Implantable Venous Access System Research Articles

Difficult removal of implantable venous access system: stepladder approach with wire stenting of a catheter—single-center experience

BackgroundPort-a-catheter insertion and removal are common procedures performed for children with chronic disease or cancer. Although its removal is usually straightforward, some difficulties during the procedure can be encountered. Several methods have been described in the literature to handle those cases where lines have become stuck.AimTo describe our simple technique in dealing with stuck port-a-catheters during removal. We will additionally report the incidence and factors associated with this complication.MethodsA retrospective chart review study was performed between January 2009 and December 2019. Of a collective 2040 ports that were removed during the research interval, cases of difficult port removal were collected and reviewed. In 42 cases, catheter removal difficulty is encountered, and a second incision at the venous access site is performed. Failure of this procedure in removing the stuck catheter is then followed by catheter stenting and removal over a guide wire.ResultsDifficult removal of port-a-catheters was experienced in 42 cases (2%). The mean age at removal for those cases was 6.6 years. Most of the port-a-cath removals were done after treatment completion (74%). Ports had been left in situ for a mean duration of 44 months. The stepladder technique with wire stenting of the catheter was successful in 37 cases (88%), while the rest were only partially removed (distal part). The retained part was extracted using an angiographic technique. No short- or long-term complications were encountered in any of those 42 patients.ConclusionsStepladder with wire stenting of catheters approach deals with difficult line removals. Our technique is, therefore, simple, feasible, and effective.Level of evidenceIV.

Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

BackgroundChildren with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts.ObjectiveTo investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents.Materials and methodsBetween April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal.ResultsPercutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur.ConclusionPeripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.

Implantable Venous Access System: Percutaneous approach at the Teaching Hospital of Point “G” in Bamako, Mali

Implantable Venous Access System: Percutaneous approach at the Teaching Hospital of Point “G” in Bamako, Mali

Innovative application of an implantable venous access system in the portal vein: technique, results and complications in three dogs

BackgroundVascular access port (VAP) systems are widely used in human medicine to provide long-term venous access. However, in veterinary medicine the use of VAP systems is not common practice and publications on their potential applications have been limited. A VAP system was used as part of an experimental study on liver regeneration and implanted in the canine portal vein to create direct access to the portal venous circulation of the liver. The aim of the present study is to describe the surgical technique, its use, and the complications of a VAP system in three research dogs.ResultsThe VAP system was successfully used for the intraoperative measurement of portal blood pressure, the administration of cell suspensions, and the collection of portal venous blood samples. Long-term complications consisted of dislocation of the VAP system in one dog (2 months after implantation) and thrombus formation at the catheter tip in two dogs (3 months after implantation). Both complications prevented further use of the VAP but had no adverse clinical implications.ConclusionsThis pilot study suggests that the VAP system is an effective and safe technique to obtain long term access to the portal venous system in dogs. However, complications with port detachment and thrombosis may limit long term use of VAPs in the portal system of dogs.

Accessing totally implantable venous access systems on the day of placement does not significantly increase the risk of infection.

Totally implantable venous access systems (ports) are commonly placed and have a low complication rate. The most common complication is infection, which can have very negative effects on patients resulting in hospitalization and/or treatment delay in the setting of neoplasm. While a number of variables have been studied in relation to diminishing infectious rates, one remaining question is the effect of accessing the port on day of placement, which is the aim of this retrospective study. After internal review board approval the electronic medical records of 2,006 patients who underwent port placement between 10/1/2008 and 9/30/2013 were reviewed. Of these patients 628 were excluded as they did not have complete placement and removal data available, leaving 1378 patients in our cohort. There was a significantly longer number of infection-free catheter days in the out-patient cohort as compared to the in-patient cohort (p = 0.027). In-patients mean day after placement when the port was first accessed (DAP) (0.5) was statistically earlier (closer to placement) than the out-patients DAP (7.2) (p<0.0001). However, the increased likelihood of infection could not be explained by DAP (p = 0.2029) even when controlling for in-patient and out-patient status (p = 0.97). Accessing the port on the day of placement does not significantly contribute to an increased likelihood of infection. This study seems to indicate that placing a port on the first day of outpatient therapy likely optimally balances respect for patient time with infection control.

Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects.

IntroductionTotally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization.AimTo present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the procedural aspects with a series of detailed angiographies.Material and methodsBetween January 2003 and December 2012 there were 14 (~0.025%) successful retrievals in 13 patients (44 ±16 years, 15% females) of embolized fragments of TIVAS (n = 10) or CVC (n = 1) or of dislodged guide-wires (n = 2) or knotted SG (n = 1).ResultsForeign bodies with the forward end located in the right ventricle (RV), as well as those found in the pulmonary artery (PA), often required repositioning with a pigtail catheter as compared to those catheter fragments which were located in the right atrium (RA) and/or great vein and possessed an accessible free end allowing their direct ensnarement with the loop snare (57.0% (4/7) vs. 66.7% (2/3) vs. 0.0% (0/3); p = 0.074 respectively). Procedure duration was 2–3 times longer among catheters retrieved from the PA than among those with the forward edge located in the RV or RA (30 (18–68) vs. 13.5 (11–37) vs. 8 min (8–13); p = 0.054 respectively). The SG catheter knotted in the vena cava superior (VCS) was encircled with the loop snare introduced transfemorally, subsequently cut at its skin entrance and then pulled down inside the 14 Fr vascular sheath.ConclusionsBy using the pigtail catheter and the loop snare, it is feasible to retrieve centrally embolized fragments or knotted central venous access devices.

Myocardial iron quantification using T2* and native T1mapping - a 250 patient study

Background The management of iron overload has been transformed by the use of T2* as a surrogate marker of cardiac iron loading. The presence of iron however not only changes T2*, but also T2 and T1. Recent advances make T1 mapping a possible complementary technique to T2*. Preliminary data are encouraging, but the relative advantages and disadvantages and optimal mathematical model for the relationship between T1 and T2* remain unknown. Methods This was a single centre prospective study of 250 patients (age 37 ± 13 years) referred with potential iron overload for T2* assessment, with 50 healthy volunteers (age 44 ± 11 years) as a reference comparison group. Each participant underwent short axis septal T2* (standard Siemens sequence using 8 different TE) at 1.5T and in addition myocardial T1 mapping (ShMOLLI sequence). Results Image quality 27% of patients required more than one T2* acquisition to obtain optimal images for analysis compared with 12% for T1 mapping. ShMOLLI images were uninterpretable in 2 patients due to the presence of an MRI conditional pacemaker, and the positioning of a PORT-A-CATH implantable venous access system. It is known that some patients were unable to complete T2* sequences (21 heart beat scan), but these were not captured by the inclusion criteria of the study. There was an exponential relationship between T1 and T2* across all patients and healthy volunteers (R 2 =0.71, p<0.001, figure 1). This was composed of a tight curvefit below T2* of 20ms (R 2 =0.83, p<0.001, figure 2A) and almost no correlation above 20ms (R 2 =0.07, figure 2B). The lower limit of normal (2SD below the mean) T1 from the healthy volunteers was 895ms. In patients with T2* above 20ms, T1 was normal in 55%, high in 1% and low in 44%. The derived equivalent T1 cutpoints for published T2* cutoffs for mild, moderate and severe iron were 20ms (846ms); 14ms (705ms) and 10ms (636ms). If T1 is accurate for iron, then using the lower limit of normal for T1 (895ms) would suggest that the normal limit for T2* would be 29ms. However, of the 50 healthy volunteers, 8 (16%) had T2*s lower than this, possibly due to relatively lower precision of T2* measurements.

Anticoagulant therapy for venous thromboembolism detected by Doppler ultrasound in patients with metastatic colorectal cancer receiving bevacizumab.

BackgroundDoppler ultrasound imaging is useful for management of venous thromboembolism associated with a subclavicular implantable central venous access system in patients receiving bevacizumab (Bev). We investigated the efficacy and safety of our anticoagulant regimen based on Doppler findings.MethodsPatients aged ≤75 years with metastatic colorectal cancer, no history of thromboembolism, and no prior use of Bev received chemotherapy plus Bev. Doppler ultrasound imaging of the deep venous system to detect thrombosis was performed after the first course of Bev and repeated after the third course in patients with asymptomatic thrombosis. Indications for anticoagulant therapy in patients with asymptomatic thrombosis were as follows: enlarging thrombus (E), thrombus >40 mm in diameter (S), thrombus involving the superior vena cava (C), and decreased blood flow (V).ResultsAmong 79 patients enrolled in this study, asymptomatic thrombosis was detected in 56 patients (70.9%) by Doppler ultrasound imaging after the first course of Bev and there was no thrombus in 23 patients (29.1%). Of these 56 patients, 11 (19.6%) received anticoagulant therapy with warfarin, including eight after the first course and three after follow-up imaging. S + V was observed in four of 11 patients (36.4%), as well as V in two (18.2%), S + V + C in one (9.1%), E + S + V in one (9.1%), E + C in one (9.1%), E in one (9.1%), and C in one (9.1%). All patients resumed chemotherapy, including seven who resumed Bev. Improvement or stabilization of thrombi was achieved in ten patients (90.9%). Only one patient had symptomatic thromboembolism. Mild bleeding due to anticoagulant therapy occurred in six patients (54.5%), but there were no treatment-related severe adverse events or deaths. Severe thromboembolism was not observed in the other 68 patients.ConclusionOur anticoagulant protocol for asymptomatic thrombosis detected by Doppler ultrasound imaging was effective at preventing severe thromboembolism during continued treatment with Bev.

Prone positioning induced tachyarrhythmias from an implantable central venous access device

SummaryWe present a case report of position‐dependent tachyarrhythmia following prone positioning for surgery in a 42‐yr‐old female with a left‐sided totally implantable venous access system (TIVAS) in‐situ. TIVASs are becoming increasingly popular for cancer patients receiving chemotherapy and who may present for either elective or emergency surgery.

P2–046 - Thrombosis by Totally Implantable Central Venous Access System in the Upper ARM: 3FR Catheter Cases

Background: We have implanted the totally implantable central venous access system in the upper arm to the patients who received chemotherapy or total parenteral nutrition. We used 5Fr regular type and 3Fr tapering type, Anthron P-U Catheter(TORAY). In these cases, thrombosis sometimes occurred.

Eustachian valve endocarditis: Rare case reports and review of literature

Eustachian valve endocarditis (EVE) is a distinctly rare and underdiagnosed entity. We report 2 new cases caused by vancomycin resistant Staphylococcus aureus and Staphylococcus hominis diagnosed on transesophageal echocardiography (TEE). Although, 63% of Eustachian valve endocarditis is caused by Staphylococcus aureus, we report the first case of vancomycin resistant Staphylococcus aureus and first case related to implantable venous access systems. EVE is now seen more commonly in elderly population with diverse microbial cultures and antibiotic sensitivities. TTE is the first modality for investigation of EVE, however a negative TTE does not preclude the diagnosis, as only 88% of cases were diagnosed on TEE.

The mechanisms of failure of totally implantable central venous access system: Analysis of 73 cases with fracture of catheter

Background Totally implantable access ports are often used for the administration of chemotherapy or prolonged intravenous infusions in patients with cancer. The technique has been well described. However, some complications would happen. The pinch-off-syndrome is one of these complications. We report another presentation of pinch-off-syndrome and how to prevent. Methods From January 2005 to December 2007, 73 patients of catheter fracture were collected. The duration of Port-A implantation ranged from January 2003 to October 2007. During this period, 3358 port-catheters were implanted. There were three brands of Port-A implanted included 46% BardPort™ (Bard, Salt Lake City, UT, USA), 42% A Port (Arrow international, Reading, PA, USA) and 12% PORT-A CATH (Deltec, St. Paul, MN, USA). Results The most common clinical presentation was difficulty in injection in 32 cases (43.8%). The incidence of brand C was far lower than brand A and B. The most common site of fracture was at the proximal part (anastomosis between injection port and catheter) in 68 cases (93.2%). The incidence of fracture of Port-A was 6 in 738 (0.81%) in cut-down method; 67 in 2620 (2.56%) in percutaneous subclavian method. Most of thecases (34%) were no more than six months. Conclusion The most frequent location of fracture Port-A was in proximal part – anastomosis between injection port and catheter. The cause of easily fracture may be associated with pinch-off-syndrome and design of Port-A. This kind of fracture could be prevented by cut-down method and fixed one stitch in proximal part.

Scheme for Creating a Subcutaneous Tunnel to Place an Indwelling Implantable Central Venous Access System in the Forearm

We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.

Venous access devices—The questionnaire regarding estimation of patient satisfaction

20723 Background: Implantable venous access systems with a long-term usage called port catheters are widely used in patients with cancer. They facilitate work on chemotherapy departments, but first...

Implantable catheter systems. Experiences with 1000 patients with central venous ports

To assess retrospectively duration of functioning and rate of complications of a totally implantable venous access system used for long-term chemotherapy. Between 1985 and 1993, a central venous access system (Port-a-Cath) had been implanted subcutaneously for long-term chemotherapy in 1000 patients (479 males, 521 females; mean age 49 [15-86] years). Follow-up observations lasted until the end of the chemotherapy or the removal of the system. Mean time of functioning of the catheter system was 284 (2-1563) days. The complication rate was 12.8%: catheter infection in 4.9% and catheter thrombosis in 3.2%. A further 4.7% of patients had less common complications (malfunction, catheter dislocation, skin necrosis, catheter break or disconnection, pneumothorax). A total of 119 (11.9%) systems had to be removed because of complications. The rates of infection and of other complications were significantly lower in patients with solid tumours (2 and 4%, respectively) than in those with haematological disease (6 and 8%) (P < 0.05 for each). Totally implantable venous access systems are suitable for long-term chemotherapy and cause few complications.

Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: Experience in a single hospital

Objective To investigate the clinical presentation of dislodged totally implantable central venous access system (central venous port-catheter) fragments and the efficacy and safety of percutaneous retrieval of them in our hospital. Materials and methods Ninety-two cancer patients, mean age of 53.8 years old with 51.1% male, were enrolled from January 2005 to March 2007. They were referred to our catheterization laboratory for retrieval of fractured central venous port-catheter in our hospital. All patients were followed in the outpatient department for at least 1 month after surgical insertion. The characteristics of disrupted central venous port-catheter were recorded. The procedure-related clinical condition was evaluated. Results The most common presentation of central venous port-catheter dislodgement is irrigation resistance to infusion (51/92). The most common location of fractured fragments is between superior vena cava and right atrium (i.e. proximal end remained in superior vena cava and distal end in right atrium) (22/92). The most common fracture site of the catheter is at the anastomosis between injection port and catheter (77/92). The retrieval set used mostly is loop snare. The success rate of the percutaneous retrieval of dislodged fragment was 97.8% and the complication rate was 3.3% only. Conclusion The faulty connection between catheter and injection port contributes mainly to dislodgement of central venous port-catheter. Percutaneous retrieval of dislodged catheter is a highly successful, safe and efficient method.

Protocol for the implantation of a venous access device (Port-A-Cath System). The complications and solutions found in 560 cases

The cannulation of suitable peripheral veins may be a very painful experience. Implantable venous access systems have to some degree relieved this problem and help to provide an improvement in terms of quality of life. We have evaluated 560 patients during a follow up period of two years. A low overall complication percentage of 7.32% was seen when using the venous access device. Complications and treatments were: pneumothorax; portal rotation or infection; catheter infection; embolism and migration; extravasation; partial or total obstruction of the device; rupture of the catheter or the membrane. There is no other system that allows repeated venous access on such a long term basis. Placing the devices completely under the skin allows the patient to conduct a normal life style, and its maintenance does not need any special care, with the exception of the monthly heparinised serum infusion. The preferred option is to insert the catheter through the cephalic vein in the delto pectoral groove.

Fully implantable venous access systems.

Abstract Central access systems are a considerable step forward in the treatment of patients with cancer. Experience with totally implantable vascular access systems is reported. Since 1986, 185 reservoir pumps have been implanted. Access was by percutaneous cannulation of the subclavian vein in 130 cases (70 per cent) and surgical exposure of the external jugular vein in 40 (22 per cent); other sites of insertion were used in 15 cases (8 per cent). The mean duration of use of the reservoirs was 276 (range 1–632) days (total 51 150 catheter-days). The mean number of injections was 390 (range 2–670). The total number of complications, mostly mechanical, was 25 (0.5 per 1000 catheter-days). Fully implantable venous access systems are safe and reliable, and their complications can be prevented with adequate management.

Intrapulmonal dislocation of a totally implantable venous access device

BackgroundTotally implantable venous access devices are widely used for infusion of chemotherapy or parenteral nutrition. Device associated complications include technical operative problems, infections, paravasal infusions and catheter or punction chamber dislocation.Case presentationWe present the case of a 49-year-old patient with the rare complication of a intrapulmonal catheter dislocation of a totally implantable venous access system. Treosulfane for chemotherapy of metastatic breast cancer was infused via the catheter causing instant coughing and dyspnoea which lead to the diagnosis of catheter dislocation. The intrapulmonal part of the catheter was removed under thoracoscopic control without further complications.ConclusionIntrapulmonal catheter dislocation is a rare complication of a totally implantable venous access device which can not be avoided by any prophylactic measures. Therefore, the infusion system should be tested before each use and each new symptom, even when not obviously related to the catheter should be carefully documented and evaluated by expert physicians to avoid severe catheter-associated complications.

Evaluation of infectious complications of the implantable venous access system in a general oncologic population

Objectives: This study was conducted to evaluate the infectious morbidity associated with 2 common types of implantable port systems used in a cancer center in Taiwan. Methods: This study is retrospective and descriptive. Five hundred seventy-two patients who received implantable ports at the cancer center between January 1994 and December 1998 were included. The following 4 types of catheter-related infections were defined in this study: bloodstream, pocket, exit-site, and tunnel. Semiquantitative methods (rolling plate) were used for cultures of removed catheters. Results: The average duration for ports after placement in patients was 358 days (range, 1-1742 days), and the median duration was 242 days. The port-related infection rate was 5.6% in 586 ports and 0.15 per 1000 device-days. Our data indicate that when a port is in use, more frequent dressing changes of the needle exit site (every 3 days vs every 7 days) appear to have no significant impact on the catheter-related infection rate (5.2% vs 7.3%, P =.3). Our observation also indicates that if the catheter is used for total parenteral nutrition (TPN), the patient has a significantly increased chance of developing an infection from the Candida species (71% vs 8%, P =.005). Furthermore, the catheters associated with infections caused by the Candida species had a shorter catheter life (median, 44 days). Conclusions: Infection is the most common complication of venous port system use among cancer patients. According to our data, it is safe and cost-effective to change exit-site needles and transparent dressings every 7 days. It is clearly demonstrated by our study that patients with ports used for the administration of TPN had a significantly greater chance of developing infection from the Candida species. Further investigation is needed to compare the relative advantages of using ports versus other devices for the administration of TPN in cancer patients. (Am J Infect Control 2003;31:34-9.)