892 Totally implantable venous access devices (TIVAD) in cancerology. Results of 141 percutaneous cannulation

Abstract

Introduction cytotoxic chemotherapy often requires a central venous access by a catheter or a TFVAD. Materials we reviewed a homogenous series of 141 patients: 87 women, 54 men, ranging in age from 20 to 80 years old (mean age 54 years). Each patient had a malignant disease, most frequently being metastasis: breast cancer (41.8%), head and neck cancer (10%), ovary cancer (7.8%), lung cancer (7%), sarcoma (5.6%) colon cancer (4.2%) and others (23.4%). The TIVAD used was the standard model Distri-cath ® (Districlass) for 90% cases, joined by a silicon catheter with an internal diameter of 1.10 mm. Methods after a prophylactic antibiotherapy, a neuroanalgesia and a local anesthetic, firstly we used the method of percutaneous cannulation of the subclavian vein and then implanted the TIVAD 2 cm under the clavicle. All implantations were made under normal sterile surgical procedures. The treatment started after 4 days and injection of heparin continued every 29 days. Results percutaneous venous access was successful 139 times (98.6%) with the puncture 112 times (79.4%) on the right. We reg ret having punctured the subsclavian artery 6 times (4.2%) but this did not cause any after-affects. However we experienced no complications of haematoma, pneumothoracis, local infections or septicaemia. Unfortunately we had to remove 7 TIVADs due to 3 ruptures of the catheter, 2 septicaemias, 1 case of ulcerated skin and 1 for psychological intolerance. The time patients spent in the operating theatre in 68% of the cases ranged between 1.5–2 hours. During this study in 1994 we did not experience any extravasation of the cytotoxic drug and no catheter blockage, nor any TIVAD related deaths. Conclusion in our series, the implantation of TIVAD by a percutaneous puncture of the subclavian vein is a quick, reliable method with a low morbidity rate. This operation can lead to many potential complications and should be carried out stringently in surgical conditions. Nevertheless we believe that the percutaneous puncture method provides good venous access and improves the security and the quality of patient life.