Abstract
Objective: The objective of this study is to assess the outcome of port-a-cath (PAC) maintenance every three months in patients with gynecologic malignancies with the goal of standardizing a safe and appropriate interval that would maintain patency and minimize side effects. Methods: We performed a retrospective medical record review and evaluation of all patients with a Bard? PAC who were noted to have no evidence of disease (NED) during the years 2003 to 2010. The interval between accessions and any complications related to the presence of the PAC were recorded. Relevant complications included skin infections, bacteremia, thrombosis, and occlusions. Statistical analysis was done using the Fisher’s exact test. Results: A total of 201 patients had PAC placed and 43 patients underwent PAC accessions to maintain patency. The total number of accessions was 150 with a median number per patient of 2.0 (range 1 - 10). The mean time between flushes was 112 days (SD = 57). When comparing women in maintenance who had flushes within 90 days versus those who had flushes over 90 days apart, there was no difference in infection or occlusion rates between these groups (p = 0.515). In the Conclusion: Infections and occlusions are rare in women with gynecologic malignancies undergoing maintenance of their PAC. Longer intervals between PAC flushes do not appear to affect the outcome in our patients. Our ongoing data and follow-up confirm that extending the interval of PAC accession to every 3 months, rather than monthly, is safe, effective and convenient in the patient population with gynecologic malignancies.
Highlights
The safe and timely administration of chemotherapy in part relies on consistent access to the venous system
There has been no standardized assessment of the safe and appropriate interval between maintenance flushing of an indwelling PAC
As gynecologic oncologists who administer chemotherapy, we have a unique perspective about long-term complications of PAC placement as we are both the surgeons who insert them and manage potential acute complications such as pneumothorax, infection, bleeding, pain, and determine the interval of follow up, as well as schedule and perform removal of these devices
Summary
The safe and timely administration of chemotherapy in part relies on consistent access to the venous system. In many patients with advanced malignancies and other medical co-morbidities, such as peripheral vascular disease, a more reliable form of access is mediated by semi-permanent or permanent devices such as a peripherally inserted central catheter (PICC), Hickman catheter, or port-a-cath (PAC). Implantable venous access devices provide repeated access to the vascular system and have been widely used in patients with malignancies receiving long-term treatments such as chemotherapy and total parenteral nutrition (TPN). Port-A-Cath consists of a port and an intravascular device. The intravascular device is inserted into a subclavian or jugular vein and tunneled under the skin of the chest wall. Many studies have analyzed the complications associated with implantable catheters, very few have commented on the ideal or recommended length of the maintenance period between flushing the port with heparin [2,3,4,5]
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