Implantable Central Venous Port System Research Articles

Radiation dose reduction during venous access port implantation: the importance of upgrading equipment and radiation-protection training.

Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers. This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation. We retrospectively analyzed consecutive venous port implantations between 2019 and 2022. The older fluoroscopy machines were replaced by two new machines. A first training session about health worker radioprotection was organized. The medical staff completed a second training course focused on protecting patients from ionizing radiation. We defined four distinct time intervals (TI): venous port implantations performed with the old equipment, the new fluoroscopy machines, after the first training course, and after the second training course. The air kerma-area product (KAP) was compared between these four TI and fluoroscopy times and the number of exposures only with the new machines. We analyzed 2587 procedures. A 93% decrease in the median KAP between the first and last TI was noted (median KAP = 323.0mGy.cm2 vs. 24.0mGy.cm2, p < 0.0001). A decrease in the KAP was observed for each of the 11 anesthetists. We also noted a significant decrease in the time of fluoroscopy and the number of exposures. Upgrading the fluoroscopy equipment and completing two dedicated training courses allowed for a drastic decrease patient exposure to ionizing radiation during venous access port implantation by non-radiologist practitioners.

Research progress on nursing of infusion extravasation of implantable central venous port system

Research progress on nursing of infusion extravasation of implantable central venous port system

Safety and feasibility of 3-month interval access and flushing for maintenance of totally implantable central venous port system in colorectal cancer patients after completion of curative intended treatments.

Patients with colorectal cancer (CRC) treated with curative intent surgery undergo continuous fluorouracil (5-FU) infusion-based chemotherapy using totally implantable central venous port system (TICVPS) in cases with high risk of recurrence. Approximately 30% of patients relapse after therapy completion, especially within 2 years. Hence, many patients with high risk CRC keep the TICVPS for 6 to 24 months after treatment with regular intervals of TICVPS flushing. However, little is known about the proper interval duration of the port. The aim of this study is to investigate whether a 3 months extended interval is safe and if port maintenance is feasible.A retrospective cohort was compiled of patients with CRC who underwent curative intent surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. The primary end point was TICVPS maintenance rate, including maintenance of TICVPS for at least 6 months, planned TICVPS removal after 6 months, and regaining the use of TICVPS at the time of recurrence.A total of 214 patients with CRC underwent curative intent treatments during the study period. Among them, 60 patients were excluded, including 6 patients for early recurrence within 3 months and 54 patients with violation of flushing interval. Finally, 154 patients were analyzed. Mean flushing interval was 98.4 days (95% confidence interval [CI], 96.2–100.6; range, 60–120). In December 2018, 35 patients kept the TICVPS, 92 patients had planned removal, 25 patients reused the TICVPS, and 2 patients had to unexpectedly remove the TICVPS due to site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8% (152/154). Thirty-eight patients relapsed, and 30 patients were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) reused the maintained TICVPS without a reinsertion procedures.Our study demonstrated that 3-month interval access and flushing is safe and feasible for maintaining TICVPS during surveillance of patients with CRC. An extended interval up to 3 months can be considered because it is compatible with CRC surveillance visit schedules.

An analysis of totally implantable central venous port system infections in an urban tertiary referral center

A frequent complication of central venous port systems (CVP) is infection (CVP-I), either local (CVP-LI) or a life-threatening blood stream infection (CVP-BSI). We examined the course of CVP-I including results of an antibiotic eradication attempt of CVP-BSI. We investigated adults with CVP-I from 2010 to 2018 who had to undergo port explantation or were treated by a combination of systemic antibiotics and antibiotic lock therapy (ALT). In nine years we diagnosed 206 CVP-I (CVP-LI: 52; CVP-BSI: 152). In 146 patients with CVP-I the port system was primary explanted, while 56 patients received antibiotics/ALT. 79% of Gram negative pathogens and 50% of coagulase negative staphylococci (CoNS) were eradicated. Failure of antibiotic treatment was more often associated with short time span since CVP implantation, neutropenia and polymicrobial infection. All patients with non-neoplastic disease survived, while 18/173 patients (10%) with underlying malignant disease had a fatal outcome in the same hospital stay.

445P - Safety and feasibility of extending flushing interval every 3 months for maintenance of TICVPS in CRC patients after completion of curative intended treatments

BackgroundColorectal cancer (CRC) patients treated with curative intended surgery undergo 5-FU continuous infusion based chemotherapy using totally implantable central venous port system (TICVPS) in case of high-risk of recurrence. Approximately 30% patients relapse after the completion of therapy, especially within 2 years. Hence, many of high-risk CRC patients keep the TICVPS during 6-24 months after treatment, with regular intervals of TICVPS flushing. The manufacturer recommends monthly flushing for maintain TICVPS, however the interval of flushing lacks scientific evidence. The aim of this study is to investigate whether the extended maintenance intervals is safe and feasible. MethodsA retrospective cohort was conducted in CRC patients who underwent curative intended surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. Patient were enrolled if TICVPS was maintained at least 6 months with 3-month interval flushing using heparin, while patient who were recurred within 1 month, removed TICVPS within 6 months without definitive causes, or violation of flushing interval were excluded. The primary end points were the functional TICVPS maintenance rate. ResultsA total of 214 CRC patients underwent curative intended treatments during the study period. Among them, 6 patients (early recurrence within 1 month) and 54 patients (violation of flushing interval) were excluded, finally 154 patients were analyzed. Mean flushing interval was 98.4 days. At the Dec 2018, 35 patients kept the TICVPS, 92 were planned removal, and 25 were reused the TICVPS, while two patients had to unexpectedly remove due to TICVPS site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8%. 38 patients were relapsed and 30 were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) were reused the existing TICVPS without re-insertion procedure. ConclusionsOur study demonstrated that 3-month interval flushing is safe and feasible in CRC patients. Extended time interval up to 3 months might be considered because it is compatible with CRC surveillance visit schedules and convenient for patients. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Evaluation of complications of totally implantable central venous port system insertion

The aim of the present study was to describe the procedure of totally implantable central venous port system (TICVPS) insertion performed at our center and investigate associated complications. The study retrospectively evaluated 827 patients who underwent a single-type TICVPS insertion from January 2013 to July 2015. The length of the procedure, long-term device function, angle (chamber-to-tip) and complications of TICVPS, including infection, skin erosion, occlusion, malposition and thrombosis, were analyzed from the patients' medical records. A total of 843 TICVPS insertions were performed in 827 patients. The TICVPS implantation was successful in all cases (100%). A total of 34 cases (4.0%) with complications were recorded. Complications at the chamber insertion site occurred in 11 patients (1.3%), including 5 infection (0.6%) and 6 erosion cases (0.7%). All patients with chamber insertion site infection were treated by administration of antibiotics and dressing. Of the patients in which chamber insertion site erosion occurred, 2 were subjected to TICVPS removal and reinsertion and 4 were treated with debridement, irrigation and resuture. The most common type of complication was catheter-associated (2.3%; n=19). Among these cases, 7 had catheter-associated infection (0.8%), 8 had catheter migration (1.0%) confirmed by chest radiography, 4 had catheter-associated thrombosis (0.5%) and 2 had chamber malposition (0.3%). The present retrospective study on TICVPS, which used a relatively large cohort, demonstrated a low complication rate (4.0%) compared with that reported in previous studies (5–20%). A well-designed procedure, experienced vascular surgeons, an aseptic operating room environment, ultrasound-guided puncture, a wide angle (chamber-to-tip) and the use of fluoroscopy with contrast agent may reduce the complication rate of TICVPS insertion.

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.

Safety of administration of bevacizumab within a week from placement of a totally implantable central venous port system.

589 Background: Totally implantable central venous port systems (TICVP) are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access for treatment of intravenous anti-cancer chemotherapy in patients with cancer but it is needed to cut 3cm of patients’ skin at the operation. Bevacizumab is one of the anti vascular endothelial growth factor (ant-VEGF) antibody which is known to improve overall survival in patients with colorectal cancer but have a side effect of delayed wound healing. There are few reports about the safety of administration of bevacizumab in a short period of time from the small surgery such as placement of TICVP. Methods: Patients who were placed TICVP in Department of Gastroenterology of Hokkaido University Hospital from July 2009 to December 2016. We planned to compare the rate of post-operative wound dehiscence (POWD) and surgical site infection (SSI) between patients who administered bevacizumab within a week from placement of TICVP (Group A) and the other patients (Group B). Patients who didn’t receive any chemotherapy after placement of TICVP were excluded. Results: We found 432 patients who implanted TICVP, and excluded 32 patients who didn’t receive any chemotherapy. 50 patients were assigned to Group A and 350 patients were assigned to Group B. Median age in both group were 67.5 in Group A and 65 in Group B. The averages of operation time were 38.7 (+/-19.3) minutes in Group A and 36.4 (+/-19.5) minutes in Group B. Prophylactic antibiotics were given to 27 patients (54%) in Group A and 146 patients (48.7%) in Group B. The rate of POWD was 0.0% (0/50) in Group A vs 1.1% (4/350) in Group B ( p = 0.45 ) , and the rate of SSI was 0.0%(0/50) in Group A vs 1.1% (4/350) in Group B ( p = 0.45 ) . The average of operation time of patients with and without POWD was 56.4 minutes and 36.7 minutes (p = 0.013). Conclusions: In our study, it was found that there is no significant increase of incidence by administration of bevacizumab within a short period from placement of TICVP. The long operation time tends to increase the rate of POWD.

Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience.

Totally implantable central venous port systems provide a safe and effective, long-term means of access for administration of hyperosmolar, local irritant medication, such as chemotherapy, antibiotics and parenteral nutrition. To evaluate the combination of access site and level of experience on fluoroscopy times (FT) and dose area products (DAP) during implantation of port catheters in a large patient population. A total of 1,870 patients (992 women, 878 men; age: 61±13.14 years) were reviewed investigating two groups of junior (≤50 implantations) and senior (>50) radiologists. Senior radiologists required less FT/DAP (0.24 s/57.3 μGy m2 versus 0.43 s/68.2 μGy m2, respectively; p<0.001). Right jugular vein access required the least FT/DAP (0.25 s/56.15 μGy m2) and right-sided implantation lower FT/DAP (right: 0.26 s/56.4 μGy m2, left: 0.40 s/85.10 μGy m2, p<0.001). Due to DAP/FT reductions, the right jugular vein seems to be the most favorable implantation side for port systems. For further dose reduction, residents should be well-trained.

Tissue reaction induced by implanted venous access ports in adult patients after infection of the implantation site

Implantable long-term central venous port systems (CVPS) are widely used as a permanent means of accessing the vascular system for intravenous delivery of drugs, parenteral nutrition, blood transfusion, and blood sampling. These systems allow easy and repetitive puncture without causing much damage to the vessels. However, the body foreign surface of CVPS induces an inflammatory response with varying intensity (depending on the implant materials) that leads to formation of a fibrous tissue capsule around the implant. This study was designed to investigate the influence of bacterial infection on the tissue reaction induced by implanted CVPS in adult patients. 20 patients (9 women, 11 men, 58 ± 14 yrs of age) were included in this study. These patients received explantation of a polysulfone based CVPS (ChemoSite™, Covidien, Mansfield, USA) due to port related infections (patients with bacterial infections at the implantation site: group A, 5 men, 1 women) or to other reasons such as termination of treatment, thrombosis, or CVPS dysfunction (patients without bacterial infections, group B, 6 men, 8 women) 299.9 ± 261.2 days after CVPS implantation. A sample of the encapsulating tissue covering the CVPS together with surrounding tissue (at least 1 × 1 cm2) was placed in a small container with fixing agent, a buffered neutral 4% formalin solution (pH 7). Histological sections of the samples were prepared for light microscopic analysis after paraffin embedding. Sections of 3 μm were cut and stained with haematoxylin and eosin, Weigert's elastic stain, and Heidenhain's azan stain. There was no difference in thickness, collagen and elastin content, or cell and capillary density of the fibrous capsule between both groups. Due to the wound healing reaction involving angiogenesis and fibroblast activation cell density and number of capillaries in the capsule tissue of all patients showed a positive correlation (r = 0.45, p < 0.05). However, the study demonstrated that at the end of the foreign body reaction the artificial tissue layer which covers the CVPS after implantation due to foreign body reaction shows only low reactivity towards infections.

Safety of a Totally Implantable Central Venous Port System with Percutaneous Subclavian Vein Access

BackgroundThe role of totally implantable central venous port (TICVP) system is increasing. Implantation performed by radiologist with ultrasound-guided access of vein and fluoroscope-guided positioning of catheter is widely accepted nowadays. In this article, we summarized our experience of TICVP system by surgeon and present the success and complication rate of this surgical method.Materials and MethodsBetween March 2009 and December 2010, 245 ports were implanted in 242 patients by surgeon. These procedures were performed with one small skin incision and subcutaneous puncture of subclavian vein. Patient's profiles, indications of port system, early and delayed complications, and implanted period were evaluated.ResultsThere were 82 men and 160 women with mean age of 55.74. Port system was implanted on right chest in 203, and left chest in 42 patients. There was no intraoperative complication. Early complications occurred in 11 patients (4.49%) including malposition of catheter tip in 6, malfunction of catheter in 3, and port site infection in 2. Late complication occurred in 12 patients (4.90%).ConclusionSurgical insertion of TICVP system with percutaneous subclavian venous access is safe procedures with lower complications. Careful insertion of system and skilled management would decrease complication incidence.

Central venous port system-related complications in outpatient chemotherapy for colorectal cancer.

The current standard chemotherapy for metastatic colorectal cancer is the FOLFOX or the FOLFIRI regimen. Although these regimens include the continuous infusion of an anticancer agent, chemotherapy is possible by using implantable central venous port systems with a portable disposable pump in an outpatient setting. This study is an evaluation of the usefulness of implantable central venous port systems for colorectal cancer chemotherapy. An implantable central venous port system was placed in 93 consecutive patients with metastatic colorectal cancer. All patients received modified FOLFOX6 ± bevacizumab or FOLFIRI ± bevacizumab regimens via the port system. Follow-up continued for each patient until removal of the port system, death or unavailability of further information. The incidence and details of the complications were investigated retrospectively. Out of 1,246 treatments, a total of 16 incidents of port system-related complications were identified (1.28%). Incidents involved infections (n=12), catheter pinch off (n=2), fibrin sheath (n=1) and drug leakage (n=1). A port system removal was required in 14 cases. Implantable central venous port systems are safe and have a low long-term complication rate. We consider port systems, such as modified FOLFOX6 ± bevacizumab or FOLFIRI ± bevacizumab regimens, useful for colorectal cancer patients receiving chemotherapy.

Satisfaction and quality of life: a survey-based assessment in patients with a totally implantable venous port system

The purpose was to assess the satisfaction and quality of life in patients with a totally implantable central venous port system using a questionnaire-based survey. A self-designed questionnaire to assess patient satisfaction and the impact of the port on daily life was dispatched 180 days after implantation. The questionnaire was combined with the commonly used short form (SF)-12 Health Survey quality of life questionnaire. Of the 98 patients who received a port system, 75 were contacted, and 42 (56%) returned the questionnaire. Most of the responding patients reported high overall satisfaction. The impact of the system on daily life was widely perceived not to be negative. The physical component summary (PCS) and the mental component summary (MCS) scores from the SF-12 were 35.5 and 45.23 respectively (general German population: PCS = 49.6, MCS = 52.3). The multiple stepwise regression showed that the cosmetic result was a predictor of overall satisfaction; the cosmetic result and a painful port together were predictors of the MCS. Overall, it was found that the cosmetic result of the implantation procedure was a predictor of satisfaction and quality of life and should thus not be underestimated.

Letter to the Editor re “Outcome analysis in 3160 implantations of radiologically guided placements of totally implantable central venous port systems”: observations about right internal jugular access.

Letter to the Editor re “Outcome analysis in 3160 implantations of radiologically guided placements of totally implantable central venous port systems”: observations about right internal jugular access.

Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems

In this retrospective study the success and complication rates after radiologically guided port catheter implantation were evaluated. Between 2000 and 2008, 3,160 port catheter systems were implanted in our interventional suite. All interventions were imaging guided. The puncture of the preferably right internal jugular vein (IJV) was ultrasound-assisted and the catheter tip position was controlled with fluoroscopy. Catheter indwelling time and rates of periprocedural, early and late complications were evaluated. 922,599 catheter days (mean, 292 days; range, 0-2,704 days) were documented. The implantation was successful in 3,153 (99.8%) cases. A total of 374 (11.8%; 0.41/1,000 catheter days) adverse events were recorded. Of these, 42 (1.33%) were periprocedural complications. 86 (3.3%; 0.09/1,000 catheter days) early and 246 (9.4%; 0.27/1,000 catheter days) late onset complications occurred after port implantation. The most common complications were blood stream infection (n = 134; 5.1%; 0.15/1,000 catheter days), catheter-induced venous thrombosis (n = 97; 3.7%; 0.11/1,000 catheter days) and catheter migration (n = 34; 1.3%; 0.04/1,000 catheter days). A total of 193 (6.1%) port explantations were required. Ultrasound guided port implantation via the IJV results in low periprocedural complication rates.

Technical benefits and outcomes of modified upwardly created subcutaneous chest pockets for placing central venous ports: Single-center experience

Traditionally, port pockets are created in a surgical fashion, with the chest pocket dissection performed by moving in the caudal direction from the incision site. However, most right-handed operators can more easily make the port pocket by dissecting upward. To evaluate the technical benefits and outcomes of modified upwardly created subcutaneous chest pockets to allow for placement of central venous ports. We retrospectively reviewed the clinical and radiological records of 756 insertion procedures in 750 patients who were referred for image-guided implantation of chest ports. Of the 121 removal procedures reviewed, a modified chest pocket was created in 104 of them. The technical benefits and outcomes of the modified procedures were evaluated. The technical success rate of the modified method was 99% for implantation and 100% for removal procedures. No patients had major immediate complications related to the procedure. Early mechanical complications were observed in two patients: one was due to a port that turned over following implantation, and the other was due to separation of the catheter and hub-port. Late mechanical complications were observed in six patients: catheter malfunction occurred in three patients due to fibrin sheath formation, and three patients experienced catheter fracture. The rate of early and late infectious complications was 0.10 and 0.09 per 100 catheter days, respectively. There were five patients with symptomatic central venous thrombosis (range 34-167 days). Modified upwardly created chest pockets are useful for implantable central venous port systems, and may be easier to implant and remove than conventional downward pocket methods.