Abstract
BackgroundWe have employed upper arm central venous ports (UACVPs) since 2006 for long-term intravenous chemotherapy (CTx) or fluid supplementation. We evaluated the long-term availability of CVPs implanted in the upper arm to determine whether UACVPs could be one of the treatment options besides chest CVPs in terms of CVP-related complications.MethodsWe reviewed the medical records of all patients who underwent subcutaneous implantation of UACVPs at Kyoto University Hospital from 1 April, 2006 to 30 June, 2009. We assessed the indwelling duration of the UACVPs and the incidences of early and late UACVP-related complications.ResultsA total of 433 patients underwent subcutaneous implantation of UACVPs during this time period. The cumulative follow-up period was 251,538 catheter days, and the median duration of UACVP indwelling was 439.0 days (1–2, 24). There was no UACVP-related mortality throughout the study period. A total of 83 UACVP-related complications occurred (19.2 %), including 43 cases of infection (9.9 %, 0.17/1000 catheter days), ten cases of catheter-related thrombosis (2.3 %, 0.040/1000 catheter days), ten cases of occlusion (2.3 %, 0.040/1000 catheter days), nine cases of catheter dislocation (2.0 %, 0.036/1000 catheter days), five cases of port leakage (1.2 %, 0.019/1000 catheter days), four cases of skin dehiscence (0.9 %, 0.015/1000 catheter days) and two cases of port chamber twist (0.5 %, 0.008/1000 catheter days). The removal-free one-year port availability was estimated at 87.8 %.ConclusionsUACVPs were of long-term utility, with complication rates comparable to those of chest CVPs previously reported.
Highlights
Central venous ports (CVPs) are good medical devices to facilitate the long-term administration of intravenous chemotherapy (CTx) or fluid supplementation
We reviewed the medical records of all patients who underwent subcutaneous implantation of upper arm central venous ports (UACVPs) at Kyoto University Hospital from 1 April, 2006 to 30 June, 2009
We performed routine computed tomography scanning every 3 or 4 months in all patients festations of UACVP-related complications. a Titanium Vital Port system. b, c CVP was implanted on the ulnar side in the upper arm. d Port pocket infection with erythematic induration. e Skin dehiscence leading to the exposure of a subcutaneous CVP. f Venous thrombosis resulting in swelling of the left upper extremity
Summary
Central venous ports (CVPs) are good medical devices to facilitate the long-term administration of intravenous chemotherapy (CTx) or fluid supplementation. Since continuous systemic chemotherapy such as FOLFOX or FOLFIRI in combination with molecular-targeted drugs has been regarded as the standard treatment for advanced colorectal cancers [1,2,3], the subcutaneous implantation of CVPs has become an essential device in daily medical care. The insertion of CVPs into the subclavian vein is sometimes complicated by pneumothorax, pneumohemothorax, or arterial punctures [5,6,7,8]. Some authors prefer to implant CVPs in the upper arm or forearm via the basilic or axillary veins because of safer puncture procedures, and concluded that arm CVPs could be suitable for long-term usage with minimal complications [15,16,17]. In order to re-evaluate the utility of UACVPs, we examined UACVP-associated complications and long-term utility of UACVPs in a larger cohort of our patients
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