Venous Port Catheter Research Articles

A potentially lifesaving error: unintentional high-dose adrenaline administration in anaphylaxis-induced cardiac arrest; a case report

BackgroundCardiopulmonary resuscitation is a crucial skill for emergency medical services. As high-risk-low-frequency events pose an immense mental load to providers, concepts of crew resource management, non-technical skills and the science of human errors are intended to prepare healthcare providers for high-pressure situations. However, medical errors occur, and organizations and institutions face the challenge of providing a blame-free error culture to achieve continuous improvement by avoiding similar errors in the future. In this case, we report a critical medical error during an anaphylaxis-associated cardiac arrest, its handling and the unexpected yet favourable outcome for the patient.Case presentationDuring an out-of-hospital cardiac arrest due to chemotherapy-induced anaphylaxis, a patient received a 10-fold dose of epinephrine due to shortcomings in communication and standardization via a central venous port catheter. The patient converted from a non-shockable rhythm into a pulseless ventricular tachycardia and subsequently into ventricular fibrillation. The patient was cardioverted and defibrillated and had a return of spontaneous circulation with profound hypotension only 6 min after the administration of 10 mg epinephrine. The patient survived without any residues or neurological impairment.ConclusionsThis case demonstrates the potential deleterious effects of shortcomings in communication and deviation from standard protocols, especially in emergencies. Here, precise instructions, closed-loop communication and unambiguous labelling of syringes would probably have avoided the epinephrine overdose central to this case. Interestingly, this serious error may have saved the patient’s life, as it led to the development of a shockable rhythm. Furthermore, as the patient was still in profound hypotension after administering 10 mg of epinephrine, this high dose might have counteracted the severe vasoplegic state in anaphylaxis-associated cardiac arrest. Lastly, as the patient was receiving care for advanced malignancy, the likelihood of termination of resuscitation in the initial non-shockable cardiac arrest was significant and possibly averted by the medication error.

A Stepwise Interventional Strategy for the Removal of Adherent Totally Implanted Central Venous Access Port Catheters

To evaluate the safety and effectiveness of a stepwise interventional strategy for the removal of adherent totally implanted central venous access port catheters, consisting of a guidewire support, antegrade coaxial separation, and retrograde coaxial separation with increasing technical complexity. This study has a retrospective design. Thirty-two patients who had failed routine removal of the port catheter and were then transferred to interventional radiology between November 2017 and December 2023 were reviewed. The technical success and complication rates were recorded. All adherent catheters were successfully removed without catheter fragmentation, using guidewire support (n=21), antegrade coaxial separation (n=5), and retrograde coaxial separation (n=6). The technical success rate was 100%, and no complications occurred. The proposed stepwise interventional strategy successfully removed adherent port catheters, with good safety and high effectiveness. It appeared to reduce the incidence of catheter fracture during the removal of adherent totally implantable central venous access port catheters.

Peculiarities of clabsi in oncologic hospitals

Currently, healthcare-associated infections (HAIs) are one of the most dangerous complications for hospitalized patients. The economic damage caused by HCAI in the Russian Federation annually is about 15 billion rubles; in addition, HCAI occupy the tenth place among the causes of mortality of the population. Catheter-associated bloodstream infection holds the leading place in the structure of ISMP morbidity. The concept of CVC-AIC (catheter-associated bloodstream infections or CLABSI), in turn, is included in CAIC. Purpose of the study. To analyze the current literature data of domestic and foreign authors for the years 2012-2022 concerning CAIC in patients of oncologic hospitals with CVCs, including subcutaneous central venous port catheters. Material and Methods. A review of 38 literature sources for the last 10 years was performed, including current information on catheter-associated bloodstream infections, measures to prevent them, and modern treatment approaches. Results. The studies have shown that the combination of drug resistance in microorganisms and immunity reduction in cancer patients, which occurs against the background of chemotherapy, makes them a risk group for the development of CAICs and episodes of their recurrence. Ensuring epidemiological safety of bloodstream catheterization in such patients is an important step in the prevention of CAIC. This is one of the priority tasks of oncoepidemiology today. Conclusion. The leading role in the occurrence of catheter-associated bleeding plays the term of catheterization and the condition of the patient, his age, stage of cancer development and concomitant chronic diseases. One of the most vulnerable risk groups are cancer patients from hemoblastosis chemotherapy and bone marrow and hematopoietic stem cell transplantation units. This may be due to the use of immunosuppressant drugs to suppress graft rejection, which significantly reduce patients' immunity. According to the results of studies, infection with drug-resistant Gram-negative microorganisms, including multidrug-resistant ones, is prevalent in cancer patients with CAIC. When using povidone iodine, there is a tendency to decrease the incidence of CAIC, but the use of chlorhexidine alcohol solution showed better results. A direct correlation was observed between the use of surgically implanted intravascular devices for long-term function and a lower incidence of CAIC, particularly in pediatric oncology.

Analysis of a Large 19-Year Database in Vascular Surgery in Southern Iran: Evaluation of Trends and Limitations

IntroductionLarge databases with data elements of clinical interest are essential for carrying out high-quality observational studies. Such databases have become increasingly popular for clinical research in fields like Vascular Surgery. Our goal is to create a solid and reliable database of the patients who have been admitted and undergone different vascular-surgery procedures over 19 years and to provide surgeons with the current trends and limitations in managing patients with vascular disease. MethodThe database of patients operated in Namazi Hospital, the referral center for Vascular Surgery in southern Iran, from 2001 to 2019, was retrieved and patients undergoing vascular procedures were parted. Demographic and perioperative data were evaluated and patients were categorized into subgroups based on the type and cause of operation. All data were analyzed with SPSS version 26.0 (IBM. NY. USA). ResultsDuring the period of our study, a total of 226,051 operations were performed at the Namazi Hospital. Among these operations, 6,386 (2.82%) Vascular Surgery-related operations were entered into our study. The average age of the patients in our study was 53.22 ± 18.92 years (range: 1 day old – 97 years) and 4,061 (63.6%) were male. Furthermore, 147 (2.3%) were operated by multiple surgeons. Moreover, 798 (12.5%) of the patients were admitted postoperatively to the intensive care unit (ICU), while the rest (5,588; 87.5%) in the common surgery ward. The cause of operation in 609 (9.5%) of the cases was trauma. Based on wound categorization, 5,132 (80.4%) were type I (clean). The most frequent operation performed in our center was arterial reconstruction and limb revascularization (31.4%), followed by hemodialysis access (31.3%). The most frequent surgery in the age group of under 18 years was fasciotomy, in the 19 to 40 years group was tumor (56.8%) and varicose veins (52.9%), in the 41 to 60 years group was implantation of ventral venous port catheter (47%). Only carotid and thoracic outlet syndrome surgeries were significantly higher in females. The remaining operations were all significantly higher among male patients. Finally, carotid body tumor surgery was the most frequent operation requiring ICU monitoring. ConclusionWe demonstrated, for the first time, an overview of Vascular Surgeries performed in a referral tertiary center in Southwest Iran. There is an increase in the number of surgical procedures in the field of Vascular Surgery, and large databases will be a valuable tool for addressing critical problems in this field and also the healthcare system.

Comparison of chemotherapy treatment administration via venous port and peripheral vascular access in terms of quality of life and costs.

In this study, it was aimed to compare the administration of chemotherapy drugs via venous port catheter and peripheral vein in metastatic colon cancer patients in terms of quality of life and treatment costs. The research was carried out in a university hospital in Turkey. The population of the study consists of 130 patients with metastatic colon cancer who were treated with chemotherapy. The sample of the study consists of 103 participants. During the data collection phase of the study, three data collection tools were used: demographic information form, EOTC QLQ-30 quality of life scale and invoices for treatments. Data were analyzed using Microsoft Office Excel and IBM SPSS 20 package programs. In the study, 71.8% of the participants received chemotherapy with a venous port catheter, 65% for more than 3months, 56.3% in the day unit. As a result of the study, it was found that there were no significant differences in the quality of life (except social function) according to the chemotherapy method. In addition, when the research results are examined in terms of cost, statistically significant differences were found in the treatment cost (except total costs excluding drugs) according to the chemotherapy application method. In line with these results, it is thought that when choosing the chemotherapy application method, factors such as the treatment duration of the patients, the ease of opening the vascular access, and the patient's psychological state should be taken into consideration.

Evaluation of Subclavian Central Venous Port Catheters Placed by Anesthesiologists: Single-Center Experience

Evaluation of Subclavian Central Venous Port Catheters Placed by Anesthesiologists: Single-Center Experience

Successful Repositioning a Migrated Totally Implantable Venous Access Port Catheter by Biopsy Forceps

Successful Repositioning a Migrated Totally Implantable Venous Access Port Catheter by Biopsy Forceps

P011 Antifungal lock therapy

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective Candida spp is the fourth leading cause of catheter-related blood stream infection (CRBSI). The standard treatment is prompt removal of the device (central venous catheter, CVC, or port or hemodialysis catheter) along with administration of systemic antifungal therapy. However, in patients with a lack of alternative intravenous access and in some critically ill patients, this standard of care is challenging. Our success with antibiotic lock solution in MDR GNB CRBSI, prompted us to consider similar therapy in Candida spp CRBSI.MethodsCatheter salvage using antifungal lock therapy was tried in a total of 15 cases in two centers. In 10 cases echinocandin (9 anidulafungin, 1 micafungin) and in 5 cases amphotericin b deoxycholate (AmB-d) were used to obtain an antifungal concentration of ∼ 1000 mcg/ml in the lock solutions. All these formulations had additional NAC, heparin, and normal saline. Systemic antifungal therapy was also administered concurrently.Success was defined as clearance of candidemia at 48 h and 14 days and/or till the use of the device was needed. Some of these patients had prior/co-infections with bacterial pathogens and they were managed with appropriate systemic antibiotics with antibiotic lock therapy.ResultsIn 11/15 episodes of CRBSI due to Candida species, catheter salvage was achieved. One case could not be assessed at 14 days as a port was removed in view of megaprosthesis in situ. In two cases this therapy failed and one patient lost to follow-up.See Figures 1 and 2 for details of all cases.ConclusionsAntifungal lock therapy using echinocandins and AmB-d appears to be a promising therapy in patients where catheter removal is difficult. However, this success neither means that this can become standard practice, nor should it make clinicians and hospital staff complacent about infection control practices.

The role of routine chest radiography after implantable venous access port catheter insertion under the guide of ultrasonography and fluoroscopy

BackgroundThe objective of this study is the evaluation of routine chest radiography following the placement of Implantable venous access port catheter (IVAPC) central lines using combined ultrasound and fluoroscopic guidance by a vascular surgeon in the operating room.Material and methodA prospective study of 189 consecutive patients who underwent IVAPC central line insertion in the vascular surgery operating room from 2016 to 2019. Venipuncture was performed with an 18-gauge needle under the guidance of sonography in each case, and the access site was noted. The line position was confirmed by fluoroscopy following the procedure. Multiple tries for puncture and patients under 18 were excluded from our study. Routine radiography of chest was performed for all patients and pneumothorax, hemothorax, and catheter malposition were evaluated in each case.ResultsThere were 2 cases of asymptomatic pneumothorax, no cases of hemothorax, and all catheter tip positions were optimal or acceptable. The annual cost of chest radiography was 33,000,000IRR, 220 h of hospital and staff time, and 1.1 mSv radiation.ConclusionIn conclusion, when imaging guidance is used for IVAPC insertion by an experienced surgeon in a high-volume center, performing post-procedure routine chest radiography shows little benefit.

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

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%.

Our central venous port catheter system practice - a retrospective study.

To evaluate indications for insertion, complications and indications of central venous port catheters, and to identify indications for their removal. The retrospective study was conducted at Okmeydani Training and Research Hospital, Istanbul, Turkey, and comprised data from January 2006 to June 2014 of patients who had central venous port catheters. The indications for removal of the catheters were also evaluated. Of the 1198 patients whose records were reviewed, 605(50.5%) were women and 593(49.5%) were men. The overall mean age was 52.3±12.78 years. Of the total, 1142(95.33%) cases related to chemotherapy treatment. There were 127(10.6%) complications; the most common being catheter occlusion 46(36.2%). The catheters were removed in 182(15.2%) patients. Among them, 83(45.6%) catheters were removed because they were no more needed. In the light of the findings, there is a need for standardised guidelines for evaluation before central venous port catheter insertion and follow-up after insertion to detect and to avoid possible complications.

A rare cause of stroke: fail-implanted venous port catheter system \u2013 a case report

BackgroundWe present the case of a 75-year-old female with acute embolic cerebral infarction caused by a fail-implanted venous port catheter system in the left subclavian artery.Case presentationA 75-year-old woman presented to our emergency room after acute onset of a right-sided hemiparesis and dysarthria. Within 2 days after admission, she developed a left-sided hemiparesis, ataxia with concordant gait disturbance and incoordination of the left upper limb. DWI-MRI showed acute multiple infarcts in both cerebral and cerebellar hemispheres. Laboratory examination, 24-h Holter electrocardiography and transthoracic echocardiography provided no pathological findings. Further examination revealed an arterially fail-implanted port catheter, placed in the left subclavian artery with its tip overlying the ascending aorta, as the source of cerebral embolism.ConclusionThis is the first case report of thromboembolic, cerebral infarction due to a misplaced venous port catheter in the subclavian artery, emphasizing the imperative need for a thorough diagnostic workup, when embolism is suspected but cannot be proven at first glance.

An evaluation of the long-term complications associated with totally implantable venous access in oncology patients

Objectives: The aim of this study was to examine long-term complications developing in venous port catheters inserted in oncological patients. Patients and methods: A total of 205 oncology patients (124 males, 81 females; mean age: 50.1±22.3 years; range, 6 months to 90 years) in whom vascular port catheters were inserted between March 2015 and April 2020 were retrospectively analyzed. The first preference for port catheter application was the right internal jugular vein. If failed, the contralateral internal jugular vein was used. The procedure was carried out in the operating room with ultrasound (US) guidance under general anesthesia. All patients were evaluated in terms of pneumothorax, catheter orientation, and kinking and malposition after the procedure. Results: A total 219 vascular ports were inserted in 205 patients. The indication for port catheter insertion was the receipt of long-term chemotherapy. Catheters were changed in four patients due to infection and in five patients due to catheter migration. The sites of catheter migration were the right atrium in two, the right ventricle in one, the main pulmonary artery in one, and the right pulmonary artery in one patient. Conclusion: Port catheter insertion under US guidance is a well-designed procedure which can be performed with low complication rates by an experienced surgeon in an aseptic environment. Even if complications develop, they can be usually successfully treated in most cases.

Long-Term Follow-Up and Clinical Relevance of Incidental Findings of Fibrin Sheath and Thrombosis on Computed Tomography Scans of Cancer Patients with Port Catheters.

PurposeThis retrospective study examined the incidence, progression, and clinical relevance of catheter-related thrombosis (CRT) and/or fibrin sheaths presenting as incidental findings on routine staging computed tomography (CT) scans performed in cancer patients.Patients and MethodsPatients who underwent central venous port catheter (CVC) placement in a tertiary care hospital between September 2010 and August 2013 were followed up for up to five years. Two radiologists assessed the presence of fibrin sheath and thrombosis in consensus in staging CT scan. Patient demographics, type of cancer, preoperative comorbidities, date of CVC placement and CTs, preexisting anticoagulation, as well as the type and treatment of catheter-related complications were determined from the electronic medical record.ResultsA total of 194 patients with 530 CT scans and a mean follow-up time of 394 days were included. Fibrin sheaths and thromboses were seen on 46 scans (8.7%) in 30 patients and 80 scans (15.1%) in 35 patients. The incidence of fibrin sheaths and thromboses was found to be 15.5% and 18%, respectively. The comparison to initial CT reports results indicated that fibrin sheaths or thromboses were missed in 106 examinations (20%). Catheter-associated complications were reported in 14 patients (21.5%) without specific therapy.ConclusionFibrin sheaths and CRTs are often overlooked on routine CT scans when patients are asymptomatic. The subsequent high complication rate demonstrates the clinical relevance of the initial incidental finding on CT scan. Further studies should elucidate the effect of thrombolytic agents and interventional radiologic treatment in asymptomatic patients.

The STAPH Score: A Predictor of Staphylococcus aureus as the Causative Microorganism of Native Vertebral Osteomyelitis.

Background Staphylococcus aureus (SA) is the most common causative microorganism in native vertebral osteomyelitis (NVO). Few studies have compared the clinical features of NVO due to SA (SA-NVO) and NVO due to other organisms (NSA-NVO). This study was conducted to validate a predictive score for SA-NVO to facilitate NVO treatment without broad-spectrum antimicrobial agents.MethodsThis retrospective study compared the clinical features of patients with SA-NVO and NSA-NVO who were diagnosed from 2004 to 2019. Univariate associations were assessed using χ 2, Fisher’s exact, or Mann-Whitney U test. Multivariable analysis was conducted using logistic regression. The optimal age cutoff point was determined by classification and regression tree analysis.ResultsAmong 155 NVO patients, 98 (63.2%) had a microbiologically confirmed diagnosis: 40 (25.8%) with SA-NVO and 58 (37.4%) with NSA-NVO. Six predictors, either independently associated with SA-NVO or clinically relevant, were used to develop the STAPH prediction score: atopic dermatitis (Skin) (3 points); recent Trauma (2 points); Age < 67 years (1 point); Abscess (1 point); central venous Port catheter (2 points); and History of puncture (2 points). In a receiver operating characteristic analysis, the area under the curve was 0.84 (95% confidence interval, 0.76–0.91). The best cutoff point was 3. A score ≥3 had a sensitivity, specificity, positive predictive value, and negative predictive value of 58%, 84%, 84%, and 73%, respectively.ConclusionsThe STAPH score has relatively high specificity for use by clinicians to predict SA as the causative microorganism in patients with NVO until results of a confirmatory culture are available.

Questionnaire-based evaluation of satisfaction levels in patients receiving chemotherapy through implanted venous access ports

Objective: This study aimed to evaluate the effect of totally implanted venous access ports on the quality of life and patient satisfaction of cancer patients.&#x0D; Materials and Methods: The study was comprised of patients who underwent implantation of a central venous port catheter (CVPC) for chemotherapy treatment at our hospital’s oncology department and continued with follow-up and treatment. The researchers conducted face-to-face interviews with the participants in which the latter responded to 15 questions concerning the effects of the port catheter on daily quality of life and satisfaction with the implantation procedure.&#x0D; Results: A total of 260 patients participated in the study. Port-related complications were observed in 54 patients (20.7%), the most common being catheter occlusion. Participants expressed high levels of satisfaction and stated that the CVPC had a positive effect on their quality of life. Overall satisfaction and quality of life were significantly different for patients who experienced complications compared to those without, however, with the former reporting decreased satisfaction and increased stress and anxiety levels. Nevertheless, there was no significant difference between the patients who developed complications and those who did not concern their response to the statement: “Faced with a similar situation requiring a port catheter, I would make the same decision" (54.5% versus 52%, p = .188).&#x0D; Conclusion: Most patients reported overall satisfaction with the CVPC system while noting a minor negative impact on daily life. Complications related to the implantation procedure have statistically been shown to be a predictor of satisfaction and quality of life.

Analgesic Effectiveness of Ultrasound-Guided Pecs II Block in Central Venous Port Catheter Implantation.

Background and AimIn oncology patients, central venous port catheter (CVPC) implantation is generally preferred for venous route. However, in this procedure, postoperative pain is often observed. This study aimed to investigate the effectiveness of ultrasound-guided Pecs II block in the management of pain after CVPC placement.MethodsOne hundred and eighty-seven patients who underwent CVPC implantation between January 2017 and August 2018 were included in the study. Patients who underwent Pecs II block under ultrasound guidance were called as the Pecs group, and those who underwent local anesthesia (LA) were referred as the LA group. All procedural parameters were analyzed, including demographic characteristics of patients, visual analogue scores (VAS) at 2nd and 24th hours, and postoperative opioid, and non-steroidal anti-inflammatory drug (NSAID) consumption.ResultsThe postoperative 2nd hour VAS scores were similar in both groups and were lower than the 24th hour VAS scores. VAS scores at the 24th hour in the Pecs group were significantly lower than the LA group (P = 0.001). While the number of fentanyl rescue doses administered in PACU was similar, the total NSAID consumption in the first 24 hours was higher in the LA group than in the Pecs group.ConclusionIn CVPC placement, ultrasound-guided Pecs II block is a more reliable, easily applicable and longer-acting approach than LA infiltration for postoperative analgesia.

Complications and pitfalls of central venous port catheters: experience with 782 patients with cancer.

The clinical use of port catheters has become widespread because they provide a safe and easy vascular route. Such widespread use of vascular port catheters has revealed early and late complications. This study was evaluated the early and late noninfectious complications and present precautions and pitfalls to handle these complications. The retrospective observational study comprised 801 vascular port catheters inserted into 782 adult patients for various reasons between 2010 and 2018. Patient demographic, indications for port catheter implantation, port catheter types, and insertion sides were noted. Port catheter implantation related early and late complications were recorded. The subclavian vein was selected as a target vein in almost all of the interventions (98.9%). Similarly, right-sided veins were used in about 90% of patients. The most common problem was technical issues related to the interventions. If venous cannulation was challenging, ultrasonography and fluoroscopy guidance roadmap technique were used. Most serious complication was pneumothorax in 7 patients. In the late period, the most common problem was thrombotic occlusion of the catheter. In two-thirds of these patients, thrombolytic therapy for thrombosed port catheters may rescue some catheters and avoid secondary port catheter insertions. Despite these benefits, port catheters are associated with various complications. However, most of these complications can be effectively prevented by proper techniques and easily applied precautions.