Central Venous Port Research Articles

Central venous access ports in the interventional radiology suite - one-centre experience.

PurposeCentral venous access ports (CVAP) are widely used to provide long-term vascular access for the delivery of chemotherapeutic medications. The aim of this study was to evaluate the clinical outcomes and complications following CVAP implantation in the interventional radiology suite.Material and methodsA retrospective analysis was conducted on 937 oncology patients who underwent CVAP implantation between January 2009 and June 2017. Information regarding patient characteristics, operative data, and procedural outcomes was collected and analysed.ResultsA total of 937 patients scheduled for CVAP were included in the final analysis. Initial success was achieved in 930 patients (99.3%), and overall completion was achieved in 933 patients (99.6%). There were 63 complications overall. Among these, 19 (2.0%) occurred during the intra- and perioperative period and 44 were late complications (4.7%). No CVAP-related mortalities were observed.ConclusionsThe analysis in the present study revealed that the CVAP is a safe and effective route for long-term administration of chemotherapy with an overall complication rate of 6.7% throughout the entire device duration. The CVAP implantation procedure carried out in the interventional radiology suite provides an advantage in the management of procedural, vascular and catheter-related complications.

Sudden occlusion of a central venous catheter port

Sudden occlusion of a central venous catheter port

Totally implantable central venous port: analysis of complications and their prevention

To analyze postoperative complications of totally implantable central venous port system (TIPCVP) deployment and develop methods of their prevention. The study involved 43 patients who underwent TIPCVP implantation through right-sided jugular access and 3 patients with migration of the catheter transferred to the Domodedovo Central City Hospital. There were four perioperative and one early postoperative complication. None of the complications was the reason for removal of TIPCVP. Pinch-off syndrome occurred in two patients who were operated in other hospitals and a catheter was inserted through the right subclavian vein. Injury of the carotid artery and pneumothorax can be avoided by ultrasound navigation during internal jugular vein puncture. Catheterization of the internal jugular vein is useful to avoid pinch-off syndrome. Migration of the catheter is successfully cured by endovascular methods.

Effect of Inhalation Aromatherapy on Procedural Pain and Anxiety After Needle Insertion Into an Implantable Central Venous Port Catheter: A Quasi-Randomized Controlled Pilot Study.

Needle insertion into an implantable central venous port catheter may lead to procedural pain and anxiety in cancer patients. The aim of this study was to determine the effects of inhalation aromatherapy on procedural pain and anxiety after needle insertion into an implantable central venous port catheter. This study included 123 cancer patients who were scheduled to undergo chemotherapy. Patients were randomly assigned to either the lavender group (n = 41), the eucalyptus group (n = 41), or a control group (n = 41). Participants in the intervention groups inhaled 3 drops of essential oil for 3 minutes before needle insertion into an implantable venous port catheter. Patients in the control group received no intervention before needle insertion. Data were collected using the visual analog scale (VAS) and State Anxiety Inventory. The average VAS scores of the lavender group were significantly lower than those of the control group (P < .05). There were no significant differences in the average VAS scores between the eucalyptus group and the control group (P > .05). In addition, the average State Anxiety Inventory scores of the lavender group, the eucalyptus group, and the control group were not significantly different (P > .05). Inhalation aromatherapy with lavender may be an effective technique to relieve pain related to needle insertion into an implantable central venous port catheter. Inhalation aromatherapy with lavender oil may be useful in the management of procedural pain levels during needle procedure. However, further randomized controlled trials are needed to validate this study.

Is Intraoperative Fluoroscopy Necessary for Central Venous Port System Placement in Children?

Central venous port (CVP) placement is traditionally performed under fluoroscopy guidance. However, efforts for radiation dose reduction in children have allowed the introduction of ultrasound guidance (USG) and anatomic landmarks as an alternative technique for CVP placement. The aim of this study is to determine whether intraoperative fluoroscopy (IF) is required to confirm the correct position of the catheter tip in children. A prospective, single-center study was performed between July and December 2017. Standard venous access site was the right internal jugular vein under USG. Estimated catheter length (ECL) was measured using anatomic landmarks. Ideal catheter length (ICL) was measured after placement under fluoroscopy guidance in the same patient. Age, sex, radiation dose, and complications were also analyzed. A t-test for paired samples and intraclass correlation coefficient were performed to analyze results. A total of 30 consecutive patients aged 7 ± 2 years underwent CVP placement. The mean ECL was 17.1 ± 1.8 cm, while the mean ICL was 17.7 ± 1.8 cm. The mean difference between measurements was 0.28 cm (95% confidence interval [CI], -0.29 to 0.86; p = 0.324). Intraclass correlation coefficient analysis showed an agreement of 0.95 (95% CI, 0.91-0.98) between measurements. Mean radiation exposure during the procedure was 1.060.78 mGym2 during 0.34 ± 0.6 minutes. There were no complications registered during CVP placement. The correlation between IF and USG and anatomically guided catheter tip placement is optimal. These results suggest that fluoroscopy and the radiation exposure it entails can be safely avoided in selected children.

WHEN EDEMA ISN'T ANGIOEDEMA: SUPERIOR VENA CAVA SYNDROME AS A CONFOUNDER IN HEREDITARY ANGIOEDEMA

Introduction Hereditary Angioedema (HAE) is characterized by bradykinin-mediated nonpitting, nonpruritic edema. Superior vena cava (SVC) syndrome often presents with facial swelling and dyspnea; benign etiologies comprise up to 40% of the known causes, most commonly caused by intravascular devices. We report the case of a patient with known HAE complicated by concomitant SVC syndrome. Case Description A 45-year-old white male with known HAE presented with a four-hour history of facial swelling and progressive dyspnea. The patient had throat and bilateral hand swelling. He was treated with C1 esterase inhibitor through an implanted central venous access port, which terminated in the lower SVC. His respiratory status declined, necessitating intubation. A C1 esterase inhibitor functional level drawn early in the hospital course was normal. The patient remained edematous throughout the admission. C1q and C4 levels were inconsistent with an acute HAE flare. A CT chest revealed chronic occlusions of the upper extremity vasculature concerning for an SVC syndrome. Eventually, the patient was successfully extubated. After discharge, a venacavogram revealed an occlusion of the superior vena cava above the junction with the right atrium. Discussion SVC syndrome is a possible confounding factor in patients with HAE flares. Despite the availability of subcutaneous formulations of C1 esterase inhibitor, many patients still receive intravenous C1 esterase inhibitor. The utilization of central venous access ports for medication administration in this population raises the risk of non-HAE mediated edema from SVC syndrome. Additionally, increased vascular pressures in SVC syndrome may also contribute etiologically to acute HAE flares. Hereditary Angioedema (HAE) is characterized by bradykinin-mediated nonpitting, nonpruritic edema. Superior vena cava (SVC) syndrome often presents with facial swelling and dyspnea; benign etiologies comprise up to 40% of the known causes, most commonly caused by intravascular devices. We report the case of a patient with known HAE complicated by concomitant SVC syndrome. A 45-year-old white male with known HAE presented with a four-hour history of facial swelling and progressive dyspnea. The patient had throat and bilateral hand swelling. He was treated with C1 esterase inhibitor through an implanted central venous access port, which terminated in the lower SVC. His respiratory status declined, necessitating intubation. A C1 esterase inhibitor functional level drawn early in the hospital course was normal. The patient remained edematous throughout the admission. C1q and C4 levels were inconsistent with an acute HAE flare. A CT chest revealed chronic occlusions of the upper extremity vasculature concerning for an SVC syndrome. Eventually, the patient was successfully extubated. After discharge, a venacavogram revealed an occlusion of the superior vena cava above the junction with the right atrium. SVC syndrome is a possible confounding factor in patients with HAE flares. Despite the availability of subcutaneous formulations of C1 esterase inhibitor, many patients still receive intravenous C1 esterase inhibitor. The utilization of central venous access ports for medication administration in this population raises the risk of non-HAE mediated edema from SVC syndrome. Additionally, increased vascular pressures in SVC syndrome may also contribute etiologically to acute HAE flares.

Spontaneous coiling of the distal tip of the chemotherapy port.

For doing systemic chemotherapy, central venous ports are used to access central veins and internal jugular vein. Installing these devices though can be with complications on the side which cause them function limits. In this text a case is presented in which after installing a complete and intact port, some malfunction was detected in the chemotherapy procedure after several months which leads us to port Malposition which is probably caused by the huge soft tissue of patient’s breast. This can be prevented simply by installing the port primarily in the zone with less soft tissue.

Dilated Thoracic Duct Terminal and Chyle Withdrawal from a Central Venous Port in Innominate Vein Stenosis

Central vein stenosis is a rare complication that occurs after central venous port placement. We report a case of chyle withdrawal from a central venous port in a patient receiving chemotherapy for stage IV rectal cancer. Dilated thoracic duct terminal and innominate vein stenosis both were clearly shown in the angiography results, and innominate vein stenosis was resolved by performing percutaneous transluminal angioplasty.

Analysis of peripheral central venous access ports at the forearm: An observational study.

The aim of this study was to analyse the characteristics of central venous catheters with brachial-implanted reservoirs and the complications associated with their use over a 4-years period. This observational study was carried out in an onco-haematological day hospital in Spain. Information was collected about 125 catheters inserted in patients requiring intravenous chemotherapy. There were more catheters implanted in women than men and the mean age was 58.6years. Seventy of the implanted catheters were made of polyurethane and 55 of silicone. Left laterality prevailed with a mean catheter dwell-time of 347.1days. A total of 164 complications were registered, 124 of them came from blood draws, where the most frequent complication was "inability to withdraw, ability to infuse". Forty complications were associated with the administration of treatments. Furthermore, there were 21 catheter removals, caused by several other complications different from those mentioned before. Statistically significant differences were found when associating types of catheters, laterality, blood draws and administration of treatments. Results showed how silicone ports would be more appropriate for patients who carry these types or ports than polyurethane because they reduce the number of complications causes by thrombosis.

JS4-1 - Three cases of venous thromboembolism in advanced cancer patients

Background: The incidence of venous thromboembolism (VTE) in cancer patients is high and the symptoms of VTE observed in daily practice are varied. Here we report three cases of VTE treated at Department of Medical Oncology in Tohoku University. Case 1: A 42-year-old man diagnosed with urachal carcinoma had received FOLFIRI for 10 months. He felt his shortness of breath became strong for several weeks. Computed tomography (CT) revealed pulmonary embolism, thus he was hospitalized urgently. Heparin was administered for 1 week, and then direct oral anticoagulant (DOAC) was started. His shortness of breath was improved and CT showed the reduction of embolism, therefore he discharged 13 days after treatment started. CT after 3 months was confirmed the loss of thrombus and recurrence was not observed. Clinically relevant bleeding was not observed, therefore chemotherapy could be continued smoothly. Case 2: A 61-year-old man diagnosed with rectal cancer had received bevacizumab + FOLFIRI for 2 months. An asymptomatic thrombus around the catheter of central venous access port was accidently pointed out by CT to evaluate the effect of chemotherapy. DOAC was administered, and then CT examination after 1 months was confirmed the loss of thrombus. Recurrence was not observed and clinically relevant bleeding was not observed. Case 3: A 51-year-old man diagnosed with rectal cancer had received cetuximab + FOLFIRI for 2 months. His performance status was poor due to tumor progression and adverse events of chemotherapy. Pulmonary embolism was detected by CT to evaluate the effect of chemotherapy, thus he was hospitalized urgently and heparin and warfarin were administered. His prothrombin time-international normalized ratio did not remain within the target range, therefore DOAC was administered. However, the bleeding of his stoma was observed after 10 days, DOAC was discontinued. Anticoagulant therapy was never performed after that because of his poor systemic condition.

P3-253 - Central venous port infection during the early postoperative period after placement in patients with solid cancers

P3-253 - Central venous port infection during the early postoperative period after placement in patients with solid cancers

Perioperative antibiotics should be used for placement of implanted central venous ports: A propensity analysis evaluating risk

ObjectiveTo quantify risk for CRI based on PABX use in CVAP placement for cancer patients. Summary background data: Central venous access ports (CVAP) are totally implanted devices used for chemotherapy. There is a temporal risk for catheter related infection (CRI) to insertion and perioperative prophylactic antibiotics (PABX) use is a contested issue among practitioners. MethodsData was collected from a single center, academic oncology center. Treatment with a perioperative PABX was compared to non-treatment, to examine the incidence of 14-day CRI. Propensity scores with matched weights controlled for confounding, using 15 demographic, procedural and clinical variables. ResultsFrom 2007 to 2012, 1,091 CVAP were placed, where 59.7 % received PABX. The 14-day CRI rate was 0.82%, with 78% of those not receiving PABX. While results did not achieve statistical significance, use of PABX was associated with a 58% reduction in the odds of a 14-day CRI (OR = 0.42, 95% CI: 0.08-2.24, p = 0.31). ConclusionThe findings suggest a reduction in early CRI with the use of PABX. Since CRI treatment can range from a course of oral antibiotics, port removal, to hospital admission, we suggest clinicians consider these data when considering PABX in this high-risk population.

Change from Cardioinhibitory Syncope to Iatrogenic Positional Syncope: Superior Vena Cava Syndrome Treated by Superior Vena Cava Stenting and Leadless Pacemaker Implantation

Symptomatic obstruction of the superior vena cava can be caused by either intrathoracic malignancy or nonmalignant etiology, resulting in superior vena cava syndrome (SVCS). The widespread use of central venous catheters, ports, pacemakers, and defibrillators has increased the incidence of benign SVCS. We present a post-pacemaker-implantation case of SVCS manifesting as positional syncope. The percutaneous intervention of stent implantation after lead removal followed by reimplantation of the leadless pacemaker may be a potential alternative treatment for pacemaker-induced SVCS, since some cases eventually may require repeat intervention.

The Safety Level of Total Central Venous Access Port Implantation Performed by Residents

The implantation of totally implantable venous access ports (TIVAPs) is one of the first procedures surgical residents learn. Complications after implantation procedures have a major impact on patient outcomes, as it may lead to a delay of chemotherapy regimens or of parenteral nutrition. The aim of this study was to compare the outcomes after totally implantable venous access ports implantations done by resident and attending surgeons. The study was performed as a retrospective analysis. The study took place in primary care at the Department of General and Visceral Surgery at Frankfurt University Hospital. A total of 760 primary totally implantable venous access ports implantations performed between March 2008 and December 2016 were included in a database. Three groups of surgeons doing the implantations were defined: Group A (residents alone), Group B (resident with help), and Group C (attending surgeons). There was a significant difference between the surgeon groups in operation time (p<0.001). The groups differed between Group A (mean, 49; SD, 22) and Group C (mean, 39; SD, 20); p<0.001) and Group B (mean, 53; SD, 23) and Group C (mean, 39; SD, 20; p<0.001). The incidence of surgical site infections between Groups A and C (3.6% vs. 0.3%; p=0.003) and Groups B and C (2.5% vs. 0.3%; p = 0.027) differed also significantly. Based on multivariable logistic regression analysis operation time in minutes (OR, 1.04; 95%CI, 1.03-1.06; p<0.001) was an independent risk factor for any intraoperative complications. For any postoperative complications younger age of the patient (OR, 0.98; 95%CI, 0.97-0.99; p=0.004) and benign primary disease (OR, 3.25; 95%CI, 1.55-6.64; p=0.002) were independent risk factors based on multivariable regression analysis. Based on multivariable regression analysis a lower body mass index of the patient (OR, 0.93; 95%CI, 0.86-0.99; p=0.044), benign primary disease (OR, 2.89; 95%CI, 1.07-7.79; p=0.036), and no chemotherapy (OR, 3.55; 95%CI, 1.50-8.39; p=0.004) were independent risk factors for postoperative catheter infections. Surgeon group was no risk factor, neither for intraoperative and postoperative complications, nor for catheter explantation due to complications. Residents performing alone or residents performing with help can safely handle a central venous access port implantation. In patients with several risk factors, however, an attending should assist.

Are Downhill Varices an Overlooked Entity of Upper Gastrointestinal Bleedings?

Aim Downhill varices are not so safe as thought and can lead to life-threating or mortal bleeding complication, even if rare. In order to draw attention to this topic, we analysed 129 patients. Materials and Methods We evaluated the electronic endoscopy data records of all patients undergoing upper gastrointestinal endoscopy over a nine-year period from January 2004 till December 2012, within a retrospective approach. The primary endpoints, incidence, causes, kind of resulting upper gastrointestinal bleeding, and the severity of the bleeding were evaluated. Secondary endpoints were the evaluation of the size of downhill varices and a comparison of the risk of bleeding between downhill varices and uphill varices. Results Downhill varices were identified, described, and/or documented in 129 patients of 25,680 upper gastrointestinal endoscopies. 26 patients had central venous catheter or port implantation, 22 patients had a history of an implantation of a cardiac pacemaker, 7 patients had severe pulmonary artery embolism, and 4 patients had severe chronic obstructive pulmonary disease. Two patients had mediastinal tumors, and one patient had a large retrosternal goiter as a possible cause of the vena cava syndrome. Altogether, 62 patients were related to a vena cava superior syndrome; 67 were not. Conclusions Downhill varices can be seen with an incidence of 0.5%. Therapeutic means are the banding therapy as a safe and effective option. Severe bleedings associated with downhill varices can be mortal. Severe forms of downhill varices should be examined in relation to the origin in order to start a specific therapy.

Comparison between Internal Jugular and Upper Arm Peripheral Veins Approach in Insertion of Totally Implantable Central Venous Ports

Objectives: To compare internal jugular vein approach and Upper arm approach through basilic or cephalic veins in insertion of total implantable central venous port regarding early post-operative complications, patency rate, compliance and patient quality of life. Patients and methods: We identified 50 patients who underwent totally implantable venous access ports (TIVAP) implantation in the arm (25 patients) or chest (25 patients) between November 2015 and November 2017. Implantation via an upper arm (cephalic or basilic) occurred through venous cut down, the internal jugular vein approach was performed using percutaneous technique.1 All approaches were Under fluoroscopic guidance. Early post-operative Complications were evaluated. During follow up, self-compliance and quality of life were assessed as well. Results: Technical success was 100%. Procedure-related arterial injury occurred in 3 patients in central approach only. Post-operative hematoma, stitch inflammation and seroma were observed. Late complications including catheter infection, occlusion, pinch off syndrome, skin dehiscence, thrombophlebitis of the vein and extravasation in both technique was documented, and quality of life was assessed during follow up. Conclusions: Totally implantable venous access ports (TIVAP) can be implanted with high technical success rates and are associated with low rates of complications. Upper arm implantation may benefit clinicians and patients with respect to safety and comfort.

Erratum to: How should urologists perform implantation of subcutaneous central venous port systems? A single center experience of 347 cases

Erratum zu: Urologe 2012 https://doi.org/10.1007/s00120-011-2715-3 Leider fehlt bei der publizierten Arbeit eine wichtige Quellenangabe. Bei der vorliegenden Arbeit handelt es sich um erweiterte Studienergebnisse der englischsprachigen Originalarbeit Schenck, M., Schneider, T., Rubben, H. et al. …

IP131. Preoperative Indicators for Venous Complications Associated With Implanted Ports

Central venous ports have been a critical part of prolonged venous access for a variety of different indications, including chemotherapy, nutritional support, repeated administration of blood products, and frequent blood draws. Complications of these ports cause delays in treatment, increased morbidity, and increased medical expenses. The ability to identify patients at risk for complications can allow prevention and alternative therapies, resulting in improved outcomes, patient care, and satisfaction. The aim of this study was to identify preoperative indicators associated with complications from implanted central venous ports. A retrospective review of 1105 charts was performed during 15 years (1999-2014). Evaluation of placement site, indication for procedure, and diagnostic laboratory values were reviewed to determine their significance related to port complications. A total of 1105 ports were placed (938 arm and 165 chest). The overall complication rate (ie, infection, thrombosis, erosion, and mechanical failure) was 12.3%, with 94 patients (8.5%) developing an infection and 29 patients (2.6%) developing deep venous thrombosis or thrombosis. There was no significant difference in overall complication rate with respect to the implantation site (P = .442). Of the ports placed, 294 had a preprocedure white blood cell (WBC) count within 5 days of port placement; 40 patients had a WBC count of 4.4 × 103 cells/μL and 88 had a WBC count of 9.7 × 103 cells/μL. A WBC count outside the normal range (4.4 × 103 or 9.7 × 103 cells/μL) had a significantly higher complication rate (P = .024). Ports placed for a nonmalignant indication (eg, anemia, depression) were associated with an increased complication rate (P < .001). Ports placed for breast malignant neoplasms had a lower risk of port complication. We have identified multiple factors that appear to increase the risk for development of a complication from an implanted central venous port. WBC count appears to have a significant association with complication rates after implantation. Both infection and thrombosis rates were increased with WBC count outside the normal limit. If possible, one should consider delaying port placement until the WBC count normalizes, using alternative venous access to decrease serious complications. Ports placed for a nonmalignant indication had a significantly increased complication rate. Further evaluation is needed to determine whether alternative access will improve outcomes in this group of patients.

Retrospective analysis of complications following central venous port insertions: A single institution experience.

e18767Background: Central venous access devices, specifically implantable ports, play an essential role in the care of oncology patients. Despite their routine use in cancer patients complications ...

Central venous access port placement by translumbar approach using angio-CT unit in patients with superior vena cava syndrome.

To evaluate the clinical results of central venous access port (CV port) placement by translumbar inferior vena cava cannulation using angio-CT unit for cancer patients with superior vena cava syndrome. A CV port was placed by translumbar inferior vena cava cannulation using an angio-CT unit, in 14 consecutive patients. All patients had occlusion or advanced stenosis of the superior vena cava due to cancer progression. The technical success rate of the percutaneous translumbar CV port placement was 100%. The only complication related to port placement was bleeding in the right iliopsoas muscle seen on CT in one patient, but it stopped with conservative treatment. The mean initial device service interval was 125days (range 6-448days). Complications in the chronic phase occurred in two patients, one with catheter-related infection and the other with catheter breakage, for a rate of 0.44/1000catheter days. In the patient with the broken catheter, the port chamber placement site was cut and replaced with a new catheter by guidewire exchange. CV port placement with translumbar inferior vena cava cannulation using an angio-CT unit for cancer patients with superior vena cava syndrome was safe and effective.