Experiencia clínica con reservorios venosos subcutáneoos en pacientes oncológicos

Abstract

IntroductionSubcutaneous venous reservoirs (SVR) are useful devices when prolonged intravenous therapy is required. However, the insertion and protracted use of the device is associated with complications. The purpose of this study was to describe our experience over the past 6 years and to summarise the complications we have encountered with the use of SVR.Material and methodsBetween January 1997 and December 2002, we implanted a total of 772 SVR devices in 743 patients in the course of cancer treatment. Age ranged between 14 and 79 years (median 54.4); 244 male (32.8%) and 499 female (67.2%). The devices were inserted in the operating theatre by percutaneous puncture of the subclavian vein (Seldinger technique) via an infra-clavicular approach, and under local anaesthetic.ResultsSVR devices were implanted for chemotherapy of solid tumours (e.g. breast, lung, colon) in 667 patients (86.4%), 95 (12.3%) for haematological malignancies and 11 (1.4%) for benign diseases (e.g. AIDS, short bowel syndrome, antibiotic therapy). In 397 patients (51%) the devices were inserted because of the lack of a useable superficial-vein network and, in 168 cases (21.7%), to facilitate the administration of ambulatory, or continuous, intravenous infusion chemotherapy. We recorded 92 (12%) early complications: haematoma or inflammation around the device in 28 cases (5.6%) and pneumothorax in 14 (1.8%). During the follow-up period, 70 (9.1%) delayed complications were registered: malfunction in 28 cases (3.6%), skin necrosis in 13 (1.6%), infections in 18 (2.3%), fracture and intra-vascular migration of the catheter in 2 (0.26%), symptomatic venous thrombosis (subclavian and/or jugular) in 8 (1%), but with no device-related mortality.ConclusionsThe SVR device represents a significant advance in the management of oncology patients with poor venous access. It is a safe and an effective system of vascular access and is associated with a low rate of complications. In our experience, percutaneous puncture of the subclavian vein is the method-of-choice. The rate of complications relates to the learning curve of the surgeon and of the personnel manipulating the system.