Implantable Venous Port Research Articles

Central venous port implantation with cephalic vein cut-down method

Background: This study aims to evaluate the surgical results of central venous port implantation using cephalic ‘cut-down’ method. Methods: B etween M ay 2 009 a nd M ay 2 010, 2 0 o f 2 3 patients (13 females, 7 males, mean age 45.5 years; range 31 to 75 years) with peripheral vein disease due to several reasons underwent venous port implantation using cephalic ‘cut-down’ method in Gazi University, Faculty of Medicine, Department of Thoracic Surgery. Surgical technique, operation time, underlying pathologies, perioperative complications and results of the procedure were analyzed. Results: The mean operation time was 38 minutes (range, 25-50 min) in 20 patients undergoing venous port implantation through cephalic ‘cut-down’ method. Breast cancer was the leading underlying pathology. Venous port implantation using cephalic ‘cut-down’ method failed in three patients due to several reasons. Venous ports were implanted percutaneously in these patients. There was no intraoperative complication in any patients. Conclusion: Venous port implantation with cephalic ‘cutdown’ method is easily practicable and very reliable procedure without any major disadvantage. Very low incidence of life-threatening complications including pneumothorax, hemothorax and great vessel injury is the most important advantage of this procedure.

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.

Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients

The purpose of this study is to characterize the risk factors of bloodstream infection (BSI) associated with the use of permanent implantable venous ports (Port-A) in solid cancer patients. Solid cancer patients implanted with a Port-A were prospectively observed for the occurrence of Port-A-associated BSI (PABSI), defined as BSI without other identifiable infection foci. A PABSI risk score was developed using the Cox proportional hazards model. A total of 415 patients were registered; 88 PABSI episodes occurred in 58 patients (incidence1.05 per 1000 catheter-days). All but one patient had stage IV cancer. Independent predictors of PABSI occurrence included neutropenia, total parenteral nutrition (TPN), chronic steroid use, invasive procedures, postoperative antibiotics, and preoperative antibiotics. A PABSI risk score with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%) was defined for stage IV cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, -0.970; postoperative antibiotics, +0.959; and invasive procedures, +1.098. The median PABSI-free survival was 4.47 months for patients with scores ≥ 0 but not reached for patients with scores <0 (P < 0.0001). The PABSI risk score can assist in identifying high-risk solid cancer patients and may assist in designing future preventive strategies.

Successful Percutaneous Transcatheter Retrieval of a Migrated Implantable Venous Port in a Patient Who Presented with Intermittent Palpitation

Correspondence to Byoung Kwon Lee, M.D., Ph.D. Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-270, Korea Tel: +82-2-2019-3307, Fax: +82-2-3463-3882, E-mail: cardiobk@yuhs.ac Copyrightc 2013 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 이동된 중심정맥도관으로 인한 간헐적 심계항진 환자의 경피적 도관 제거

Pinch-off syndrome

Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.

Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devices approved for high-pressure injections

To evaluate the technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) approved for high-pressure injections, and to analyse their value for arterial phase CT scans. Retrospectively, we identified 204 patients who underwent TIVPP implantation in the forearm (n=152) or chest (n=52) between November 2009 and May 2011. Implantation via an upper arm (forearm port, FP) or subclavian vein (chest port, CP) was performed under sonographic and fluoroscopic guidance. Complications were evaluated following the standards of the Society of Interventional Radiology. Power injections via TIVPPs were analysed, focusing on adequate functioning and catheter's tip location after injection. Feasibility of automatic bolus triggering, peak injection pressure and arterial phase aortic enhancement were evaluated and compared with 50 patients who had had power injections via classic peripheral cannulas. Technical success was 100%. Procedure-related complications were not observed. Catheter-related thrombosis was diagnosed in 15 of 152 FPs (9.9%, 0.02/100 catheter days) and in 1 of 52 CPs (1.9%, 0.002/100 catheter days) (p<0.05). Infectious complications were diagnosed in 9 of 152 FPs (5.9%, 0.014/100 catheter days) and in 2 of 52 CPs (3.8%, 0.003/100 catheter days) (p>0.05). Arterial bolus triggering succeeded in all attempts; the mean injection pressure was 213.8 psi. Aortic enhancement did not significantly differ between injections via cannulas and TIVPPs (p>0.05). TIVPPs can be implanted with high technical success rates, and are associated with low rates of complications if implanted with sonographic and fluoroscopic guidance. Power injections via TIVPPs are safe and result in satisfying arterial contrast. Conventional ports should be replaced by TIVPPs.

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.

Abstract 2656: Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients

Abstract Background There is no literature for stratification of permanent implantable venous ports (Port-A) related bloodstream infection (BSI) in solid cancer patients. We conduct this study to characterize the risk factors of BSI associated with the use of Port-A (PABSI) in solid cancer patients. Methods The study is done in a teaching hospital in Taiwan. Solid cancer patients who were implanted with a Port-A for systemic anti-cancer therapies were prospectively followed for the occurrence of PABSI, defined as BSI without other identifiable infection foci. Patients with PABSI during the follow-up period constitute the case cohort (N = 58) and 174 patients were randomly selected from those without BSI as the control cohort. PABSI risk score was developed by Cox proportional hazards model. Results 416 patients were registered (Table 1). Eighty-eight PABSI episodes occurred in 58 patients, with an incidence of 1.05 per 1000 catheter-days. All but one patient had stage 4 cancer. Independent predictors of PABSI occurrence included neutropenia (HR = 3.86, 95% CI = 1.75-8.50), total parental nutrition (TPN) (HR = 3.51, 95% CI = 1.86-6.63), chronic steroid use (HR = 7.01, 95% CI = 2.78-17.65), invasive procedure (HR = 3.00, 95% CI = 1.29-6.98), postoperative antibiotics (HR = 2.61, 95% CI = 1.43-4.75), and preoperative antibiotics (HR = 0.38, 95% CI = 0.17-0.83). A PABSI risk score, with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%), was defined for stage 4 cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, –0.970; postoperative antibiotics, +0.959; and invasive procedure, +1.098. The median PABSI-free survival was 4.47 months for patients with score β0 but not reached for patients with score &amp;lt; 0 (p &amp;lt; 0.0001). Conclusions The PABSI risk score can help define high-risk groups in solid cancer patients and may help design future preventive strategies. Presence of any risk factor would render patients as high risk. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2656. doi:1538-7445.AM2012-2656

Common and Uncommon Complications of Totally Implantable Central Venous Ports: A Pictorial Essay

The purpose of this study is to present the characteristic radiologic features of common and uncommon complications in totally implantable central venous ports. The authors reviewed 138 implantations of central venous ports in oncologic patients during an 18-month period and present the characteristic imaging features of the complications detected. All chest ports were placed via the internal jugular vein using both fluoroscopic and ultrasound guidance. The technical success rate was 99.3% (137/138). All catheter or port-related complications were retrospectively assessed. Sixteen complications were detected during the follow-up period, and catheter removal was required in 10 patients. Image-guided central venous port catheter implantation is a very safe procedure with a low rate of complications. The typical imaging features of common and uncommon complications are very helpful in establishing the correct diagnosis and thus tailoring the appropriate therapy.

Implantable Venous Access Ports for Chemotherapy in Lung Cancer Patients: Comparison of the Femoral and Subclavian Vein Approaches without Guidance

Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous access ports without guidance in lung cancer patients. Methods: We conducted a retrospective review of total 163 lung cancer patients who underwent implantations of a central venous access port for chemotherapy. 95 patients received the ports by the femoral vein blind-puncture technique and 68patients had the port implanted via the subclavian vein blind-puncture technique. The initial success rate of port implantation and the frequency of occurrence of complications were calculated. Results: The primary success rate of venous port implantation was 93.7% for femoral approach and 88.2% for the subclavian approach respectively (p < 0.05). Intraoperative complications developed in two patients (2.1%) in the femoral approach group and in five patients (7.4%) in the subclavian approach group. Although a higher intraoperative complication ratio for the subclavian approach was encountered compared to that for the femoral vein approach, there was no statistically significant difference (p = 0.103). Nor was there any statistically significant difference in terms of the occurrence of late complications. Conclusions: Venous access port implantation via the femoral vein approach is safe, and its success rate is very high, with the equal complication rates comparable to the subclavian approach. This approach avoids many of the intraoperative complications. Thus, the femoral vein approach for implanting a venous access port in lung cancer patients should be considered a valid, and safe technique.

癌治療における皮下埋め込み型中心静脈カテーテル用ポート留置症例の検討

癌治療における皮下埋め込み型中心静脈カテーテル用ポート留置症例の検討

Central venous port implantations via the cephalic vein applying an intravasal electrographic control of the catheter tip position: a single-center experience of 316 cases

The aim of this study was the analysis of the feasibility and complication rate of central venous port implantation with the surgical cut-down technique applying an intravasal electrographic control of the catheter tip position performed by urologists. In the time from December 1999 to November 2010, implantation of 324 subcutaneously implanted venous port systems (NuPort-System) has been performed in 316 patients, 221 men (mean age 59.5years, range 11-87years) and 95 women (mean age 57.6years, range 7-85years). Two hundred and fifty-nine (79.9%) port systems were placed under electrographic control of the catheter tip position. Duration of procedure, long-term device function, and complications such as infections, occlusions, dislocations, and thrombosis were all retrospectively measured and recorded until removal of the device, patient's death or the last known recorded documentation. In total, 359 devices have been used in 348 surgical procedures, 324 implantations (90.25%), and 35 explantations (9.75%). Port systems were implanted using the cephalic vein in 275 patients (84.9%), and in 49 (15.1%), the subclavian vein was used for insertion of the catheter. Mean surgical implantation time was 38.8min (15-85min). The median follow-up was 490.6days (range 2-2,568); 159,764 catheter days (mean, 234days, range 2-2,604) were documented. Of 35 explanted devices, the explantation was necessary due to complications in 28 cases (8.6%) with infection n=6 (1.9%, 0.037 per 1,000 catheter days), occlusion n=8 (2.5%, 0.050 per 1,000 catheter days), dislocation n=7 (2.2%, 0.044 per 1,000 catheter days), deep vein thrombosis of the upper extremity n=6 (1.9%, 0.037 per 1,000 catheter days), and clotting n=1 (0.3%, 0.006 per 1,000 catheter days). Premature catheter removal (<30d post-operatively) was required in 6 patients (1.9%, 0.037 per 1,000 catheter days) due to complications: 3 catheter dislocations/malfunctions (0.9%, 0.019 per 1,000 catheter days), one port related infection, one pocket port infection, and one deep vein thrombosis of the upper extremity (0.3%, 0.006 per 1,000 catheter days). The intra-atrial ECG techniques to judge correct tip positioning for central venous port implantations are simple and economical. The exact position can be determined intraoperatively. It can justify a delayed postoperative chest X-ray to confirm CVC line tip placement. Nevertheless, the procedure and handling of the device later on has to be performed with care in order to avoid infections and technical problems.

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.

Erratum to: Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis

Erratum to: Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis

Reply to Letter to the Editor re: “Radiologically guided placements of totally implantable central venous port: observations about right internal jugular access”

Dear Editor, We thank the correspondents for their comments. Our low periprocedural complication rate is related to our very standardized implantation technique. We start with an ultrasound examination before the implantation to verify the appropriate venous access and to rule out venous thrombosis. All central venous punctures were performed under ultrasound guidance and the guide wire and catheter placement were fluoroscopically controlled. Our early and late complication rate did not differ from other studies. A final chest X-ray should be always performed to exclude a pneumothorax or a large mediastinal haematoma. The final results were always documented by x-ray in all our patients. For the Seldinger technique we used a 18 G—singlewall entry needle for all port implantations. A micropuncture needle set is recommended for residents starting with the ultrasound guided puncture technique of the internal jugular vein (IJV) or for partially thrombosed central veins. The IJV typically presents itself with a relatively large lumen. In that case the success rate is very high in the hands of an experienced interventional radiologist.

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.

Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis

This study was designed to compare central venous ports (CVP) from two different routes of venous access-the subclavian vein and arm vein-in terms of safety for patients with head and neck cancer (HNC). Patients with HNC who underwent image-guided implantations of CVPs were retrospectively evaluated. All CVPs were implanted under local anesthesia. Primary outcome measurements were rates and types of adverse events (AEs). Secondary outcomes included technical success and rate and reason of CVP removal. A total of 162 patients (subclavian port group, 47; arm port group, 115) were included in this study. Technical success was achieved in all patients. The median follow-up period was 94 (range, 1-891) days. Two patients in the subclavian port group experienced periprocedural complications. Postprocedural AEs were observed in 8.5 and 22.6% of the subclavian port and arm port group patients, respectively (P = 0.044). Phlebitis and system occlusions were observed only in the arm port group. The rate of infection was not significantly different between the two groups. The CVP was removed in 34 and 39.1% of the subclavian port and arm port patients, respectively. Both subclavian and arm CVPs are feasible in patients with HNC. AEs were more frequent in the arm port group; thus, the arm port is not recommended as the first choice for patients with HNC. However, further experience is needed to improve the placement technique and the maintenance of CVPs and a prospective analysis is warranted.

Retained Catheter: A Rare Complication Associated with Totally Implantable Venous Ports

Totally implantable venous ports are the main access for chemotherapy. The complications associated with these devices occur most frequently over the course of their use. We report two cases of a complication that had only been described in patients with partially implantable catheters for hemodialysis: retention of a catheter fragment within a vessel during port removal. Both patients underwent adjuvant chemotherapy through the port and even after indication of catheter removal because at the end of treatment, they remained with the devices for long periods of time (7 and 8 yrs, respectively). Due to adherence of the catheters along their intravascular portions, complete removal was impossible. The catheters were sectioned and ligated close to the site where it entered the access vein. After 1 yr of follow-up, both patients were asymptomatic and imaging examinations showed the retained catheters. We believe that an implantable port should be removed after appropriate oncological follow-up.

Invisible Venous Ports from Medcomp

To the Editor, Totally implantable venous ports play a vital role in many oncology patients’ chemotherapy regimens and occupy a serious amount of the daily workload for interventional radiology staff worldwided [1–3]. So many manufacturers are releasing different types of venous ports with different reservoirs or catheter materials in different sizes. Medcomp (Harleysville, PA) recently introduced the Pro-Fuse CT-compatible plastic port and then released the subgroup of ‘‘Dignity’’ ports, which are shaped port reservoirs constructed of magnetic resonance imaging–compatible, lightweight engineering plastic that allows for power injection of contrast media B5 cc/s @ 300psi for contrast-enhanced CT imaging (online product brochure from Medcomp). Using a unique printing technique, the letters ‘‘CT’’ can be visualized on X-ray to provide recognition of the power injectable Pro-Fuse CT device (Fig. 1). From our stand point, CT mark may also be great help in determining whether if the port is actually turn upside down. On the other hand, the most important downside of the Dignity ports is the plastic reservoir, which raises the question of the long-term durability of these ports compared with ports having titanium reservoirs. We have been using this port in our patients for the last year, and so far we have never had a problem with leakage as a result of reservoir puncture due to repetitive needle access. However, we recently noted a visibility problem with the Dignity port despite the clear CT mark at the base in a few patients. In most of our patients, the Dignity port reservoir and CT mark can easily be seen even on low frame–rate fluoroscopy images, whereas in some patients the reservoir itself cannot be seen on X-ray even with single-shot films (Figs. 2A, B, 3A, B). In these few cases, one can easily appreciate the CT mark of the port reservoir, but not the reservoir itself, as well as the indwelling port catheter (Figs. 3A, 3B). Because the port catheters, the connection material, and the syringe itself can be seen prominently under X-ray, lack of visualization of the reservoir seems to be caused mainly by the reservoir material and irrelevant with regard to X-ray values, port position, or tissue thickness over the port pocket. The question at this point is whether or not there is a manufacturing defect on some Dignity ports. The question was referred to the manufacturer and they emphasized the fact that the Dignity Port design complies with the international standard ASTM F640-07 titled ‘Standard Test Method for Determining Radiopacity for Medical Use’. Although, the CT mark, as the primary radiopaque feature desired is well seen, they stated that they will work on the exact cause of visibility issue of the rest of the reservoir. Although this issue does not seem to be a major concern at the moment, it made us question the quality of the relevant port material. Moreover, it is important to share this information with the