuven
| | - C Janssens
- Nursing Centre of Excellence, University Hospitals Leuven, Leuven
| | - W E Peetermans
- Department of Internal Medicine, University Hospitals Leuven, Leuven
| | - S Fieuws
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven; Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Universiteit Hasselt, Hasselt
| | - P Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven
| | - J Verschakelen
- Department of Radiology, University Hospitals Leuven, Leuven
| | - K Peerlinck
- Centre for Molecular and Vascular Biology, KU Leuven, Leuven
| | - M Jacquemin
- Centre for Molecular and Vascular Biology, KU Leuven, Leuven
| | - M Stas
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
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Taxbro K, Berg S, Hammarskjöld F, Hanberger H, Malmvall BE. A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital. Acta Oncol 2013; 52:893-901. [PMID: 23432403 DOI: 10.3109/0284186x.2013.770601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Reliable central vein access is a fundamental issue in modern advanced oncological care. The aim of this study was to determine the incidence of complications and patient perception regarding central vein access ports. METHODS We prospectively studied 249 single lumen access ports implanted between 1 July 2008 and 15 March 2010 in a mixed patient population at a 500-bed secondary level hospital in Sweden. We determined the number of catheter days, infection rate and mechanical complications, as well as patient satisfaction regarding the access port, over a six-month follow-up period. RESULTS Two hundred and forty-four different patients received 249 ports yielding a total of 37 763 catheter days. Ultrasound and fluoroscopic guidance was used in 98% of procedures. Vein access was obtained percutanously by an anaesthesiologist in all cases. There was no case of pneumo- or haemothorax. The incidence of catheter-related bloodstream infection, was 0.05/1000 catheter days and the incidence of pocket/tunnel infection was 0.39/1000 catheter days. Clinically apparent deep vein thrombosis occurred in four patients (1.6%). Patient satisfaction was overall high. CONCLUSION These results confirm that our team-based approach with written easily accessible evidence-based guidelines and a structured education programme leads to a very low complication rate and a high degree of patient satisfaction.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
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30
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De Lucia R, Segreti L, Soldati E, Di Cori A, Zucchelli G, Bongiorni MG. Port-a-Cath complicated by infection or migration not removed by manual traction: usefulness of cardiac pacing leads extraction techniques. Ann Vasc Surg 2013; 27:529-36. [PMID: 23540666 DOI: 10.1016/j.avsg.2012.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Long-term use of Port-a-Caths (PACs) is related to device-related delayed complications. The aim of this study is to describe the high success rate and safety of cardiac pacing lead extraction techniques used for PACs complicated by infection or migration and not removed by manual traction. METHODS During a 13-year period (1997-2010), 19 consecutive PAC recipients (54.1±13 years, 11 females) were referred to our hospital for PAC-related delayed complications and PACs not removable by manual traction (mean dwelling time 29.3±31 months). RESULTS PAC implantation indications included gastrointestinal cancer (21%), breast cancer (15.7%), other malignant diseases (52.6%), and nonmalignant diseases (10.5%). PAC removal indications were breakdown due to subclavian crush (63.1%), breakdown due to unsuccessful previous removal attempt (21%), sepsis (10.5%), or malfunction (5.3%). Removal of fractured free-floating catheters (16) migrated toward the venous blood course was attempted by tool-guided traction in all cases except 1 in whom mechanical dilation was necessary. For the 3 intact ones (2 infected and one malfunctioning) we used tool-guided traction and single-sheath mechanical dilation, depending on the vascular/cardiac-catheter setting. By using multiple venous approaches we removed 18 catheters completely and 1 partially, achieving clinical success in all of the patients. The most commonly used venous approach was transfemoral (TFA; 73.6%), followed by the original venous entry site approach (VEA; 15.7%) and internal transjugular approach (ITA; 10.5%). No major or minor complications were observed. CONCLUSIONS In experienced centers, cardiac pacing lead extraction techniques may be considered as an additional, efficacious, safe option for extraction of otherwise nonremovable entrapped PACs before surgery.
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Affiliation(s)
- Raffaele De Lucia
- Second Cardiology Division, Cardiothoracic and Vascular Department, Santa Chiara University Hospital, Pisa, Italy.
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31
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Chang YF, Lo AC, Tsai CH, Lee PY, Sun S, Chang TH, Chen CC, Chang YS, Chen JR. Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis. Palliat Med 2013; 27:185-91. [PMID: 22126844 DOI: 10.1177/0269216311428777] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer. AIM The aim of this study was to assess the risk of port system failure in patients with advanced cancer. DESIGN We conducted a retrospective cohort study in a comprehensive cancer centre. SETTING/PARTICIPANTS A detailed chart review was conducted among 566 patients with 573 ports inserted during January-June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion. RESULTS Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2-46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m(2) (HR = 3.4, P = 0.029) increased the risk of port system occlusion. CONCLUSIONS Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.
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Affiliation(s)
- Yi-Fang Chang
- Department of Haematology and Oncology, Mackay Memorial Hospital, Taipei, Taiwan.
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32
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A complication of port-a-cath: disconnection and migration of central venous catheter to pulmonary artery. A case report. Crit Ultrasound J 2012. [PMCID: PMC3524470 DOI: 10.1186/2036-7902-4-s1-a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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33
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Garajová I, Nepoti G, Paragona M, Brandi G, Biasco G. Port-a-Cath-related complications in 252 patients with solid tissue tumours and the first report of heparin-induced delayed hypersensitivity after Port-a-Cath heparinisation. Eur J Cancer Care (Engl) 2012; 22:125-32. [PMID: 22966988 DOI: 10.1111/ecc.12008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of the subcutaneous Port-a-Catheters (Port-a-Caths) provides an important mean of venous access for oncological patients. The aim of our retrospective consecutive single-centre study was to investigate Port-a-Cath-related complications in 252 cancer patients. Overall period of Port-a-Caths maintenance was 25 months. The strategy of our centre is to keep Port-a-Caths in situ up to the end of follow-up in adjuvant cancer patients. A total of 22 complications were recorded (8.73%). Interventional complications occurred in four patients. The main complications during Port-a-Cath use included thrombosis (4 patients, 1.58%), infections (4 patients, 1.58%), persistent pain or discomfort (3 patients, 1.19%) and dislocations (2 patients, 0.79%). Median time to the occurrence of any type of complications was 4.5 months. Eleven Port-a-Caths were removed due to complications (4.36%). Similar rate of Port-a-Cath-related thrombosis/infection was seen in adjuvant and advanced cancer patients (no statistical significance). Continuous infusion of anticancer therapy via a Port-a-Cath system is a relatively safe procedure, although major complications might occur. We are first to describe heparin-induced delayed hypersensitivity after heparinisation of Port-a-Cath. This fact should influence the preference to keep the Port-a-Cath after completion of adjuvant anticancer treatment.
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Affiliation(s)
- I Garajová
- L & A Seràgnoli Department of Hematology and Oncological Sciences, University of Bologna, Bologna, Italy.
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Lin CY, Chang HY, Lin SP, Chiu NC, Wang NL. Migration of a port-a-cath from the femoral vein into the duodenum 10 months after implantation. J Pediatr 2012; 161:165.e1. [PMID: 22483602 DOI: 10.1016/j.jpeds.2012.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan
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35
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Honório RPP, Caetano JÁ, Almeida PCD. [Validation of standard operating procedures in nursing care of patients with totally implanted catheters]. Rev Bras Enferm 2012; 64:882-9. [PMID: 22460490 DOI: 10.1590/s0034-71672011000500013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 12/09/2011] [Indexed: 11/22/2022] Open
Abstract
Care protocols are important technological resources in health practice and should be validated for the sake of scientific credibility in professional practice. This research aimed to validate the items of the proposed standard operating procedures (SOPs) related to access, heparinization and dressing of totally implanted catheters, using concept analysis as proposed by Hoskins. The study involved two phases. In the first, a form was elaborated to validate the SOPs. In the second, the SOPs contents were subject to expert validation. Suggestions addressed aspects like reformulations, adding actions to make them clearer and more comprehensive, the order of procedure steps and the material to adapt the instrument. Further research is needed to orient professionals, mainly regarding the heparinization of catheters and the first dressing change after the access, with a view to standardizing conducts based on safe scientific evidence.
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Abstract
In delivering safe care to their patients, oncology nurses should be familiar with the proper use and maintenance of implanted ports. Yet, despite the ubiquitous presence of implanted ports, accessing techniques and patency maintenance remain controversial. Additional research is needed to establish practices based on evidence.
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37
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Goossens GA, Stas M, Jérôme M, Moons P. Systematic review: malfunction of totally implantable venous access devices in cancer patients. Support Care Cancer 2011; 19:883-98. [DOI: 10.1007/s00520-011-1171-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/18/2011] [Indexed: 11/25/2022]
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