Abstract
Introduction: Totally implantable venous access port (TIVAP) is essential prerequisite for most of chemotherapy protocols. Flushing with 0.9% sodium chloride becomes an alternative to heparinized solution. As flushing and locking solutions are still controversial, this study was conducted to compare efficacy of heparinized solution versus normal saline solution for locking in ports TIVAP. Patients and Methods: Prospective Cohort study performed in teaching hospital Sulaymaniyah-University of Kurdistan, Iraq, including 384 TIVAP implanted in cancer and non-cancer patients. The study reports the TIVAP outcome in 2 groups of patients where 2 different solutions used for maintaining catheter’s patency by heparinized solution in group (A), versus normal saline for group (B). Results: In group A, the rate of complications was 8.2% (n = 16) while in group B complications rate was 7.9% (n = 15). Thrombosis in group A occurred in 1.03% of the cases and in group B was 1.57%. There were no significant differences between the two groups regarding the causes for unwanted removals of the TIVAP. Conclusions: The results of our study suggest that heparin has no role in preventing the early or late complications of TIVAP and we do not recommend using it as a locking solution.
Highlights
Implantable venous access port (TIVAP) is essential prerequisite for most of chemotherapy protocols
Though rare, heparin may cause drug interaction, heparin induced thrombocytopenia and hemorrhage [6], thence controversies regarding the efficacy of this practice recently been a matter of debate between many health institutions around the world [3] [5] [6]. As consequence of these debates, flushing with 0.9% sodium chloride or normal saline alone started to be used as an alternative to heparinized solution. In this prospective cohort study we report our results for the first patient series with Totally implantable venous access port (TIVAP) in Iraq and as flushing and locking solutions are still controversial, this study was conducted to compare efficacy of heparinnized solution versus normal saline solution for locking purposes in ports of cancer and non-cancer patients
The study reports the (TIVAP) outcome observed in 2 groups of patients where 2 different solutions used for maintaining catheter’s patency, that is, by using heparinized solution in group (A), versus using normal saline solution only for locking the device in the period between infusions in group (B)
Summary
Implantable venous access port (TIVAP) is essential prerequisite for most of chemotherapy protocols. Totally implantable venous access port (TIVAP) becomes an essential prerequisite for most of chemotherapy protocols for solid and hematological malignancies and chronic illnesses require long duration care [1]. TIVAP is a subcutaneously implanted port made of titanium connected to a silicon central venous catheter (Figure 1) which provides a safe and easy long term vascular access for the delivery of chemotherapy and supportive therapy including fluid, blood products, solutions for parenteral nutrition and intravenous medications [1]. It facilitates frequent blood sampling with minimal discomfort [2]. The risk of infection with ports occurs less frequently than with catheters [3], complications such as infection, thrombosis, and catheter fracture are still a matter of concern, which may have adverse effect on the patient and may require undesirable removal of the port [4].
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