Implantable Vascular Access Devices Research Articles

Staphylococcus lugdunensis bacteraemia secondary to an infected intracardiac fragment of a vascular access device

We report a case of Staphylococcus lugdunensis bacteraemia following infection of a fragmented totally implantable vascular access device. This report highlights the virulence of S. lugdunensis especially in immunosuppressed patients with prosthetic devices as well as the importance of distinguishing between contamination and blood stream infection when this organism is cultured from blood. The importance of prompt removal of implantable vascular access devices when they are no longer required, to prevent catheter related infections is also reflected in this report. J Microbiol Infect Dis 2015;5(2): 85-88 Key words: Staphylococcus lugdunensis, bacteraemia, vascular access devices.

Longitudinal impact of demographic and clinical variables on health-related quality of life in cystic fibrosis

ObjectivesThe insights that people with cystic fibrosis have concerning their health are important given that aspects of health-related quality of life (HRQoL) are independent predictors of survival and a decrease...

Central venous thrombosis and thrombophilia in cystic fibrosis: A prospective study

Background and AimsCatheter venous thrombosis may result in life-threatening embolic complications. Recently, a thrombophilic tendency was described in cystic fibrosis (CF), the significance of which remains unclear. The aims of this study were to (1) document the frequency of catheter venous thrombosis detected by colour-Doppler-ultrasound (Doppler-US), (2) assess genetic and acquired thrombophilia risk factors for catheter venous thrombosis and hypercoagulability status and (3) provide recommendations on laboratory screening when considering insertion of a totally implantable vascular access device (TIVAD) in CF patients. MethodsWe designed a multicentre prospective study in patients selected at the time of catheter insertion. Doppler-US was scheduled at 1 and 6months after insertion and before insertion in case of a previous central line. Blood samplings were drawn at insertion and at 1 and 6months later. ResultsOne-hundred patients received a TIVAD and 90 completed the 6-month study. Prevalence of thrombophilia abnormalities and hypercoagulability was found in 50% of the cohorts. Conversely, catheter venous thrombosis frequency was low (6.6%). ConclusionOur data do not support biological screening at the time of a TIVAD insertion. We emphasise the contribution of a medical history of venous thromboembolism and prospective Doppler-US for identifying asymptomatic catheter venous thrombosis to select patients who may benefit from biological screening and possible anticoagulant therapy.

Totally implantable vascular access devices for cystic fibrosis

Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Their use is associated with some complications such as thrombosis, embolism and infection. To assess if totally implantable venous access devices provide a safe and effective route for venous access for intermittent administration of intravenous antibiotics in people with cystic fibrosis. Also to assess strategies to reduce possible complications of totally implantable venous access devices (e.g. anticoagulants to reduce the risk of thrombosis). We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search: 05 April 2012. Randomised and quasi-randomised controlled trials which compared the use of totally implantable venous access devices in people with cystic fibrosis to other means of vascular access, trials which compared the different types of these devices against each other and trials which assessed strategies to reduce complications of these devices. No relevant trials were identified. No trials were included in this review. Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Reports of their use in people with cystic fibrosis suggest that they are safe and effective. These reports also suggest that certain interventions might reduce the risk of complications; however, it is disappointing that these reports have not been assessed by randomised controlled trials. This systematic review identifies the need for a multicentre randomised controlled trial assessing both efficacy and possible adverse effects of totally implantable venous access devices in cystic fibrosis.

Totally Implantable Vascular Access Devices in Adult Patients for Cystic Fibrosis Management

Totally Implantable Vascular Access Devices in Adult Patients for Cystic Fibrosis Management

Totally Implantable Vascular Access Devices in Adult Patients for Cystic Fibrosis Management

Totally Implantable Vascular Access Devices in Adult Patients for Cystic Fibrosis Management

Improvement of care for patients with cystic fibrosis: introducing the electronic transmural patient dossier with home monitoring

Background: Of the 377 adult patients at the regional Cystic Fibrosis (CF) Unit, Leeds, 166 (44%) have Totally Implantable Vascular Access Devices (TIVAD). For the remaining 211 (56%) requiring intravenous antibiotic therapy, peripheral longlines are the preferred option for prolonged IV access. Following a reduction in medical cover (FY2) the CF Clinical Nurse Specialists (CNS) underwent training to extend their role and insert peripheral longlines. We aimed to compare the patient experience and complication rates following insertion by doctors or CNS. Methods: CNS received formal training on longline insertion, and achieved practical competencies for this technique. An audit was completed over a 9 month period measuring patient satisfaction and associated complications in 9 key areas. Patient satisfaction was measured on a scale of 1−4 (1 = poor, 4 = excellent). Results: 62 insertions were recorded (36 by doctors, 26 by CNS). There were no differences in patient satisfaction score [Median Patient satisfaction score was 3.5 (doctors) v 4.0 (CNS)], Mean Patency of longline was [10.8 days (doctors) v 10.2 days (CNS)], percentage insertions requiring more than 1 attempt [24% (doctor) v 19% (CNS)] or infection rates. Difference in waiting time to longline insertion was significant [40 min (doctor) vs 20 min (CNS); p< 0.05]. Conclusion: CNS achieved the same patient satisfaction scores and low complication rates as medical staff, whilst reducing waiting times. Extended CNS roles improve the patient experience.

Vascular stenosis in CF patients with totally implantable vascular access devices

Vascular stenosis in CF patients with totally implantable vascular access devices

Seat belt associated central line fracture—A previously unreported complication in cystic fibrosis

Totally implantable venous access devices (TIVAD) are used widely in the management of cystic fibrosis (CF) [Standards of Care: Standards for the clinical care of children and adults with cystic fibrosis in the UK. The Cystic Fibrosis Trust's Clinical Standards and Accreditation Group. Cystic Fibrosis Trust, London, UK, 2001]. They have been shown to be safe and advantageous in the long term administration of intravenous antibiotics [A-Rahman A, Spencer D. Totally implantable vascular access devices for cystic fibrosis. Cochrane Database Syst Rev 2003(3)]. However, TIVADs are not without short and long term complications including infections, thrombosis and mechanical failure [Munck A, Malbezin S, Bloch J. Follow up of 452 totally implantable vascular devices in cystic fibrosis patients. Eur Respir J 2004;23:430–4; Aitkin ML, Tonelli ML. Complications of indwelling catheters in cystic fibrosis: a 10-year review. Chest 2000;118:1598–602; Deerojanawong J, Sawyer SM, Fink AM, Stokes KB, Robertson CF. Totally implantable venous access devices in children with cystic fibrosis. Thorax 1998;53:285–89; Rodgers HC, Liddle K, Nixon SJ, Innes JA, Greening AP. Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions. Eur Respir J 1998;12:217–20; Yung B, Campbell IA, Elborn JS, Harvey JS, Shale DJ. Totally implantable venous access devices in adult patients with cystic fibrosis. Respir Med 1996;90:353–56; Kariyawasam HH, Pepper JR, Hodson ME, Geddes DM. Experience of totally implantable venous access devices (TIV Ads) in adults with cystic fibrosis over a 13-year period. Respir Med 2000;94:1161–5]. Patients should be counselled prior to TIVAD insertion regarding the risks and instructed on post-operative care of the device to minimise the risks. However it is not routine practice to advise on seating position within the car in relationship to the seatbelt placement over the anterior chest wall. Line failure due to direct pressure from a seatbelt worn to prevent injury in the sudden deceleration involved during a motor vehicle accident (MVA) has not been described previously in the CF literature We report the case of an 8 year old child who fractured her Vascuport® line secondary to seatbelt trauma following a road traffic accident (RTA). Children and adults with CF should be advised to sit in the car on the side that places the shoulder strap of the seatbelt on the opposite side to the TIVAD line.

Complications associated with an implantable vascular access device

Purpose Implantable vascular access devices (ports) are well accepted in the management of many pediatric conditions. Modifications have improved port function, patient satisfaction, and enhanced compatibility with imaging studies. We reviewed our experience with a port system and identified unique mechanical complications. Methods From 1998 to the present, 301 patients underwent 296 port insertions and 175 port removals. We assessed medical records, radiographs, and operative findings. The 6.6F MRI Low-Profile Implanted Port (Bard Access Systems, Salt Lake City, Utah) was used almost exclusively and was assembled by the operating surgeon. Outcome measures included port reservoir leakage, catheter dislodgment, and number of device days until complication. Ports were implanted for multiple medical problems including 74.2% in hematology/oncology patients. Results For 296 port insertions, 15 complications (5.1%) were identified in 13 patients (mean age, 8.4 years). Eleven leaks (3.7%) in 9 patients were found, with 9 leaks resulting from needle perforation of the port base and 2 leaks seen at the catheter connection site. Average port duration was 425 days (range, 12-1266 days) before leakage. Four patients had catheter dislodgment (1.4%), with 3 of 4 catheters embolizing to the heart or pulmonary artery. Patients were asymptomatic, and catheters were retrieved by interventional radiology. Dislodgment at the catheter-port connection site was seen in 3 of 4 cases, and average port duration was 1075 days (range, 269-2657 days) until catheter separation. Twelve of 13 patients had successful implantation of a new port system. Conclusions This study identifies that (1) mechanical port complications (5.1%) are not rare for this device; (2) regardless of port age, the thin plastic base may result in a risk of perforation not seen in other devices; (3) the extended period before embolization likely indicates device wear rather than faulty assembly; and (4) complications could be successfully managed including retrieval of embolized catheters.

Implantable vascular access devices in the treatment of colorectal liver metastases.

Implantable vascular access devices in the treatment of colorectal liver metastases.

1589 POSTER Occlusion in totally implantable vascular access devices: what is its incidence and what actions do nurses take to restore patency?

The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons. Alternative settings for the introduction of totally implantable venous access devices (TIVAD) and the search for lower rates of morbidity led to the choice of other central veins. This study compares two different venous accesses, the subclavian (SC) versus the internal jugular (IJ), in terms of early and late morbidity.This is a prospective, non-randomized, observational, uni-institutional (tertiary cancer centre) study. From March 2003 to March 2006, 1231 TIVADs were placed (1201 patients), in an ambulatory operating room, under vital signs and EKG monitoring, using local anaesthesia and without perioperative radiological control.Of the 1231 TIVAD, 617 were inserted via the SC and 614 via the IJ vein. The two groups (SC vs. IJ) were comparable as to general patient characteristics. Immediate complications were more frequent in the SC than in the IJ approach (respectively, 5.0% vs. 1.5%; p < 0.001); Catheter malposition occurred in 2.3% when using the SC vein and in 0.2% for the IJ (p = 0.001). Long term morbidity was also more frequent in the SC than in the IJ group (respectively, 15.8%, 87/551, vs. 7.6%, 39/512; p < 0.001). Venous thrombosis developed in 2.0% of patients with an SC TIVAD as compared to 0.6% with an IJ TIVAD (p = 0.044). Catheter malfunction was significantly dependent on the vein used: SC - 9.4% vs. IJ - 4.3% (p = 0.001).Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD.

Prospective study comparing Broviac cuffed catheter and implantable vascular access device for adjuvant and neoadjuvant chemotherapy for breast cancer : infectious and mechanical risks

8114 Background: Some studies have failed to demonstrate the superiority of implantable ports for short-course chemotherapy for cancer patients with a low risk of infection. Methods: we present the...

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients.

The use and complications of totally implantable vascular access devices (TIVADs) were examined during multiple courses of antibiotics in cystic fibrosis (CF) patients. This retrospective study involved 36 CF centres. Risk factors for removal and septicaemia were sought by survival analysis of censored data. Multivariate Cox models were constructed with removal or septicaemia as the event and the characteristics of TIVADs as explanatory variables. TIVADs (n = 452) were implanted in 315 patients. The mean functional time per device was 32 +/- 25 months. Long-term complications occurred with 188 devices (42%); they consisted mainly of occlusion (21%, requiring removal in 77%), infection (9.3%, requiring removal in 851%; septicaemia in 7.3%; rate 0.3 per 1,000 days, Candida in 66%), and vascular thrombosis (4.7%, removal in 58%). Multivariate survival analysis showed that removal, whatever the reason, was associated with polyurethane (versus silicone) and routine use of the device for blood sampling (versus never). No risk factors, including heparin lock, were identified for septicaemia or for removal for obstruction. Totally implantable venous access devices appear to be safe and reliable for long-term intermittent venous access. Although retrospective, this study suggests that the characteristics of the material and blood sampling are risk factors for removal.

Totally implantable vascular access devices for cystic fibrosis.

Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Their use is associated with some complications such as thrombosis, embolism and infection. To assess if totally implantable venous access devices are a safe and effective route for providing venous access for intermittent administration of intravenous antibiotics in people with cystic fibrosis, also to assess strategies to reduce possible complications of totally implantable venous access devices (e.g. anticoagulants to reduce the risk of thrombosis). We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Date of the most recent search: May 2003. Randomised and quasi-randomised controlled trials which compared the use of totally implantable venous access devices in people with cystic fibrosis to other means of vascular access, trials which compared the different types of these devices against each other and trials which assessed strategies to reduce complications of these devices. No relevant trials were identified. No trials were included in this review. Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Reports of their use in people with cystic fibrosis suggest that they are safe and effective. These reports also suggest that certain interventions might reduce the risk of complications; however, it is disappointing that these reports have not been assessed by randomised controlled trials. This systematic review identifies the need for a multicentre randomised controlled trial assessing both efficacy and possible adverse effects of totally implantable venous access devices in cystic fibrosis.

Complications associated with implantable vascular access devices in the patient with cancer.

Implantable vascular access devices (IVADs), or implantable ports, have been used for patients with cancer for more than 20 years. Although these devices have greatly improved infusion access for this population of patients, complications may still occur. Nurses working with oncology patients who have IVADs must be aware of possible problems for these patients, as well as the importance of early assessment and intervention. The diagnosis of cancer and potential treatments for this disease may make these patients at higher risk for complications associated with the use of IVADS.

Epidemiology of device-associated infections related to a long-term implantable vascular access device.

To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device. Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia. 123 consecutive patients who received a PAS-Port implantable venous access device between January 1 and June 30, 1995. Retrospective cohort study with follow-up > or = 1 year following device implantation. Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/1,000 device days). Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.

Totally implantable venous access devices in children with cystic fibrosis: incidence and type of complications

BACKGROUNDTotally implantable vascular access devices (TIVADs) are accepted as a safe and effective method of facilitating long term intravenous therapy. We report our experience of the use of these devices...

Totallt implantable vascular access devices in 131 pediatric oncology patients: J.E. Sola, M.M. Stone, and P.M. Colombani. Pediatr Surg Int 11:156–158, (February), 1996

Totallt implantable vascular access devices in 131 pediatric oncology patients: J.E. Sola, M.M. Stone, and P.M. Colombani. Pediatr Surg Int 11:156–158, (February), 1996

Totally implantable vascular access devices in 131 pediatric oncology patients

The use of totally implantable vascular access devices (TIVAD) has gained acceptance in oncology patients, with lower overall complications and maintenance costs than percutaneous silastic catheters. We inserted 135 TIVAD in 131 selected pediatric oncology patients (mean age 8.9 years) for chemotherapy of 68 solid tumors, 39 leukemias, and 24 lymphomas. Patients were required to have an absolute neutrophil count of 1,000/μl prior to TIVAD insertion. The cumulative duration of access was 45,098 days, with a mean of 334 days per device (range 5 to 981 days). At the time of review, 53 (39%) TIVAD were functioning without complication, 69 (51%) were removed at the end of therapy or were functioning at the time of death, and 13 (9.6%) were removed due to complications. Complications (n = 23) included 12 episodes of septicemia and 4 pocket infections for an infection rate of 11.8% (1 in 2,819 access days). Infections were more common in patients with leukemia compared to all others (P <0.001). Coagulase-negative staphylococci were isolated in 10 of the 16 infections; 7 infections resolved with antibiotic therapy. Mechanical complications were associated with 7 (5.2%) devices (1 in 6,443 access days). These data suggest that in selected non-neutropenic pediatric oncology patients, TIVAD can be utilized with minimal morbidity in the delivery of long-term chemotherapy.