Port Catheter Research Articles

The Efficacy and Tolerability of Xeliri-Aflibercept Combination in A Metastatic Colorectal Cancer Patient After 5-Fu- Induced Symptomatic Bradycardia: A Case Report and A Brief Review of Literature

5-Fluorouracil (5-FU) and oral fluoropyrimidines are the backbone of colorectal cancer (CRC) chemotherapy, but these have many traditional and cardiotoxic side effects. Rechallenge is usually not recommended due to high mortality rates after ischemic symptoms and other cardiac side effects, but replacing these drugs with another fluropyrimidine, or bolus 5-FU, can be considered for some patients. Aflibercept combined with a FOLFIRI regimen is an accepted second-line therapy for metastatic colorectal cancer (mCRC) patients. XELIRI is another effective and feasible irinotecan and fluoropyrimidine combination, which is more toxic than the FOLFIRI regimen and is not routinely recommended. However, modified doses of XELIRI (mXELIRI) were found to be non-inferior to FOLFIRI. The efficacy of the mXELIRI and aflibercept combination has not investigated yet. We present a patient with infusional 5-FU-induced sinus bradycardia that we could not continue FOLFIRI-aflibercept due to this cardiac side effect. We replaced infusional 5-FU with reduced dosages of capecitabine and irinotecan as in the mXELIRI regimen and combined those with aflibercept. The patient tolerated this regimen well without cardiac or severe gastrointestinal side effects, and had 12 months of progression-free survival. Replacing capecitabine with infusional 5-FU might be an option for some patients experiencing 5-FU-related sinus bradycardia. However, oncologists should arrange the treatment plan according to the risk/benefit ratio. Aflibercept combined with mXELIRI may be an alternative regimen for patients who refuse port catheter placement or who are not able to receive infusional-5-FU due to adverse side effects.

Fracture and Migration of Port Catheter: Rare Complication

Fracture and Migration of Port Catheter: Rare Complication

Typical doses and typical values for fluoroscopic diagnostic and interventional procedures

To implement typical doses (TD) and typical values (TV) for fluoroscopic diagnostic and interventional procedures. A total of 3811 fluoroscopic procedures performed within 34 months on three devices were included in this retrospective study. Dose-, patient- and procedure-related information were extracted using the institutional dose management system (DMS). TD/TV were defined as median dose and calculated for the five most frequent procedures per device for dose area product (DAP), cumulative air kerma (CAK) and fluoroscopy time (FT). National diagnostic reference levels and other single facility studies were compared to our results. Additionally, the five procedures with the highest doses of each device were analysed. To evaluate the data coverage of the DMS compared to the picture archiving and communication system (PACS), procedure lists were extracted from the PACS and compared to the procedure information extracted from the DMS. TD/TV for 15 procedures were implemented. Among all devices, TD for DAP ranged between 0.6 Gycm2 for port catheter control (n = 64) and 145.9 Gycm2 for transarterial chemoembolisation (n = 84). TD for CAK ranged between 5 mGy for port catheter control and 1397 mGy for aneurysm treatment (n = 129) and TV for FT ranged between 0.3 min for upper cavography (n = 67) and 51.4 min for aneurysm treatment. TD for DAP and CAK were lower or within the range of other single facility studies. The five procedures with the highest median DAP per device were identified, 6 of 15 procedures were also found to be among the most frequent procedures. Data coverage of the DMS compared to the PACS ranged between 71% (device 2, stroke treatment) and 78% (device 1, lower limb angiography) for the most common procedure per device. Thus, in 22%–29% of cases dose data of the performed procedure was not transferred into the DMS. We implemented TD/TV for fluoroscopic diagnostic and interventional procedures which enable a comprehensive dose analysis and comparison with previously published values.

EVALUATION OF TOTAL INTRAVENOUS PORT CATHETER PROCEDURES WITH ULTRASONOGRAPHY

Aim: In our study, we aimed to evaluate our total intravenous port catheter procedures accompanied by ultrasonography. Methods: 107 patients over 18 years of age who underwent total intravenous port catheter with ultrasonography in order to perform oncological treatment between January 2014 and January 2019 were included in the study. The files of the patients included in the study were analyzed retrospectively and patient demographic information, malignancy type, accessed vein, duration of operation, and complication rates were evaluated. Patients under 18 years old and whose records could not be reached were excluded from the study. Results: 72 of the patients included in the study were male and 35 were female, and their mean age was 61.38 ± 11.26. While catheter was placed in the internal jugular vein in 105 of the patients who applied total intravenous port catheter, 2 of patients were placed in the subclavian vein. During the procedure, complications developed in 16 (14.95%) patients. These were arterial puncture and hematoma in 11 patients, pneumothorax in 3 patients, hemothorax in 1 patient, and hemopneumothorax in 1 patient. Conclusion: The use of ultrasonography in total intravenous port catheter lengthens the processing time and decreases the complication rate as the experience of use increases.

Sorafenib Plus Hepatic Arterial Infusion Chemotherapy versus Sorafenib for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis: A Randomized Trial

Background The prognosis of hepatocellular carcinoma (HCC) with major portal vein tumor thrombosis (PVTT) is dismal after standard treatment with sorafenib. Hepatic arterial infusion chemotherapy (HAIC) has been suggested for patients with HCC and major PVTT. Purpose To compare the efficacy and safety of sorafenib plus 3cir-OFF HAIC versus sorafenib alone for advanced HCC with major PVTT. Materials and Methods This phase II trial recruited systemic treatment-naïve patients with HCC and major PVTT (portal vein invasion grade Vp3 [first branch] and Vp4 [main trunk]) between June 2017 and November 2019. Patients were randomly assigned (1:1 ratio) to receive sorafenib (400 mg twice daily) plus 3cir-OFF HAIC (35 mg/m2 oxaliplatin [hours 0-2] followed by 600 mg/m2 5-fluorouracil [hours 2-24], days 1-3) with a standardized percutaneous port catheter system or sorafenib alone (400 mg twice daily) every 4 weeks. The primary end point was overall survival (OS). The secondary end points were objective response rate, progression-free survival (PFS), and safety. OS and PFS were assessed using the Kaplan-Meier method and log-rank test. Results The intent-to-treat population included 64 patients, with 32 in each group. The median OS was 16.3 months (95% CI: 0.0, 35.5) with sorafenib plus HAIC and 6.5 months (95% CI: 4.4, 8.6) with sorafenib alone (hazard ratio [HR] = 0.28; 95% CI: 0.15, 0.53; P < .001). A higher objective response rate (41% [n = 13] vs 3% [n = 1], P < .001) and a longer median PFS (9.0 months vs 2.5 months; HR = 0.26; 95% CI: 0.15, 0.47; P < .001) were observed in the sorafenib plus HAIC group. Grade 3 or 4 adverse events were more frequent in the sorafenib plus HAIC group, including diarrhea (n = 7 [22%] vs n = 5 [16%]), hand-foot syndrome (n = 6 [19%] vs n = 2 [6%]), and thrombocytopenia (n = 7 [22%] vs n = 0). Conclusion Sorafenib plus 3cir-OFF hepatic arterial infusion chemotherapy may be a promising treatment in patients with hepatocellular carcinoma and major portal vein tumor thrombosis because of the improved survival and an acceptable safety profile. Clinical trial registration no. NCT03009461 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Chung in this issue.

Percutaneous Retrieval of Dislodged Chemo Port Catheter With Inaccessible Tips by a Simplified Technique

Central venous port catheters (CVPCs) are commonly employed for long-term chemotherapy. One of the rare complications associated with CVPCs is catheter fracture and further embolization of the fragmented segment into the heart. The most common site of embolization is the superior vena cava-right atrium (RA) junction. However, infrequently, the catheter may embolize further distally into the right ventricle (RV) and beyond making the fragmented tips difficult to access directly with a snare. Here, we report a case wherein both the catheter tips were lodged in the RV cavity forming a loop in the RA. This necessitated the use of a modified technique to retrieve the fragment percutaneously.

Venous port catheter implantation for chemotherapy: Our experience in pediatric cases

Venous port catheter implantation for chemotherapy: Our experience in pediatric cases

Examining the Frequency of Port Catheter Complications and the Duration of Its Performance Associated with the Length of the Catheter in Patients with Port Placement

Background and Aim: Considering that the use of port catheters in long-term treatments and the quality of life (QoL) of patients with special conditions, including children, is particularly important, we decided to investigate the effect of the length of the port catheter on the duration of its performance in children. Materials and Methods: All the files of patients referred to the Surgery Department of Hazrat Masoumeh (PBUH) hospital, who underwent catheterization, were examined by observing the inclusion and exclusion criteria. The inclusion criteria included patients aged 14 years or younger with proven acute leukemia and the need for long-term intravenous access, survival of more than one week at the time of the patient’s entry into the study, and undergoing aggressive chemotherapy. The exclusion criteria included any contraindication to surgery or local anesthesia, sensitivity to lidocaine or anesthetics, evidence of any contraindication to using a subcutaneous catheter, clinical superior vena cava syndrome, and any mass or anatomical anomaly. A pediatric surgeon performed all ports. In the last stage, all the information related to the research was extracted from the existing files of these patients and analyzed with SPSS software, version 22. Results: In this study, the infection rate was 4(3.3%), bacteremia rate 5(4.2%), and thrombosis 13(10.8%). No statistically significant relationship was observed between the frequency of catheter port complications (infection, bacteremia, and thrombosis) with the gender of the patients or the catheter length. Furthermore, it was found that with the increase in the length of the catheter port, the time of complications also increased, and this increase was statistically significant. Conclusion: Considering the complications of catheter port, the correct way to use and how to take care of the catheter during the treatment of patients should be optimally done.

Complications after Totally Implantable Venous Port Catheter Intervention in Cancer Patients

The mean age of the patients was 53.6 years, with the sample consisting of 304 (55.98%) females and 239 (44.02%) males. The first three cancer diagnoses were breast cancer (35.72%), colon cancer (31.67%), and stomach cancer (12.89%). In most patients (72.37%), the right subclavian vein was used as the intervention site. Complications occurred in 8.8% (48 patients) of the patients in the early (1.28%) or late periods (6.8%) after the procedure. Catheter-related infection was the most common complication, at 2.5%.

Outcomes of Port A Catheter Implantations in Cancer Patients: Experience in 102 Cases

Abstract Aim This study evaluates cancer patients undergoing port catheter implantation. Patients and methods The study was conducted among patients admitted to the cardiovascular department of Düzce State Hospital from June 2018 to July 2020. The inclusion criterion was the implantation of a vascular port for at during 2 years. One hundred and two patients were enrolled in the study. The most common acute outcomes such as pneumothorax, haemothorax, thoracic duct damage and cardiac tamponade and the demographic characteristics of all patients were recorded. Patients were evaluated for the late complications of port catheter, such as thrombosis, infection and kinking, catheter fracture and occlusion. Results Complications of port catheter occurred early (≤30 days) and delayed (&gt;30 days) at rates of up to 8% and 15%, respectively. The most common early and late complications were pneumothorax and non-functional port (occlusion, thrombosis, kinking), respectively. Conclusions Thrombosis is the most common cause of dysfunction in central port catheters used in the treatment of cancer patients. Routine radiological imaging can help in early detection of catheter-related complications.

Port catheters: Indications, complications and quality of life

Port catheters: Indications, complications and quality of life

Does catheter material affect functional performance of intravenous ports via the superior vena cava?

IntroductionThe catheter is the only intravascular portion of an implanted port and plays a crucial role in catheter related complications. Both polyurethane and silicone are biocompatible materials which are utilized for catheter manufacturing, but their correlation to complications remains controversial. The aim of this study was to try to analyze the relationship between catheter materials and complications.Materials and methodsA total of 3144 patients who underwent intravenous port implantation between March 2012 and December 2018 at Chang Gung Memorial Hospital, Linkou, Taiwan were recruited. Of these, 1226 patients received silicone catheter port implantation and 1679 received polyurethane catheter ports. Case matching was done prior to analysis and catheter related complications and cumulative complication incidence for each group were compared.ResultsIntergroup differences were identified in entry vessel (p = 0.0441), operation year (p < 0.0001), operation method (p = 0.0095), functional period (p < 0.0001), patient follow up status (p < 0.0001), operating time for vessel cutdown (p < 0.0001) and wire assisted approach (p = 0.0008). Stratified by specific entry vessel, no statistical difference was found in complication rate or incidence between the silicone and polyurethane groups. We further compared the cumulative complication incidence of the silicone and polyurethane groups, and also found no statistical difference (p = 0.4451).ConclusionAs long as external stress forces generated by surrounding structures and focused on potential weak points are avoided, both silicone and polyurethane materials provide sufficient structural stability to serve as reliable vascular access for patients.

Successful percutaneous transvenous removal of a fractured port catheter via novel technique: Balloon-supported retrieval.

The totally implantable venous access device (TIVAD) is widely used for drug access or infusion during cancer treatment (1). A central venous catheter can improve the quality of the patient’s life by administering chemotherapy agents and drugs. Sometimes, several complications associated with the use of these devices can be seen. Fracture of the catheter may be the most serious complications, which could lead to pulmonary embolism, arrhythmic events, endocarditis, and perforation of the myocardium; although it occurs in around 1% of the patients (2). About 90% of foreign materials can be extracted by percutaneous transcatheter removal technique, a minimally invasive approach (3). Forceps, basket, gooseneck snare, and triple loops snare were reported to retrieve the fractured catheter successfully (4). To the best of our knowledge, herein, we report the first case of successful percutaneous transvenous removal of a fractured chemotherapy port catheter with a novel technique, balloon-supported retrieval.

Venous Thromboembolism in Pediatric Cancer Patients with Central Venous Catheter-A Systematic Review and Meta-analysis.

Pediatric cancer patients hold an increased risk of venous thromboembolism (VTE) due to their cancer. Central venous catheters (CVCs) further increase the VTE risk. This systematic literature review elucidates the VTE incidence in pediatric cancer patients with CVC. MEDLINE and EMBASE were searched in August 2020 without time limits. We included studies reporting original data on patients ≤18 years with any CVC type and any cancer type, who were examined for VTE with ≥7 days follow-up. In total, 682 unique records were identified, whereof 189 studies were assessed in full text. Altogether, 25 studies were included, containing 2,318 pediatric cancer patients with CVC, of which 17% suffered VTE. Fifteen studies (n = 1,551) described CVC-related VTE and reported 11% CVC-related VTE. Concerning cancer type, 991 children suffered from acute lymphoblastic leukemia (ALL) and 616 from solid tumors. Meta-analysis revealed VTE incidence (95% confidence interval) of 21% (8-37) for ALL and 7% (0.1-17) for solid tumors. Additionally, 20% of children with tunneled or nontunneled CVC and 12% of children with implantable ports suffered VTE. In conclusion, pediatric cancer patients with CVC have substantial VTE risk. Children with ALL and CVC have higher VTE incidence than children with solid tumors and CVC. Implantable port catheter should be preferred over tunneled or nontunneled CVC to reduce VTE risk. Thrombophilia investigation does not seem relevant in pediatric cancer patients with CVC and VTE. To prevent VTE, intensified catheter care is recommended, especially in children with ALL.

Comparison of 2% Chlorhexidine Gluconate in 70% Alcohol and 10% Povidone-Iodine Used for Port Catheter Dressing Changes in Pediatric Hematology-Oncology Patients: A Prospective Observational Study.

Objective:This study aimed to compare the effectiveness of 2% chlorhexidine gluconate in 70% alcohol with that of 10% povidone-iodine, for dressing changes in pediatric hematology–­oncology patients with port catheters, in preventing catheter-related bloodstream infection (CRBSI). Methods:In this prospective, multicenter, observational, and cross-sectional study, 45 patients (25 patients for chlorhexidine, 20 patients for povidone-iodine) with port catheters were evaluated from January 2018 to May 2019. The sociodemographic, clinical, and port catheter-related variables were evaluated. The mean age of the patients was 6.28 ± 4.58 years, and 60% of patients were female.Results:Among the patients whose dressings were changed using 2% chlorhexidine gluconate in 70% alcohol, the mean number of dressing changes was 39.52 ± 29.7 and the rates of exit-site infection and CRBSI were 20% (2.37/1000 catheter-days) and 16% (1.90/1000 catheter-days), respectively. Among the patients whose dressings were changed using 10% povidone-iodine, the mean number of dressing changes was 48.0 ± 31.48 and the rates of exit-site infection and CRBSI were 15% (1.59/1000 catheter-days) and 10% (1.06/1000 catheter-days), respectively. None of the patients developed pocket infections. The rates of CRBSI and exit-site infections were not different between the 2 antiseptic solutions.Conclusion:This study found no differences between the effectiveness of 2% chlorhexidine in 70% alcohol and that of 10% povidone-iodine solution in preventing CRBSI. Therefore, both solutions can be used in dressing changes.

Catheter Port Reversal in Citrate Continuous Veno-Venous Hemofiltration

IntroductionKnowledge of effects of catheter port reversal (CathPR), when blood is withdrawn from the venous port and returned via the arterial port, often used in dysfunctional catheters in renal replacement therapy, is limited in the setting of citrate continuous veno-venous hemofiltration (CVVH).MethodsIn this open trial, post-filter ionized calcium (PfiCa), post-filter citrate concentration (PfCC), catheter recirculation, and solute clearance were measured before, during, and after 6 hours of CathPR, in well-functioning catheters. All other settings, including citrate settings, were left constant during the study.ResultsTwenty-three patients were included. Mean PfiCa before CathPR of 0.36 mmol/L (SD 0.06) decreased to 0.31 (0.04) after 2 hours (P = 0.002), 0.31 (0.04) (P = 0.002) at 4 hours, and 0.31 (0.04) at 6 hours (P = 0.001). Return to normal increased mean PfiCa to 0.34 (0.06) (P = 0.006). Mean PfCC rose from 592 mg/L (SD 164) before CathPR to 649 mg/L (190) after 2 hours (P = 0.045), to 696 mg/L (192) after 4 hours (P < 0.001), and to 657 mg/L (214) after 6 hours (P = 0.018). Return to normal decreased mean PfCC to 598 mg/L (184) (P = 0.024). Mean recirculation increased during CathPR (from 4.3% [0–8.7] before to 13.8% [9.7–22.2], P < 0.001). Urea, potassium, and creatinine clearances dropped significantly, but calcium clearance was unaffected.ConclusionCathPR caused a significant decrease in PfiCA and increase in PfCC. Calcium handling differs from other solutes because of increases caused in citrate concentration and subsequent effects on calcium chelation. In citrate CVVH, CathPR in dysfunctional catheters should be limited in time, with intensive follow-up. Trial registration: ClinicalTrials.gov: NCT024600416. Registered 9 November 2015.

Health Informatics Study of Related Complications Relating to Upper Arm Implantable Intravenous Infusion Port in Breast Cancer Patients

Objective: In order to explore the clinical application effect of the upper arm venous infusion port, analyze the prevention and treatment effect of catheter rupture of the upper arm venous infusion port, and conduct a series of studies on postoperative related complications, as well as analyze the prevention and treatment of catheter rupture of the upper arm venous infusion port effect using chest radiography and computed tomography. Methods: We collected clinical data of 98 patients implanted in the upper arm venous infusion port in the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine and Hangzhou Shulan Hospital from January to December 2017, divided the 98 patients into two groups, and gave 49 patients in group A Based on the patient’s basic intervention, 49 patients in group B were given prevention and treatment intervention of catheter rupture, and the intervention effects of the two groups were compared. Consult the nursing records during the hospitalization and maintenance period after the implantation of the upper arm vein infusion port, summarize the complications, analyze the causes, and discuss the formulation of feasible nursing countermea-sures. Results: 98 patients were followed up for 5-16 months, with a median follow-up time of 10 months. Within 2 weeks after implantation of the upper arm vein infusion port and during discharge maintenance, the incidence of complications was 24.49% (24/98), 8.16% (8/98), the difference in the incidence of complications between the two time periods was statistically significant (P &lt; 0.05). Among them, common complications include incision bleeding at the port body, poor healing of the incision, local swelling, obstruction of catheter withdrawal, extravasation of transfusion at the port body, catheter blockage, catheter displacement, and catheter-related thrombosis. There was a difference in the incidence of catheter rupture, catheter rupture time, and patient satisfaction after intervention between the two groups of intravenous implantation patients (P &lt; 0.05), which was statistically significant. Conclusions: Complications within 2 weeks after implantation of the upper arm venous infusion port are significantly higher than the maintenance period. Among them, infusion extravasation, catheter-related thrombosis, catheter blockage, and catheter displacement at the port body are serious complications that directly affect the use of the upper arm infusion port . The prevention and treatment of catheter rupture for patients who have used implanted intravenous infusion ports for a long time has significant effects, which can reduce the occurrence of catheter rupture and ensure the safety of patients’ lives and health.

Subcutaneous implantable pleural port catheter in the management of malignant pleural effusions in young patients with solid tumors: A new option in the armamentarium of symptomatic treatment.

The contribution of subcutaneous implantable pleural port catheter (SIPP) for malignant pleural effusions (MPE) management in young patients with cancer, in a palliative care setting is not well explored. This monocentric series analyzed 38 patients, median age 18years (range 3-25) with significant pleural effusion. SIPP were considered efficient for eight of 12 evaluable patients (67%) and allowed MPE outpatient management in five cases. SIPPs are safe and efficient device to manage MPE patients with solid tumors, in the palliative care setting. This original tool could help health care providers for thoracic symptom management in alternative to iterative pleural punctures.

ПРИМЕНЕНИЕ СИСТЕМ ПОСТОЯННОГО ВЕНОЗНОГО ДОСТУПА У ДЕТЕЙ С ГЕМОФИЛИЕЙ: ОПЫТ ОДНОГО ЦЕНТРА

To improve the results of treatment of severe hemophilia in children, the efficiency and safety of the use of venous catheter ports in patients of this group has been analyzed. The problem of optimizing vascular access in hemophilia, especially young patients, remains relevant, despite the emergence of drugs with a subcutaneous route of administration. In global clinical practice, implantable permanent venous access devices (IVAD) have been successfully used for a long time to initiate preventive therapy or to conduct immune tolerance therapy when detecting inhibitor to coagulation factor VIII as early as possible. In Russia, this experience is still local and not reflected in the literature. Materials and methods of research: a single-center retrospective uncontrolled non-randomized study was performed. In a total of 19 patients (100% boys) between the age of 1 and 8 years (median 2 years [1; 6]) have been installed 21 IVADs. The observation period ranged from 200 to 1,897 days, with a total number of 17,484 catheter days in the group. Results: a statistically significant decrease in the number of hemorrhages requiring treatment per year (p&lt;0,001) has been observed in the general group of patients following the implantation of IVAD and the optimum treatment. The incidence of infectious complications was 0,22 per 1000 catheter days with no other complications recorded. Conclusion: the results of the presented case report demonstrate that the use of a port-type IVAD to ensure adequate vascular access in young children with severe hemophilia with a high degree of safety significantly increases the effectiveness of substitution/hemostatic therapy.

Totally implanted chemotherapy port catheters: literature review and report of four cases.

ABSTRACTTotally implantable catheters tend to be the most popular choice because once installed they allow permanent access to a deep vein, which is gained by puncturing the port rather than a vein.In this article, we explain four cases of chemotherapy port complications: superior vena cava (SVC) syndrome in a metastatic colorectal cancer patient who presented with bilateral mastitis, snare technique for removal of migrated catheter line, carotid artery placement of a port in a 5-year-old child that was referred to our hospital from a pediatric center and adhesive port tip in the heart that finally we left the port in situ.In SVC syndrome, treatment should be guided by the severity of symptoms, etiology of the obstruction, prognosis of the patient and treatment goals. We propose timely removal of port-a-cath following completion of intended chemotherapeutic regimen.