P176 Implantable venous access devices in the era of Trikafta®– time for a rethink?

Abstract

Totally Implantable Venous Access Devices (TIVADs) have commonly been used in people with cystic fibrosis (pwCF) due to difficult venous access and repeated respiratory exacerbations requiring IV antibiotics. Elexacaftor/tezacaftor/ivacaftor (ETI, Trikafta™) has had a significant impact on the lives of pwCF and has enabled them to engage in increased amounts of strenuous physical activity. The increased physical activity may lead to an increased rate of portacath complications, including fractures. In this case series we present two such patients who experienced portacath fractures within 18 months of being on ETI and participating in strenuous activity, specifically weightlifting. The patients both presented after pain on routine portacath flushing. Imaging showed dislodgement of the fractured portion of the catheter tubing into proximal large vessels. They required interventional radiology guided removal of the dislodged tubing. The evidence of portacath fractures in the era of ETI puts into question whether TIVADs need to be part of standard therapy for pwCF. This should also trigger a discussion about port removal to avoid potential complications in patients engaging in strenuous physical activity.