Implantable Access System Research Articles

Safety and Feasibility of Repeatable Hepatic Vascular Isolation Chemotherapy: A Pilot Study.

The authors herein describe a novel method of repeatable hepatic isolation using an implantable access system allowing simultaneous control of hepatic arterial and portal flows by multiple endovascular catheters. The aim of this study was to assess the feasibility and safety of the system and to compress standard intravenous chemotherapy into 4weeks of targeted intra-arterial delivery. An arterial access system was implanted to the axillary artery via an anastomosis. Infusions of oxaliplatin were performed biweekly for 4weeks, using balloon catheters to achieve hepatic isolation and segmental selectivity for 20-25min. Fifty-seven treatments under general anesthetic were performed in ten patients with inoperable chemotherapy-refractory metastatic colorectal cancer. Systemic, intrahepatic, and hepatic venous pressures were recorded to assess vascular isolation, and platinum levels were measured to assess chemotherapy distribution. Pressure verified, multiple day-only hepatic vascular isolation infusions were achieved in nine of ten patients, with a single patient receiving multiple hepatic arterial infusions. Positron emission tomography-computed tomography (PET-CT) imaging confirmed partial response in three of ten patients and stable disease in three of ten patients. Systemic toxicity was minimal as all treatment-related gastrointestinal and neuropathic symptoms reported throughout the 4weeks were grades 1-2. Intra-arterial chemotherapy infusions with hepatic vascular isolation can be achieved repeatedly with targeted selectivity and minimal complications using an implantable multicatheter access system. Oxaliplatin infusions over a 4-week period may achieve tumor response in selected patients in the salvage setting. The technique should be further assessed in a phase Ib/II study.

Role of Peritoneal Ports for Treatment of Intractable Ascites

Introduction: Ascites is a common complication of advanced malignancies and cirrhosis. Symptoms of marked abdominal distention, shortness of breath, diminished appetite, fatigue, and lower-extremity edema can significantly compromise a patient’s everyday life. Treatment options for intractable ascites include serial paracentesis, peritoneovenous shunting, transjugular intrahepatic portosystemic shunt (TIPS) creation, and tunneled peritoneal catheters that may be external or, more recently, attached to subcutaneous ports. It is therefore appropriate to evaluate a port specifically designed for peritoneal access as a mean of controlling intractable ascites. We present a minimally invasive treatment for palliative drainage of symptomatic ascites in patients with advanced malignancy. Aim of the work: The aim of this work is to evaluate the percutaneous implantable access system specifically designed for peritoneal access as a method to control intractable ascites as regards complications and patency. Methods: This is a prospective intervention study will be conducted on 40 patients with intractable ascites referred from the oncology clinic to the diagnostic imaging department for percutaneous placement of peritoneal portcath as a palliative treatment for the patient. Results: Good technical success rate (100%) in insertion was found with removal of ascites gradually. Immediate relief of symptoms (100%). There were no major complications. There was one minor complication(2.5%), a leakage at the port placement site in a patient with pancreatic carcinoma. The leakage stopped spontaneous with removal of ascites and the patient underwent conservative management. Conclusion: peritoneal port systems for treatment intractable ascites is efficient way to avoid ascites related morbidity with increases patient compliance, satisfaction by decreased hospital visits as the drainage and patients monitor can be done in their homes. Port aspiration can be performed in some cases by patients or family members without nursing assistance. In comparison with tunneled peritoneal catheters with external components, the complication rate appears to be minimal.

Utilisation du cathéter à chambre implantable pleural dans la gestion des pleurésies malignes Expérience de l’Institut Curie

Malignant pleural effusion has a very poor prognosis, raises problems of medical management and impairs quality of life. The authors report the first experience of a pleural implantable access system for the treatment of recurrent symptomatic malignant pleural effusion. Prospective follow-up of 26 patients between 20/8/2005 and 2/11/2006 in a single center. Thirty pleural implantable access systems were placed in 26 patients (22 patients with breast cancers, 3 bilateral placements and one case of replacement) under sedation following the decision of a multidisciplinary meeting. Twenty-five patients obtained partial or complete relief of their dyspnea. Four patients underwent spontaneous pleurodesis after a maximum of 2 months. Twelve patients were receiving chemotherapy at the time of placement. The number of aspirations performed varied between 1 and 28 over a period of 11 to 330 days. Eight patients died within 1 month after placement of the system and 6 survived more than 6 months. Seven patients died at Institut Curie or in a palliative care unit without returning home. The other 16 patients presented a total of 198 days of hospitalization for 2,305 days of catheter implantation. No placement failures were observed in this series. Two infectious complications (infectious pleuro-pneumonia and skin infection over the puncture site) and two mechanical complications (expulsion of the port and disconnection between the port and the catheter) were observed and easily treated. One patient developed loculation of the pleural cavity after 16 thoracenteses making further thoracentesis ineffective. The pleural implantable access system is an interesting alternative in terms of efficacy and safety for the outpatient management of malignant pleural effusion. It shows a number of advantages in terms of comfort and infectious risk compared to tunneled pleural catheters.

Use of a Pleural Implantable Access System for the Management of Malignant Pleural Effusion: The Institut Curie Experience

Malignant pleural effusion has a very poor prognosis, raises problems of medical management, and impairs quality of life. The authors report the first experience of a pleural implantable access system for the treatment of recurrent symptomatic malignant pleural effusion. Prospective follow-up of 29 patients between August 20, 2005 and August 1, 2007 in a single center. Thirty-four pleural implantable access systems were placed in 29 patients (23 patients with breast cancers, 4 patients with bilateral placements, and 1 patient with a replacement) under sedation after the decision of a multidisciplinary meeting. Twenty-eight patients obtained partial or complete relief of their dyspnea. Six patients underwent pleurodesis after a maximum of 2 months. Fifteen patients were receiving chemotherapy at the time of placement. Seven patients died at the Institut Curie or in a palliative care unit without returning home. The other 22 patients presented a total of 280 days of hospitalization for 2,717 days of catheter implantation. No placement failures were observed in this series. Two infectious complications (infectious pneumonia and skin infection over the puncture site) and two mechanical complications (expulsion of the port and disconnection between the port and the catheter) were observed and easily treated. One patient had loculation of the pleural cavity develop after 16 thoracenteses making further thoracentesis ineffective. The pleural implantable access system is an interesting alternative in terms of efficacy and safety for the outpatient management of malignant pleural effusion. It presents a number of advantages in terms of comfort and infectious risk compared with tunnelled pleural catheters.

Treatment of dialysis catheter infections in 2004

Hemodialysis catheter associated infections are a major source of morbidity and mortality in end stage renal disease patients. There is disagreement about the management of catheter infections, particularly concerning the removal of potentially infected tunneled dialysis catheters. A dialysis catheter should generally be removed when an infection involves a temporary hemodialysis catheter, a septic patient, a patient with a tunnel tract infection, or a patient with evidence of a metastatic infectious complication. In treating stable patients with clinically mild catheter associated bacteremia, parenteral antibiotics alone have a low success rate in eliminating the infection. Antibiotic locks are an emerging strategy for treating these patients, but at present higher rates of success and lower costs are achieved by exchanging the catheter over a guidewire. Antibiotic lock solutions, antibiotic coated catheters, and totally implantable dialysis access systems may play a large role in prevention of catheter associated infections in the future; however, further randomized controlled trials of these strategies are needed. Future efforts should concentrate on limiting the use of traditional tunneled cuffed hemodialysis catheters by early referral to vascular surgery for the creation of an arterio-venous fistula.

Dialysis ports: A new totally implantable option for hemodialysis access

Current options for hemodialysis access have significant limitations. Chronic central venous catheters have even more problems. In an effort to surmount many of the problems associated with chronic central venous catheters, totally implantable access systems have been designed. This article reviews the 2 devices currently available or under investigation for use as dialysis ports. Operational principles are described, and insertion technique is highlighted. Performance characteristics are then addressed. Copyright 2002, Elsevier Science (USA). All rights reserved.

Phase II Study of Repeated Intrapleural Chemotherapy Using Implantable Access System for Management of Malignant Pleural Effusion

To examine the effectiveness of repeated intrapleural chemotherapy using an implantable access system (INFUSE-A-PORT; Horizon Medical Products; Manchester, GA) for the management of a malignant pleural effusion (MPE). Twenty-two patients with histologically proven MPEs (11 men and 11 women; mean age, 63.8 years; age range, 51 to 81 years; performance status, less-than-or-equal 3) were enrolled in this study. There were 17 patients with MPEs resulting from primary lung cancer; of whom 7 had metastatic disease (stage IV), 3 had stage IIIB disease, and 7 had postoperative recurrences. Three patients had MPEs that were caused by mesothelioma, and two had MPEs caused by breast cancer. Intrapleural catheters were placed by a video-assisted thoracoscopic procedure. The intrapleural administration of 5-fluorouracil (5-FU; 250 mg per body) and cisplatin (10 mg per body) using the implantable access system was performed biweekly at the outpatient clinic. Drainage of the MPEs through the port was performed only when the patients had some manifestations that occurred due to increasing effusion. The mean total administered doses of 5-FU and cisplatin were 3,290 and 124 mg, respectively. The mean follow-up period was 431 days (range, 209 to 792 days). The median survival period was 403 days, and the longest survival period was 792 days. No treatment-related mortality, renal dysfunction, bone marrow suppression, or infection occurred. One patient experienced a hemothorax after eight instances of intrapleural administration. The port and the catheter were involved with the tumor in one patient. Repeated intrapleural chemotherapy using the implantable access system is useful and safe for patients with MPEs. In the future, prospective randomized studies will be necessary to compare the efficacy of therapy for MPE using the implantable access system with that of pleurodesis.

Placement of Vascular Access Devices for Parenteral Nutrition

In the past 30 years, substantial progress has been made in the development of devices and catheters used for central venous vascular access. Temporary, semipermanent, and totally implantable access systems have each undergone multiple design revisions to improve their ease of insertion, durability, and potential for complication. This article provides methodology for the insertion of central venous access systems currently used for parenteral nutrition. The article also discusses the more common complications of these access devices and makes recommendations for management.

Formulation of a flush solution of heparin, vancomycin, and colistin for implantable access systems in oncology

Introduction: Because of the increased use of im plantable access systems, the incidence of blood stream and catheter infections associated with these systems has concomitantly increased. Classically, he parin-lock flush solutions were used to prevent thrombosis; more recently, vancomycin was added to the solution to prevent infections caused by Gram- positive bacteria, particularly coagulase-negative Staphylococci. Disorders due to Gram-negative organ isms have now appeared in oncologic patients. We therefore tested the addition of colistin to heparin- vancomycin solutions. Colistin was chosen for its good activity against Gram-negative bacteria (98% susceptibility in our hospital), its good tolerance due to low systemic passage, and its low cost. Methods: We developed formulations contain ing heparin (100 IU/mL) and various concentrations of vancomycin (10-500 μg/mL) and colistin (10-100 μg/mL) in 0.9% NaCl. Each sterile solution was tested for physical and chemical compatibility (spectropho tometry, nuclear magnetic resonance, and pH mea surements) and its antibacterial activity (against ox acillin-resistant Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae exhibiting broad- spectrum betalactamase (BSBL), imipenem-resistant Pseudomonas aeruginosa) for 2 months at 4°C and at room temperature. Results: The most suitable combination of drugs is heparin (100 IU/mL), vancomycin (100 μg/mL), and colistin (100 μg/mL). This flush solution main tains activity when stored at 4°C for up to 1 month. Conclusions: We feel that the combination of heparin, vancomycin, and colistin can be used as a flush solution for indwelling catheters.

Implantable access system for prolonged intrapleural immunotherapy.

We describe our experience using an implantable Port-A-Cath access system for intrapleural administration of gamma-interferon (gamma-IFN) in malignant mesothelioma patients. Twenty nine patients, with histologically proven malignant mesotheliomas were included in this study. To avoid complications the device was implanted in a subcutaneous pocket, and the catheter was connected via a tunnel. Also, a suction drain was installed in the pocket after placement. This procedure greatly reduced the high infection rate (64%) encountered with conventional open chest tubes. Patients' tolerance was excellent and maintenance minimal. In our opinion, the Port-A-Cath system is the most suitable device for intra-cavitary long-term therapy of malignant pleural effusions.

Establishment of a radiological service for the insertion of an implantable vascular access system

Establishment of a radiological service for the insertion of an implantable vascular access system

Long‐term epidural pain relief using a totally implantable access system

The majority of cancer patients at the terminal stage experience pain as a major symptom, and less than 60% of patients receive adequate pain relief. To relieve this symptom we have placed epidural catheters and attached them to an implantable access system. On this method the patients required 0.4-3.5 mg of morphine per hour with occasional boluses. Catheter life span ranged from 15 to 157 days with an average of 57 days.