Abstract
Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.
Highlights
An intravenous port provides secure vascular access for delivery of treatment in cancer patients
Several native vessels can be used as the entry vessel for chest port insertion, including the cephalic vein [2,3], deltoid branch of the thoracoacromial vein [8], the axillary vein [1,9], the internal jugular vein [3], the external jugular vein [2], the left brachiocephalic vein [10,11], and the subclavian vein [12,13,14]
There has been no consensus on recommendations because most clinical practitioners just consider intravenous ports as vascular access instead of seeing them as part of an integrated cancer treatment plan
Summary
An intravenous port provides secure vascular access for delivery of treatment in cancer patients. There has been no consensus on recommendations because most clinical practitioners just consider intravenous ports as vascular access instead of seeing them as part of an integrated cancer treatment plan. As cancer treatment has improved, the possibility of secondary malignancy and the need for port re-implantation have gradually increased. This highlights the important role of patients’ native vessels, even with suboptimal quality, and of preserving the entry vessels for port re-implantation. Alternative entry vessels may be needed if the cephalic vein is absent or if the vessel has a small caliber or a tortuous configuration. In order to preserve the entry vessel and resolve these difficulties, a standard algorithm has been proposed [16]
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