Implantable Venous Access Port Systems Research Articles

Retrospective analysis: 5509 cases of "totally implantable venous access port systems implantation (TIVAPS) depth" assisted by digital radiography.

Modern oncological treatment in breast cancer patients requires the precise delivery of chemotherapy infusion into the central venous systems without toxicity. TIVAPS is the significant method of chemotherapy delivery although certain internal or external complications associated with their placement. However, the long-term use of TIVAPS is still a concern to minimize the complications such as venous thrombosis syndrome (VTS) and cardiac defects. The aim of this study is to investigate the potential disadvantages that may be avoided by digital radiography (DR)-assisted measurement of catheter depth pertinent to TIVAPS implanted system. Retrospective analysis related to 5509 TIVAPS recipients of 99% female breast cancer patients and 1% male blood disorder patients registered from April 2013 to November 2017 were included in the study. Patients with TIVAPS catheter tip depth into superior vena cava into upper (group A), middle (group B), and lower (group C) parts were stratified for evaluation during implantation; DR-assisted measurement of TIVAPS was performed to decipher "tip depth of catheter" and determined the relevance of tip depth to complications such as VTS and cardiac defects. Incidence of VTS complications were significantly higher in TIVAPS recipients of group A (82.7%) than group B (16%) and group C (0.12%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). Defects in heart function are higher in group C (59.6%) than group A (15.8%) and group B (24.6%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). DR-assisted measurement can more accurately determine the depth of TIVAPS catheter implantation, and avoid the incidence of related complications, and provide a better method for surgeons.

İntravenöz Port Kateter İmplantasyonu: Tek Merkezli Retrospektif Çalışma

Objective: Totally implantable venous access ports (TIVAPs) are widely preferred for oncology patients who need chemotherapy. Although peripheral cannula or catheter in a large vein may help chemotherapy treatment; some complications such as vascular irritation, thrombosis may interrupt the treatment. To avoid this interruption, TIVAPs are usually preferred. The aim of the study was to evaluate device related complications and safety with anesthesia team implanted TIVAPs. Methods: This retrospective study was conducted on patients who underwent procedure for implantation of TIVAPs in our hospital between the dates of January 2017 - December 2020. The demographic data, vascular access side, complications seen related to TIVAPs insertion procedure, the number of removed catheters, reasons of removal of catheters were recorded. Results: During this study period 700 TIVAPs procedure have been performed in our clinic. While 646 patients (92.3%) had right sided TIVAPs, 678 patients (96.8%) had TIVAPs inserted to subclavian vein. When the most common cancer seen in this patient group was colorectal cancer, hepatobiliary tract cancer group came second. Total number of removed catheters for some reasons was 107 which is 15.2% of all patients. When the causes for catheter removal were examined, it was discovered that although systemic infection was the most common reason (47 patients, or 6.7%), the number of patients with positive culture from the port was extremely rare (19 patients) (2.71%). Conclusion: We think that when TIVAPs are inserted under ultrasound guidance and fluoroscopy control in the operating room, the incidence of complications will be relatively low. Especially in cancer patients, TIVAPs can be inserted and used safely with high patient comfort. Keywords: Totally implantable venous access port systems, complications, patient safety, port infection

Totally Implantable Venous Access Port Systems: Implant Depth-based Complications in Breast Cancer Therapy - A Comparative Study.

Totally implantable venous access port system (TIVAPS) is widely used in breast cancer therapy; TIVAPS has several associated complications depending on the depth of implantation in breast cancer (BC) patients during continuous infusional chemotherapy regimens. The purpose of this study is to find out the optimal depth of TIVAPS implantation to reduce the incidence of complications during infusional chemotherapy. This study reviewed the depth of TIVAPS implantation in the internal jugular vein in 1282 breast cancer patients over a ten-year period (2009-2019), and associated complications. We segregated the patients as 5 groups: 'Group A (depth < 4 mm), Group B (depth of 4-8 mm), Group C (depth of 8-12 mm), and Group D (depth of 12-16 mm), and Group E (depth of > 16 mm)'. Consequently, the 'internal complications' such as infection, venous thrombotic syndrome, catheter folding & migration, extravasation, whereas the 'external complications' viz., inflammation, local hematoma, local cutaneous reactions, and port exteriorization were significantly analyzed during TIVAPS implantation at different depths in BC patients. Overall incidence of 'internal complications' such as infections (8.6%, 2/23 cases), venous thrombotic syndrome (7.69%, 1/13 cases), catheter folding & migration (8.3%, 1/12 cases), and extravasation (8.3%, 1/12 cases) was comparatively lesser in Group C (8-12 mm) (p<0.01) than the Group A, Group B, Group D, and Group E respectively. Mainly, the external complications such as inflammation in Group C (8-12 mm) (pp< 0.01) was lesser (6.8%, 3/44 cases) than Group A, Group B, Group D, Group E. On the similar note, the local hematoma, and local cutaneous reaction, and port exteriorization were observed as '5% (1/20 cases), 4.2% (2/47 cases), and (3.2%, 1/31 cases)' in Group C patients (p<0.01), which were comparatively lesser than the other groups. Subcutaneous implantation of TIVAPS at a depth of 8-12 mm could be preferred due to the lowest incidence of internal and external complications compared to the incidence of these complications in other groups; this depth could be referred to as the safe and convenient implantation depth for the effective delivery of chemotherapy regimen in BC patients without difficulty in transcutaneous access to the port.

Complications associated with implantation and use of totally implantable venous access port in pediatric and adult patients

Introduction: The use of totally implantable venous access port systems (TIVAPS) is crucial for long-term intravenous treatment in children and adults patients. The purpose of this article is to examine the extent of existing research on complications related to implantation and management of TIVAPS. Methods: A scoping review was performed from September to December in 2019. The MEDLINE, CINAHL and PubMed databases were used to review and analyze the literature using various combinations of keywords and their English-language synonyms. Quantitative clinical research published from 2010 to December 2019 were included in the analysis. The PRISMA-ScR recommendations were followed. Results: Out of the 219 search results, 26 studies were included in the final analysis. To identify complications associated with the implantation and handling of TIVAPS, free codes were identified by thematic analysis leading to the development of 17 primary grade descriptive subthemes. For the development of the thematic framework, all secondary level sub-topics were synthesized into three main themes: time-bound complications, infection-related complications, and TIVAPS removal complications. Discussion: Nurses who use TIVAPS on children and adult patients should be aware of the possible complications associated with TIVAPS. Refinement of surgical techniques and improving care process may improve the longevity of the line. Proper and careful management with TIVADs and more frequent observation by nurses are likely to have positive consequences for patients and positive cost implications for the hospital.

Early Results of Totally Implantable Central Venous Access Port Insertion Through a Supraclavicular Approach

Cancer patients usually require repeated venous punctures for chemotherapy or other reasons. Therefore, totally implantable venous access port (TIVAP) systems have been helpful for patients with difficult vascular access. The purpose of this study was to evaluate the safety and feasibility of the totally implantable venous access port (TIVAP) implanted using a supraclavicular approach. After identification of the anatomical landmarks (clavicular head of the sternocleidomastoid muscle) for a supraclavicular approach, the patient was anesthetized with 1% lidocaine. After puncturing the central vein with an 18-G needle, the Seldinger catheterization procedure was performed. Between March 2017 and February 2018, 89 totally implantable venous access ports (TIVAPs) were inserted in 89 consecutive patients (32 men and 57 women) with a mean age of 57.5 years (range, 19–89 years) through a supraclavicular approach. Successful totally implantable venous access port (TIVAP) implantation was achieved in 96.6% (86 of 89) of patients. In 2 patients, port catheter placement failed despite successful vascular puncture because a wire could not be passed after cannulation of the blood vessel. The other case of failed placement was due to development of pneumothorax during vascular puncture. Venous port-related complications such as bleeding, infection, thrombosis, malfunction, or catheter fracture did not occur within 2 postoperative weeks. Totally implantable venous access port (TIVAP) implantation through the supraclavicular approach can be performed safely and feasibly for oncologic patients with difficult central or peripheral venous access.

1406 - Management and early complications of totally implantable venous access port systems in 81 children diagnosed with cancer

1406 - Management and early complications of totally implantable venous access port systems in 81 children diagnosed with cancer

Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients

BackgroundTotally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. Patients and methodsBetween January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10–20%), or high (>20%) risk for inducing neutropenia. ResultsThe overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0–5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003). ConclusionAn interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens.

Totally implantable venous access port systems and associated complications: A single-institution retrospective analysis of 2,996 breast cancer patients.

Totally implantable venous access port systems (TIVAPS) are widely used in breast cancer patients. However, complications are frequent and may necessitate device replacement or removal, resulting in additional patient stress and treatment delays. The aim of this study was to investigate possible risk factors for complications. A total of 2,996 consecutive female breast cancer patients, with a median age of 50.2 years (range, 21.2-85.5 years) were enrolled in this observational, single-centre study between December, 2008 and April, 2014. TIVAPS implantation was principally performed using local anaesthesia and the blind puncture or Seldinger technique through internal jugular or subclavian vein access. A retrospective chart review was conducted to obtain information associated with TIVAPS and patient data. Insertion performed by blind puncture and Seldinger technique had a success ratio of 96.34 and 99.80%, respectively (χ2=29.905, P<0.001). However, the success ratio of the puncture technique group was 99.76% when the TIVAPS was implanted in the right internal jugular vein. The most common complications were late complications, with an overall incidence rate of 5.41% (162/2,996) during the entire device duration. The most common late complications included fibrin formation (1.84%, 55/2,996), port-related bacteraemia (1.44%, 43/2,996) and deep vein thrombosis (0.63%, 19/2,996). No patient died during the study. Our results demonstrated that insertion of TIVAPS by blind puncture or the Seldinger technique through internal jugular or subclavian vein access is convenient, and insertion by the Seldinger technique through the right internal jugular vein is the preferred method. Therefore, TIVAPS is safe for continuous infusional chemotherapy regimens for breast cancer patients.

Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte)

BackgroundMany cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as “intervention”), we compared luer lock caps with a “closed access system” consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety).MethodsFor determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation.Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination.ResultsWith the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value<0.05) confirmed the significance of the result.In 50 reviewed samples (TWC’s), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%.Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%.ConclusionsIn the present research, the closed access system with a divided split septum was superior to conventional luer lock caps. The advantage of the closed access system lies in the simplified handling for staff, which results in a reduced risk of patient infection due to improved clinical hygiene.

Analysis of totally implantable venous access port systems (TIVAPS) related adverse events (AEs) in metastatic colorectal cancer (mCRC) patients treated with and without bevacizumab.

e14623 Background: TIVAPS are widely used for cancer chemotherapy. Bevacizumab, a key drug for mCRC, associates with AEs such as thromboembolism, bleeding, and impaired wound healing. Bevacizumab may complicit in increasing incidence of TIVAPS related AEs. To assess the incidence of TIVAPS related AEs in mCRC patients who received chemotherapy with and without bevacizumab. Methods: We retrospectively reviewed the medical records of consecutive patients whose TIVAPS were placed at our institution between Apr. 2004 and Apr. 2009. Major selection criteria were histologically proven colorectal adenocarcinoma, metastatic disease, and receiving chemotherapy after TIVAPS placement. We assessed the incidence of AEs occurred from the first administration of chemotherapy via TIVAPS to TIVAPS removal, death, or the last follow-up. We compared the incidence of TIVAPS related AEs in the cases bevacizumab was administered (group A) with that in the cases without bevacizumab administration (group B). Results: TIVAPS was placed 549 times for 505 patients, and 544 TIVAPS placements for 501 patients were analyzed. Bevacizumb was administered in 174 patients (32%), and median duration of bevacizumab therapy was 9.2 months. Characteristics of the cases in the group A and B were: male (60% and 59%); primary site colon (60% and 57%); catheterized in left subclavian vein (85% and 81%); history of prior chemotherapy (53% and 60%); median time from TIVAPS placement to administration of chemotherapy (1 day and 1 day). Incidence of common AEs in the group A and B were: infection (7.5% and 6.8%); venous thromboembolism (3.4% and 1.4%); TIVAPS occlusion (2.3% and 1.9%); delay of wound healing (1.1% and 0.5%); hematoma (0.6% vs 0%). Median time to AE in the group A and B was 21 months and 9 months. There was no significant difference in the incidence of TIVAPS related AEs between group A and B. During median observation period of 40.5 months, no arterial thrombotic event or AE resulted in death occurred. Conclusions: Addition of bevacizumab did not increase TIVAPS related AEs during chemotherapy for mCRC.

Higher complication risk of totally implantable venous access port systems in patients with advanced cancer – a single institution retrospective analysis

Background: Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer. Aim: The aim of this study was to assess the risk of port system failure in patients with advanced cancer. Design: We conducted a retrospective cohort study in a comprehensive cancer centre. Setting/participants: A detailed chart review was conducted among 566 patients with 573 ports inserted during January–June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion. Results: Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2–46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m2 (HR = 3.4, P = 0.029) increased the risk of port system occlusion. Conclusions: Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.

Totally implantable venous access port systems and risk factors for complications: A one-year prospective study in a cancer centre

Background Totally Implantable Venous Access Port Systems (TIVAPS) are widely used in oncology, but complications are frequent, sometimes necessitating device removal and consequently delays in chemotherapy. The aim of this study was to investigate possible risk factors for morbidity. Methods A total of 815 consecutive cancer patients (median age: 56.2 years [0.8–85.2]; 522 female) were enrolled in this observational, single-centre study between May 2nd 2006 and April 30th 2007. TIVAPS implantation involved principally cephalic or external jugular vein access. Patients were followed up for one year unless the device was removed earlier. Results The overall morbidity rate was 16.1% (131/815). Complications necessitated device removal in 55 patients a mean of 3.7 months [0.2–12.0] after implantation. These comprised TIVAPS-related infection (19), port expulsion (14), catheter migration (6), venous thrombosis (5), mechanical problems (3), skin disorders (2), pain (2), drug extravasation (2) infection unrelated to TIVAPS (1) and inflammation (1). No patient died during the study. The factor most strongly predictive of complications was the interval between insertion and first use of the TIVAPS, ranging from 0 to 135 days (median: 8.0 days). The morbidity rate was 24.4% when this interval was 0–3 days, 17.1% when it was 4–7 days and 12.1% when it exceeded 7 days ( p < 0.01; Chi 2 test). The median interval was 6 days (0–53) and 8 days (0–135), respectively, in patients with and without complications ( p < 0.001). Conclusion To reduce complications, an interval of at least 8 days between placement of the TIVAPS and its first use may be advisable.

Efecto en pruebas de coagulación del procedimiento de extracción desde catéter reservorio vascular subcutáneo

Introduction The number of patients with Implantable Venous-Access Port Systems (IVAPS) seen in Phlebotomy Outpatients, as well as requests for drawing blood samples through this system instead of conventional venepuncture, are continuously increasing. The aim of this study was to assess if drawing blood samples through IVAPS, despite using a specific procedure, may alter results of basic blood coagulation tests. Material and methods We studied 10 patients with IVAPS, who came to Phlebotomy Outpatients at our hospital, and who were attended to by two nurses with experience in handling these devices. Two samples were obtained from each patient, one of them drawn through IVAPS, and the other by peripheral venepuncture, and the results for blood coagulation tests (Prothrombin Time-PT, PT derived Fibrinogen, Activated Partial Thromboplastin Time-APTT and D-Dimer) were evaluated. Results Statistically and clinically significant differences were found, for APTT, between IVAPS and venepuncture: mean values were, respectively, 24.9 s and 27.9 s ( P < .05). No other results (PT, PT derived Fibrinogen or D-Dimer) showed statistically significant differences. Conclusions The difference observed in APTT results between samples drawn through IVAPS compared to samples obtained by venepuncture, suggests that peripheral venepuncture should be used in these patients. The use of IVAPS is convenient for the patient, but it is not always recommended, as it may lead to laboratory errors.

Further Data About Upper Extremity Ports

We would like to reply to the questions raised by article published in the April 2010 issue by Goltz et al. [1], ‘‘Peripherally Placed Totally Implantable Venous Access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients.’’ The authors report on one of the largest series of percutaneous ultrasound-guided arm vein access with concomitant port chamber placement in the forearm. The authors state—and we fully agree—that percutaneous access via radiological guidance increases the technical success rate and greatly decreases the procedurerelated complication rate in comparison to the surgical techniques. With ultrasound real-time guidance, the technical success vein access rate reaches up to 99–100% vs. 94% by venography guidance [2–4]. To our opinion, the latter should only be indicated in obese patients, in whom ultrasound scan is often of poor quality, and in patients with previous ipsilateral catheter [5]. Goltz et al. also question two main issues: the value of antibiotic prophylaxis, and the necessity of randomized trials comparing upper extremity and surgical chest port device insertion techniques. We recently collected the data of a randomized trial granted by the French Ministry of Health, the aim of which was to compare image-guided arm port device insertion in the interventional radiology suite (R) to surgical chest port placement using the cephalic vein cutdown in the operating room (S) [6]. Among 382 oncology patients, 230 were randomized to one of the two groups. Patients receiving anticoagulant therapy or with a history of thromboembolic events were excluded from the trial. No patients received antibiotic prophylaxis before venous device placement. Our analysis showed that septic complications, including local and systemic infections, accounted for 0.02 of 100 patient-days (cumulative duration with implanted port device of 61,082 days). Compared to the reported septic rate of Goltz et al. of 0.013 per 100 patient-days obtained with antibiotic prophylaxis (cumulative duration of 372,499 days), this difference seems to be nonsignificant by Fisher’s exact test. We thus advocate such a prophylaxis in selected patients including immunocompromised patients or those presenting diabetes mellitus. Concerning septic complications, in our own trial, bacterial result assessment disclosed a strong predominance of Staphylococcus aureus in patients with sepsis in whom the procedure had been performed in the radiology suite, whereas resistant germs (nosocomial infections) were found in the operating room group (surgical chest port patients). It is noteworthy that the C-reactive protein curve mapped during follow-up was used as a key retrospective diagnostic tool to incriminate the port device as the cause of sepsis in doubtful cases. A marked drop in C-reactive protein levels after removal of the suspicious device was P.-Y. Marcy (&) N. Amoretti Interventional Radiology Department, Antoine Lacassagne Cancer Research Institute, Sophia Antipolis University, 33 Avenue Valombrose, 06189 Nice cedex 1, Nice, France e-mail: pierre-yves.marcy@cal.nice.fnclcc.fr; pymarcy@hotmail.com

Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients

The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheter-days) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.

Venöses Portsystem. Implantation in Vollnarkose oder Lokalanästhesie? Eine retrospektive Aufwandsanalyse

Implantation of venous access port systems can be performed in local or general anesthesia. In spite of the increasing rate of interventionally implanted systems, the surgical cut-down represents a safe alternative. Thus, the question arises whether--in context to the increasing health-economic pressure--open implantation in general anesthesia is still a feasible alternative to implantation in local anesthesia regarding OR efficiency and costs. In a retrospective analysis, 993 patients receiving a totally implantable venous access device between 2001 and 2007 were evaluated regarding OR utilization, turnover times, intraoperative data and costs. Implantations in local (LA) and general anesthesia (GA) were compared. GA was performed in 762 cases (76.6 %), LA was performed in 231 patients (23.3 %). Mean operation time was similar in both groups (LA 47.27 +/- 1.40 min vs. GA 45.41 +/- 0.75 min, p = 0.244). Patients receiving local anesthesia had a significantly shorter stay in the OR unit (LA 95.9 +/- 1.78 min vs. GA 105.92 +/- 0.92 min; p < 0.001). Specifically, the time from arrival in the operating room to surgical cut (LA 39.57 +/- 0.69 min vs. GA 50.46 +/- 0.52 min; p < 0.001) was shorter in the LA group. Personnel and material costs were significantly lower in the LA group compared with the GA group (LA: 400.72 +/- 8.25 euro vs. GA: 482.86 +/- 6.23 euro; p < 0.001) Blood loss as well as duration and dose of radiation were similar in both groups. Our study shows that implantation of totally implantable venous access port systems in local anesthesia is superior in comparison to the implantation under general anesthesia regarding procedural times in the OR unit and costs. With the same operation duration, but less personnel and material expenditure, implantation in local anesthesia offers a potential economic advantage by permitting faster changing times. Implantation in GA only should be performed at a special request by the patient or in difficult venous conditions.

Patients' attitudes to totally implantable venous access port systems for gynecological or breast malignancies

Aims The aim of this study was to analyze patients’ port-related quality of life. Patients and methods 260 consecutive patients with gynecological or breast malignancies were asked to take part in a questionnaire-based survey including 26 questions, and 232 women agreed to participate in the study. The questionnaire inquired about port-related aspects of everyday life and the use of a central venous access port device for chemotherapy and supportive cancer care. Multivariate analysis was used to identify parameters associated with satisfaction and dissatisfaction in relation to the port. Results Most of the women were very satisfied with the use of a port to provide venous access for chemotherapy and supportive cancer care. Faster hospital procedures, good cosmetic results, and the ability to cope with the social environment had a significant influence on the degree of satisfaction. Fear of port punctures, inconvenient heparinization of the port, and fear of complications were found to be negative variables associated with the method. Conclusions Port catheters are well accepted by patients for chemotherapy and supportive cancer care. Generally ports should be rapidly removed after the end of antineoplastic treatment in order to improve patients’ satisfaction with the procedure.

Totally implantable venous access port systems for patients receiving chemotherapy for gynaecological or breast malignancies: A prospective clinical trial examining the safety, efficacy and impact on quality of life

Totally implantable venous access port systems for patients receiving chemotherapy for gynaecological or breast malignancies: A prospective clinical trial examining the safety, efficacy and impact on quality of life