Totally implantable central venous catheters for chemotherapy: experience with 793 patients

Multi-professional development of a competency framework for patients with a Port-a-Cath (PAC)

PURPOSE

In France, 40,000 Port-a-Cath (PAC) are inserted each year. These medical devices are prone to complications during their insertion or use. The education of patients wearing these devices could be a lever to reduce the risk of complications. The objective of this work was to develop, in a multi-professional and consensual manner, a unique and specific skills reference framework for patients with PAC and to propose it as a reference tool for health professionals.

METHODS

A multidisciplinary working group was set up to draw up this reference framework of skills. The first stage of the work consisted of a reflection leading to an exhaustive list of competencies necessary for the patient. These skills were then classified according to three different fields of knowledge (theoretical, know-how and attitudes). Finally, the working group identified priority competencies and established a grid that can be used to evaluate the level of acquisition of these competencies.

RESULTS

Fifteen competencies were identified: five relating to theoretical knowledge, six relating to know-how and four relating to attitudes. These competencies were broken down into sub-competences. Seven competencies or sub-competencies were selected to constitute the list of priority competencies.

DISCUSSION

This competency framework provides a reference framework for the education of patients with PAC and will help to harmonise practices within the different teams that care for patients with PAC.

Evaluation of totally implantable catheters in healthy horses

BACKGROUND

For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device's placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted into one cephalic vein in ten adult horses (n = 10). Twenty-four hours following placement, IVRLP with contrast was performed via the TIC and evaluated with radiography. Physical examinations, lameness evaluation, hematologic assessment, and the catheter patency tests were performed at scheduled intervals for the duration of catheterization (7-60 days).

RESULTS

Catheters were implanted without difficulty and allowed for IVRLP 24 h post implantation. Complications resulted in removal of the catheters, with four maintained for 7 days, three in place for 15 days, and three catheters maintained for 60 days. Complications included lameness, limb swelling, catheter kinking, and venous thrombosis.

CONCLUSIONS

The implantation technique of the TIC in the cephalic vein of horses is feasible and requires minimal technical effort. Although TIC allows venous access without the need for repeated venipuncture, its long-term use presents complications. For horses requiring prolonged daily cephalic IVRLP, the use of a TIC could be indicated. However, the high incidence of venous thrombosis may limit clinical application.

Chemoport-associated Complications and Its Management

Chemoport is being routinely used to administer chemotherapy, blood, blood products, total parenteral nutrition, and also to draw blood for investigations. We started using chemoport in our institute. We use it exclusively to administer chemotherapy. We analyzed our results of chemoport usage and confirm that the rate of complications associated with chemoport usage is at par with the available literature. We also conclude that with regular use, the intra-op and post-op complications will reduce further.

Embolização para veia cava inferior de cateter totalmente implantável para quimioterapia

A fratura com embolização de cateter inserido perifericamente em pacientes que receberam quimioterapia representa uma complicação grave e rara, constituindo menos de 1% das complicações relacionadas a esse procedimento. Relatamos aqui um caso de embolização de cateter totalmente implantável em uma paciente de 57 anos submetida a laparotomia por lesão anexial complexa devido a um câncer de ovário com carcinomatose intraperitoneal disseminada diagnosticado no intraoperatório. A paciente foi submetida a histerectomia e salpingooforectomia bilateral, não sendo realizada cirurgia oncológica radical. A análise histopatológica revelou adenocarcinoma de ovário G3. Em outubro de 2013, exame radiológico de rotina diagnosticou fratura e embolização de segmento distal do cateter para veia cava inferior retro e supra-hepática. A paciente não apresentou nenhuma sintomatologia. Procedeu-se à retirada do cateter através da veia femoral pela técnica do laço, sem complicações. Paciente está sem evidência de doença 24 meses após a realização do procedimento.

Incidentes relacionados a medicamentos em um ambulatório de quimioterapia

Resumo Objetivo Identificar os incidentes relacionados a medicamentos em um ambulatório de quimioterapia de um hospital universitário. Métodos Estudo transversal, descritivo, com fichas de acompanhamento dos pacientes atendidos no ambulatório de quimioterapia de um hospital público do Sul do Brasil, no período de junho a agosto de 2016. Para a coleta dos dados, foi utilizado um instrumento de pesquisa dividido em quatro blocos: bloco A - questões relacionadas à caracterização do paciente; bloco B - questões relacionadas à prescrição médica; bloco C - questão relacionada à dispensação dos medicamentos; e o bloco D - questões relacionadas à administração de medicamentos. Resultados Ocorreram 5012 incidentes de prescrição médica, 21 de dispensação e 27 de administração de medicamentos, totalizando 5061 incidentes com e sem danos. Conclusão Observou-se que o número total de incidentes foi de 5061, sendo a média de incidentes por atendimento de 3,6. Esse resultado evidenciou que os incidentes, realmente, estavam presentes no ambiente ambulatorial/hospitalar e que sua média por atendimento foi relativamente elevada. Os achados do estudo poderão informar aos profissionais sobre a realidade da instituição frente aos incidentes que ocorrem na prática em saúde.