Port Occlusion Research Articles

Impact of central venous port implantation method and access choice on outcomes.

Although the number of patients who need central venous ports for permanent vascular access is increasing, there is still no "gold standard" for the implantation technique. To identify the implantation technique that should be favored. Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated. Patients were assigned into two groups according to the access method. The first group comprised patients whose jugular veins were used, and the second group comprised patients whose subclavian veins were used. Groups were evaluated regarding age, sex, application side, primary diagnosis, active follow-up period in the hospital, chemotherapy agents administered, number of complications, and the Clavien-Dindo severity score. The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test. The χ 2 test was used to analyze the variables. There was no statistically significant difference between the groups regarding age, sex, side, number of chemotherapy drugs, and duration of port usage (P > 0.05). Only 2 patients in group 1 had complications, whereas in group 2 we observed 19 patients with complications (P < 0.05). No port occlusion was found in group 1, but the catheters of 4 patients were occluded in group 2. One port was infected in group 1 compared to three infected ports in group 2. Two port ruptures, two pneumothorax, one revision due to a mechanical problem, one tachyarrhythmia during implantation, and four suture line problems were also recorded in group 2 patients. We also showed that it would be sufficient to evaluate and wash ports once every 2 mo. Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.

Safety of immediate use of totally implantable venous access ports in adult patients with cancer: a retrospective single-center study.

Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications. Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients' clinical data was performed to investigate catheter days and complications of TIVAPs. Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10-457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054-1.414; P=0.008). This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.

Long-term Outcome of Peripherally Implanted Venous Access Ports in the Forearm in Female Cancer Patients.

The aim of this retrospective study was to analyze the long-term outcome of peripherally implanted venous access ports in the forearm at our institution in a female patient collective. Between June 2002 and May 2011, a total of 293 female patients with an underlying malignancy had 299 forearm ports implanted in our interventional radiology suite. The mean age of the cohort was 55 ± 12 years (range 26-81 years). The majority of women suffered from breast (59.5 %) or ovarian cancer (28.1 %). Complications were classified as infectious complications, thrombotic and nonthrombotic catheter dysfunction (dislocation of the catheter or port chamber, fracture with/without embolization or kinking of the catheter, port occlusion), and others. We analyzed a total of 90,276 catheter days in 248 port systems (47 patients were lost to follow-up). The mean device service interval was 364 days per catheter (range 8-2,132, median 223 days, CI 311-415, SD 404). Sixty-seven early (≤ 30 days from implantation) or late complications (>30 days) occurred during the observation period (0.74/1,000 catheter days). Common complications were port infection (0.18/1,000 days), thrombotic dysfunction (0.12/1,000 days), and skin dehiscence (0.12/1,000 days). Nonthrombotic dysfunction occurred in a total of 21 cases (0.23/1,000 days) and seemed to cumulate on the venous catheter entry site on the distal upper arm. Peripherally implanted venous access ports in the forearm are a safe alternative to chest or upper-arm ports in female oncology patients. Special attention should be paid to signs of skin dehiscence and nonthrombotic dysfunction, especially when used for long-term treatment.

Effect of port-care frequency on venous port catheter-related complications in cancer patients

Subcutaneous central venous port catheters (SCVPC) are of great importance in the treatment of patients with malignancies since they provide secure vascular access. Our aim was to assess the impact of long-term catheter care frequency on the frequency of port-related complications. Two hundred and seven patients who had not been on active chemotherapy through their SCVPC for at least 3 months were enrolled into the study. Those who received catheter care every 3 months or more frequently were assigned to the frequent care group, and the others to the infrequent care group. The patients were examined for port-related complications and thrombosis including port occlusion. Routinely in our clinic, catheter care was done by using 300 IU of heparin. According to the frequency of SCVPC care, 49 (23.7 %) patients were in the frequent care group and 158 (76.3 %) were in the infrequent care group. Median follow-up of all patients was 671 days (range 133-1712). Median frequency of port care in the frequent care group was 90 days (range 30-90), but 441.5 days in the infrequent care group (range 91-1630). None of the patients experienced port-related severe complications during the follow-up time. None of them presented with port occlusion. When the groups were analysed for thrombus (symptomatic and asymptomatic), there was no statistically significant difference (6.4 vs 13.8 %, p = 0.17). Those patients who had received more than first-line chemotherapy were found to have more thrombi than the patients who were treated with only one type of chemotherapy protocol (28.6 vs 10.2 %, p = 0.01), and the patients who had metastatic disease at the last control were found out to have thrombi more frequently than the non-metastatic patients (24.3 vs 9.3 %) (p = 0.01). In the present study, there was no difference in port-related severe complications between frequent and infrequent care groups during follow-up. However, the rate of thrombosis was slightly higher in the infrequent port care group.

Efficacy of Normal Saline Versus Heparinized Saline Solution for Locking Catheters of Totally Implantable Long-Term Central Vascular Access Devices in Adult Cancer Patients

Heparin solution is routinely used to maintain the patency of infusion devices. Literature supports the alternative use of normal saline solution for flushing and locking intravenous infusion devices especially for pediatric patients. There is uncertainty regarding safety and efficacy of this policy for intermittent locking of implanted ports. This study evaluates efficacy and safety of normal saline solution for intermittent locking procedures of implanted ports. This is a retrospective observational cohort study of 610 implanted ports receiving 2 different locking solutions conducted at the National Institute for Cancer Research, IST Genova, Italy, from January 2007 to August 2009. Group A (n = 297) received heparinized solution (10 mL/500 U heparin), whereas group B (n = 313), 10 mL normal saline. Primary endpoint was irreversible port occlusion. Minimum follow-up was 12 months. The role of age, type of tumor, disease stage, access site, access body side, catheter tip position, and concomitant use of parenteral nutrition and chemotherapy was evaluated in secondary aim. : Results fail to show statistically significant differences in implanted ports survival free from failure for occlusive events between the use of heparinized solution and that of normal saline for the maintenance of port patency, both in univariate (P = .9) and in multivariate analyses (P = .7). Normal saline solution seems to be as effective as heparinized solution for keeping patent implanted ports in adult cancer patients. Switching from heparinized solution to normal saline for catheter intermittent lock of ports seems a safe procedure.

Venous Port Implantation in Adult Patients: Retrospective Evaluation

In the cancer therapy, the role of central venous access device has been increased because of factors; such as accessing to vein frequently, having long term therapy, using of sclerosan agents, giving much fluid. A chemoport is a thin, soft, plastic tube surgically implanted into a vein in chest or arm. Portacath doesn't have a huge size and it can generate numerous advantages. All the same, portacaths have risks such as infection, thrombosis, mechanical failure, pneumothorax, arterial injury. A retrospective study was performed with analysis of records of 82 patients admitted to our clinics between December 2006 and November 2008 for permanent catheterisation via subclavian vein. The most frequent complication was occlusion of port (3.66%). Further complications were infection (2.43%), migration out of the blood vessel (1.22%), and catheter rupture (1.22%). As a result, made by people who experienced venous ports inserted, provided the opinion that a safe and comfortable method.

How frequently is subcutaneous central venous catheter care required to prevent luminal thrombosis?

e19587 Background: Subcutaneous central venous port cathaters (SCVPC) are of great importance in treatment of patients with malignancies since they provide secure vascular accesses. Our aim was to assess impact of long- term care on the frequency of endo-luminal thrombosis when they are not routinely used. Methods: Two hundred and seven patients who had not been on active chemotherapy through their SCVPC for at least 3 months were enrolled into the study. Those who received catheter care every 3 months or more frequently were assigned to the first group, and the others as the second group. The patients were physically examined for the thrombosis including port occlusion and signs of infection. Results: Median follow-up duration was 671 days (min:133, max:1712, IQR:625). Of all the patients, 49 (23.7%) were in the first group and 158 (76.3%) in the second group. Median maintenance frequency was 90 days (min:30, max:90) in the first group and 441.5 days (min:91, max:1630) in the second group. For both groups, port maintenance was done using 300 IU of unfractionated heparine. Neither lower doses of heparin nor less frequent port care did not led to port occlusion. The rate of symptomatic thrombus was 5% (10 patients), and asymptomatic was 9% (18 patients). Those patients who had received more than one lines of chemotherapy when compared to one line and those who had metastatic disease at the last control in comparison to nonmetastatic cases were found out to have thrombi more frequently (p = 0.04, p = 0.003, respectively). Thrombus was detected in 3 patients (6.4%) in the first group, and 25 patients (16.3%) in the second group (p:0.08). Conclusions: In the present study, we found out that there is no need for very frequent port care. Besides that, longer interval cares and lower doses of heparin may even be sufficient and safe since there was no important port occlusion problems and the rate of thrombosis were not statistically different between the groups. No significant financial relationships to disclose.

Factors Affecting the Completion of Intraperitoneal Chemotherapy in Women With Ovarian Cancer

The use of intraperitoneal (IP) chemotherapy as treatment for ovarian cancer has been demonstrated to result in improved survival. However, it is associated with significant toxicity, resulting in the early discontinuation of therapy in many cases. This report quantifies and analyzes the reasons why patients discontinue therapy before completion and discusses strategies for improvement. One hundred seventy-seven women with ovarian cancer who received IP chemotherapy for a 10-year period at a regional cancer center were followed, and demographic and treatment data were collected. SigmaStat (v2.0) was used to make statistical calculations regarding the data. One hundred seventy-seven subjects received 915 cycles of IP therapy. One hundred forty subjects received IP chemotherapy as initial treatment. Ninety-five (68%) of the 140 subjects completed 6 planned cycles. Thirty-seven subjects received IP for recurrent disease. Only 14 (38%) of the 37 subjects completed 6 cycles (P = 0.001). The most common reason for noncompletion of IP therapy was port occlusion (39/68 of the patients, 57%). Very few subjects refused treatment (9/68 of the patients, 13%). The rate of completion of therapy improved over time in this program (2001, 36%; 2009, 75%). The rate of completion of IP chemotherapy was higher in this institution than in other reports, including randomized multicenter trials. Port occlusion was the most common reason why IP chemotherapy was not completed. Subjective reasons for stopping therapy were rare. The establishment of a comprehensive, coordinated IP administration program is likely to result in improved completion rates. Completion rates within an institution improve with experience as well.

INCIDENCE OF TRIPLE LUMEN CATHETER AND PORT OCCLUSION UTILIZING NORMAL SALINE FLUSHES

PURPOSE: Catheter occlusion (inability to infuse or withdraw fluids) has been reported to occur in up to 25% of central venous catheters. Controversy exists regarding the type of flush solution which best prevents catheter occlusion, however, there is little data to support the use of heparin versus normal saline for these flushes. We attempted to identify the incidence of catheter and port occlusion with the use of saline, as opposed to heparin, flushes in our ICU.

A randomized prospective study of comparison of reservoir ports versus conventional vascular access in advanced-stage ovarian carcinoma cases treated with chemotherapy

Vascular access ports were developed to overcome many of the problems associated with limited peripheral access, combined with the need for frequent venipuncture, in oncology patients receiving long-term intensive therapy. In this study, we compared the effectivity and acceptability of vascular access port with conventional needle application together with complication rates in ovarian cancer patients. Advanced-stage ovarian carcinoma cases under chemotherapy treatment were equally randomized into two groups, implantable vascular access ports applied to one group (22 cases) and conventional vascular access applied to the other (38 cases) as a control group. Anteroposterior thoracic X-rays of implantable port-applied cases were taken before and after the application. Vortex reservoir ports (Horizon Medical Products, Inc., Manchester, GA) were used in the application to the subclavian vein. Classic peripheral venipuncture method (Medikit), Mediflon(trade mark) IV cannula with PTFE radiopaque catheter and injection valve, Eastern Medikit Ltd, Gurgaon, Haryana, India) was used in the control group. Vascular accesses of all cases were controlled just after the application, 12 h after the application, and during each drug or intravenous fluid application. Mean port insertion time was 26.3 min. Total port occlusion was observed in two of the port-applied cases (11.7%) and partial port occlusion was observed in five of the port-applied cases (29%). Heparin and saline combination was used in order to open the port tip, in five cases, two with total occlusion and three with partial occlusion. Infection was observed in only one case (5%) to whom appropriate therapy was given, and the port was taken out. Ports of two cases were also taken out because of skin dehiscence. No change in port tip position was observed in any of the cases. Total occlusion was observed in 16 of the 38 cases (42.1%) with conventional vascular access. In 12 cases (31.5%), a need arose to change the conventional vascular access. No vascular access was found in 13 of the 38 cases (34.2%). Application of reservoir ports especially to cases with advanced-stage carcinomas, under chemotherapeutic drug treatment, leads to minimal anxiety for the patient and his/her family and minimal risk of physical trauma to the patient with only one vascular access. Reservoir ports occlude or cause infection to a lesser extent than classic vascular access methods. Occlusion or infection rates of reservoir ports are statistically significant, lower than those of classic venipuncture.

A randomized prospective study of comparison of reservoir ports versus conventional vascular access in advanced-stage ovarian carcinoma cases treated with chemotherapy

Vascular access ports were developed to overcome many of the problems associated with limited peripheral access, combined with the need for frequent venipuncture, in oncology patients receiving long-term intensive therapy. In this study, we compared the effectivity and acceptability of vascular access port with conventional needle application together with complication rates in ovarian cancer patients. Advanced-stage ovarian carcinoma cases under chemotherapy treatment were equally randomized into two groups, implantable vascular access ports applied to one group (22 cases) and conventional vascular access applied to the other (38 cases) as a control group. Anteroposterior thoracic X-rays of implantable port-applied cases were taken before and after the application. Vortex® reservoir ports (Horizon Medical Products, Inc., Manchester, GA) were used in the application to the subclavian vein. Classic peripheral venipuncture method (Medikit®, Mediflon™IV cannula with PTFE radiopaque catheter and injection valve, Eastern Medikit Ltd, Gurgaon, Haryana, India) was used in the control group. Vascular accesses of all cases were controlled just after the application, 12 h after the application, and during each drug or intravenous fluid application. Mean port insertion time was 26.3 min. Total port occlusion was observed in two of the port-applied cases (11.7%) and partial port occlusion was observed in five of the port-applied cases (29%). Heparin and saline combination was used in order to open the port tip, in five cases, two with total occlusion and three with partial occlusion. Infection was observed in only one case (5%) to whom appropriate therapy was given, and the port was taken out. Ports of two cases were also taken out because of skin dehiscence. No change in port tip position was observed in any of the cases. Total occlusion was observed in 16 of the 38 cases (42.1%) with conventional vascular access. In 12 cases (31.5%), a need arose to change the conventional vascular access. No vascular access was found in 13 of the 38 cases (34.2%). Application of reservoir ports especially to cases with advanced-stage carcinomas, under chemotherapeutic drug treatment, leads to minimal anxiety for the patient and his/her family and minimal risk of physical trauma to the patient with only one vascular access. Reservoir ports occlude or cause infection to a lesser extent than classic vascular access methods. Occlusion or infection rates of reservoir ports are statistically significant, lower than those of classic venipuncture.

Early results of laparoscopic adjustable gastric banding using the new low-pressure Soft Gastric Band®

BACKGROUND: Gastric banding represents the most commonly performed restrictive bariatric procedure nowadays in Europe and Australia. In order to reduce the rate of band migration through the gastric wall, different types of low-pressure bands have recently been developed. The aim of this study was to evaluate the safety and efficacy of a new type of low-pressure gastric band. METHODS: Within a period of 18 months the Soft Gastric Band® was implanted in 60 morbidly obese patients (female, 43; male, 17; mean age, 38.4 years; range, 14.5–63.3 years). In all patients, implantation was performed using the "pars flaccida" technique, all procedures were completed laparoscopically. The average duration of surgery was 80 ± 30 minutes. RESULTS: Mean body mass index at time of surgery was 48.1 ± 6.7 kg/m2; mean body weight was 140 ± 26 kg. After a median follow-up of 12 months in 93% of the patients an average excessive-weight loss at 6, 12, 18 and 24 months of 26.8% ± 11.4%, 36.2% ± 16.7%, 45.0% ± 18.0% and 49.0% ± 37.1%, respectively, was achieved. This corresponds to the results of other band types. Complications consisted in port occlusion in three patients and abscess formation at the port site in one patient. In one patient, re-banding was performed due to band leakage 42 months postoperatively. Up to now, neither band migration nor pouch enlargement or slipping was observed during follow-up. CONCLUSIONS: Gastric banding using the Soft Gastric Band® is a safe and effective procedure in bariatric surgery. No band migration through the gastric wall was observed. A longer follow-up has to be achieved to point out the real incidence of long-term complications.

Auto-Positive End-Expiratory Pressure During One-Lung Ventilation Using a Double-Lumen Endobronchial Tube

The present study was undertaken to investigate the possible relationships between the magnitude of autopositive end-expiratory pressure (auto-PEEP) and measured PaO2 during one-lung ventilation (OLV). Forty-one adults received OLV anesthesia using a tidal volume of 8 mL/kg and a respiratory rate of 12 breaths/min. Auto-PEEP was quantified using an end-expiratory port occlusion method. During two-lung ventilation (2LV), auto-PEEP was observed in 18 of 41 patients and ranged from 0.5 to 2.5 cm H2O. During OLV, auto-PEEP was observed in 34 of 41 patients and ranged from 0.5 to 10 cm H2O. The mean (+/- SD) value of auto-PEEP was significantly higher during OLV than during 2LV (3.2 +/- 3.3 cm H2O versus 0.5 +/- 0.7 cm H2O, P < 0.0001). Auto-PEEP during OLV correlated inversely with preoperative forced expiratory volume in 1 s/forced vital capacity (y = 12.5 - 0.13x, r = -.05, P < 0.005). During OLV, there was no significant correlation between auto-PEEP and measured PaO2. These findings confirm that many patients do not exhale completely to functional residual capacity during OLV.