Single-lumen Port Research Articles

A comparative analysis of infection and complication rates between single- and double-lumen ports.

Port-a-caths are implanted intravascular chest ports that enable venous access. With more port placements performed by interventional radiologists, it is important to discern differences in infection and complication rates between double- and single-lumen ports. We retrospectively reviewed 1,385 port placements over 2 years at the University of Miami. Patients were grouped by single- or double-lumen ports. Data on duration of catheter stay, bloodstream infections, malfunctions, and other complications (fibrin sheath, thrombosis, catheter malposition) were collected. Multivariate Cox regression was performed to identify variables predicting port infection. The mean patient age was 58.8 years; the mean BMI was 26.9 kg/m2; and 61.5% of these patients were female. Our search revealed 791 double-lumen ports (57.1%) and 594 single-lumen ports (42.9%). The median follow-up was 668 days (range, 2-1,297). Double-lumen ports were associated with significantly higher rates of bacteremia (2.78% vs 0.84%; P = .02), port malfunction (8.3% vs 2.0%; P < .001), fibrin sheath formation (2.2% vs 0.5%; P < .02), catheter tip malposition (1.0% vs 0; P = .01), and catheter-associated thrombosis (1.4% vs 0; P = .003). Multivariate Cox regression analysis, after adjusting for other variables, showed that double-lumen chest ports had 2.98 times (95% confidence interval, 1.12-7.94) the hazard rate of single-lumen ports for developing bloodstream infection (P = .029). Double-lumen chest ports are associated with increased risk for bloodstream infection, malfunction, fibrin sheath formation, catheter tip malposition, and catheter-associated thrombosis. Interventional radiologists may consider placing single-lumen ports if clinically feasible; however, future studies are needed to determine clinical significance. The study limitations included the retrospective study design and the potential loss of patient follow-up.

Comparison of Infection Rates between Single-Lumen and Double-Lumen Chest Ports among Patients with Cancer: A Propensity Score Matching Analysis

PurposeTo compare the port infection rate between single-lumen (SL) and double-lumen (DL) ports and to determine whether the use of a DL port is an independent risk factor for port infection among patients with cancer. Materials and MethodsThis retrospective study included 2,573 adult oncologic patients (aged >18 years) who had either a SL (n = 841) or a DL (n = 1,732) chest port implanted between 2013 and 2020 at a single institution. Patients who had port infection, including port-site infection and port-related bloodstream infection, were identified through chart review. After propensity score matching based on 13 potentially confounding variables, a total of 493 pairs of patients with either SL (SL group) or DL (DL group) ports were subjected to analysis. The port infection rate was compared between the 2 groups using Poisson regression. Multivariate proportional subdistribution hazards regression (PSHREG) analysis was conducted to determine whether use of a DL port is an independent risk factor for port infection. ResultsThe cumulative follow-up period for the matched cohort was 371,853 catheter-days (median, 297 catheter-days per port; range, 0–1,903 catheter-days). The port infection rate of the DL group was significantly higher than that of the SL group (0.232 vs 0.113 infections per 1,000 catheter-days; P = .001). PSHREG analysis demonstrated that use of a DL port was an independent risk factor of port infection (subdistribution hazard ratio, 2.30; 95% CI, 1.33–3.78; P = .002). ConclusionsDL ports were associated with a higher risk of port infection compared with SL ports in adult oncologic patients.

Abstract No. 202 Association between the number of port lumens (single versus double) and chest port infections: a propensity score matching analysis

Abstract No. 202 Association between the number of port lumens (single versus double) and chest port infections: a propensity score matching analysis

3:09 PM Abstract No. 356 Chest port flipping: incidence and risk factors

To retrospectively investigate the incidence and risk factors of chest port flipping in adult patients (age ≥18 years). A total of 2859 adult patients (male: 1442 and female: 1417, median age: 61) who underwent chest port (port) placement between January 2013 and August 2019 were included in the study. There were 2707 (94.7%) oncology and 152 (5.3%) non-oncology patients. Either single (n = 915) or double lumen (n = 1944) ports were placed without suture fixation. Patients with port flipping were identified through chart and imaging review. Port flipping was diagnosed when the port was not accessible and the reservoir had rotated at least 90°. To elucidate the risk factors for port flipping, binary logistic regression analysis was conducted with using variables from patients’ demographics (age, sex, body mass index (BMI), clinical history) and port characteristics (right vs. left placement, number of lumen(s)). A total of 10 patients with port flipping (0.3%) including 9 female and one male were identified. The median time to port flipping was 14.5 days (range, 2-63 days). All except one were single-lumen ports. Seven patients (70%) had BMI>30. Of all, 4 were exchanged for double lumen ports, 3 including one double lumen port were removed, 2 were fixed with sutures, and 1 was replaced in a new pocket. In multivariate analysis, single lumen (odds ratio (OR) 17.9, confidence interval (CI) 2.26-142.9, P = <0.01) was significant, and BMI>30 (OR 3.74, CI 0.96-14.6, P = 0.06) and female sex (OR 7.78, CI 0.98-61.7, P = 0.052) were marginally significant risk factors for port flipping. Flipping of ports placed without suture fixation is a rare complication. Suture fixation may need to be considered when placing a single lumen port in female patients with BMI>30 to prevent port flipping.

3:00 PM Abstract No. 191 Risk factors for chest port infections in patients with solid cancers: multivariate analysis of 1158 patients

To identify risk factors for chest port (port) infections in patients with solid cancers. A retrospective chart review of 1158 adult patients (≥ 18 years old) with solid cancers (male/female: 551/607, mean age: 58.1 years) who had a port placed between January 2012 and December 2015 was conducted to identify patients port infections. Port placement was generally avoided in patients with severe neutropenia (absolute neutrophil count or ANC<500/μL). The most frequent site of cancer was lung (n = 258, 22.3%) followed by breast (n = 240, 20.7%). Port infections included port site (local) and blood stream infections. The patients were divided into two groups based on the records of port infections (infection vs non-infection). Variables including the patients’ demographics, medical history, laboratory data at the time of port placement, medication used, and port characteristics were compared between groups. To elucidate risk factors for port infections, multivariate proportional subdistribution hazard regression analyses were performed. A total of 389,815 catheter-days (median per patient: 522 catheter-days) were observed. Port infections were identified in 80 patients (6.9%) including 45 with port-site, 27 with bloodstream, and 8 with both. The infection rate was 0.21/1000 catheter-days. The median time to infection was 244 days (Range, 11-828 days). The infection group had significantly more patients with history of prior port placement (p = .01) and use of double lumen port (P = .001), and significantly shorter median duration of follow-up (P = .001) compared to the non-infection group. In backward stepwise multivariate analyses, prior port placement (p = 0.03, HR = 2.23, 95% CI [1.08-4.62]), use of double-lumen port (p = 0.01, HR = 2.08, 95% CI [1.15-3.74]) thrombocytopenia (platelet count<150,000/μL) (p = 0.01, HR = 2.16, 95% CI [1.19-3.90]) remained statistically significant. Neutropenia (ANC<1500/μL) was not the risk factor. Solid cancer patients with thrombocytopenia or a history of prior port need to be closely monitored for port infections. A single lumen port would be advised in these subgroups.

Factors that Predict Increased Catheter Tip Movement in Left Internal Jugular Vein Implantable Venous Access Ports upon Standing

To determine the characteristics that predict catheter tip movement with positional changes in patients with left-sided, internal jugular vein (IJV) implantable venous access ports. A retrospective review revealed 264 patients with left IJV ports placed at one academic institution from 2008 to 2013 with follow-up upright chest radiographs. Demographic information was recorded and anatomic measurements were made on both procedural fluoroscopic imaging and upright chest radiographs. Multivariate regression analysis was performed to determine which factors had statistically significant relationships with catheter tip movement distance. Mean catheter tip movement was 1.49 ± 1.97 cm. There was a statistically significant positive relationship between catheter tip movement distance and age (p = 0.03), body mass index (BMI) (p = 0.02), innominate vein angle (p<0.01) and dual- compared to single-lumen ports (p = 0.02). Port pocket location, venous access site and gender did not demonstrate statistical significance. The factors associated with increased positional catheter tip movement for left IJV ports include patient age, BMI, innominate vein angle and dual- vs single-lumen port. This information can be useful in determining initial placement position and avoiding complications associated with catheter malposition.

Dual-lumen chest port infection rates in patients with head and neck cancer.

The aim of this study was to investigate dual-lumen chest port infection rates in patients with head and neck cancer (HNC) compared to those with other malignancies (non-HNC). An IRB-approved retrospective study was performed on 1,094 consecutive chest ports placed over a 2-year period. Patients with poor follow-up (n = 53), no oncologic history (n = 13), or single-lumen ports (n = 183) were excluded yielding a study population of 845 patients. The electronic medical records were queried for demographic information, data regarding ports and infections, and imaging review. HNC patients experienced more infections (42 vs. 30), an increased infection rate per 1,000 catheter days (0.68 vs. 0.21), and more early infections within 30 days compared to non-HNC patients (10 vs. 6) (p < 0.001, p < 0.001, p = 0.02, respectively). An existing tracheostomy at the time of port placement was associated with infection in the HNC group (p = 0.02) but was not an independent risk factor for infection in the study population overall (p = 0.06). There was a significant difference in age, male gender, and right-sided ports between the HNC and non-HNC groups (p < 0.01, p < 0.001, and p = 0.01), although these were not found to be independent risk factors for infection (p = 0.32, p = 0.76, p = 0.16). HNC patients are at increased risk for infection of dual-lumen chest ports placed via a jugular approach compared to patients with other malignancies. Tracheostomy is associated with infection in HNC patients but is not an independent risk factor for infection in the oncologic population as a whole.

Analysis of chest X-ray plain film images of intravenous ports inserted via the superior vena cava

The optimal tip position for an intravenous port and the angle between the locking nut and the catheter are still debatable. This study evaluates the use of chest X-ray plain films for screening patients with potential intravenous port complications. We reviewed, retrospectively, 1505 patients who had an intravenous port implanted between January 1 and December 31, 2006 at Chang Gung Memorial Hospital, and were followed up until June 30, 2010. Of the 1119 patients with an intravenous port implanted via the superior vena cava (SVC), 279 underwent re-interventions for complications. There were four different types of single lumen port, and entry vessels on the right side were utilized as the predominant entry sites through the vessel cut-down method for catheter cannulation. The anatomic catheter tip was confirmed on the postero-anterior view of plain chest X-ray films. We used the Picture Arching and Communicating System (PACS) (GE, Fairfield, CT, USA) to record the angle and distance in degrees and centimeters, respectively. The tracheal carina was seen easily on the chest X-ray plain film and the location of the catheter tip and the angle between the locking nut and the catheter were identified. The location of the catheter tip was significantly related to migration (p<0.0001). The cut-off value of the receiver operating characteristic (ROC) curve for location and migration was 0.68cm below the carina. The area under the curve (AUC) was 0.8385 and had favorable predictive power. The ideal position of an intravenous port to avoid migration is 0.68cm below the carina. For surgeons, a quantified reference may minimize technical errors. Patients with shallow tip location should be followed up regularly and aggressive intervention initiated for any intravenous port malfunction.

Abstract No. 393 - Endovascular snaring technique for shortening of central venous port catheters in children

Abstract No. 393 - Endovascular snaring technique for shortening of central venous port catheters in children

3:57 PM; Abstract No. 130; FEATURED ABSTRACT - Cone beam CT venography vs. cortisol measurements to confirm selective right adrenal vein catheterization during adrenal vein sampling: does anatomical selectivity correlate with biochemical selectivity ratios?

body. Regression analysis was performed to determine if there were statistically significant relationships between catheter tip migration distances and innominate vein angles, internal jugular vein access locations, subcutaneous pocket locations, number of catheter lumens and various patient demographics. Results: The range of catheter tip migration distances for the entire population was -4.01 to 9.97 cm with a mean of 1.49 cm 1.97. There was a statistically significant positive relationship between catheter tip migration distance and age (P1⁄40.0319), body mass index (BMI) (P1⁄40.0244), innominate vein angle (P1⁄40.0028) and dual compared to single lumen ports (P1⁄40.0199). Whereas port pocket location, venous access site, gender and number of days between initial placement and follow-up radiograph did not demonstrate statistical significance. Conclusion: Increased age, increased BMI, increased innominate vein angle and dual vs single lumen ports predict increased positional catheter tip migration for left internal jugular subcutaneous central venous ports. This information can be useful during initial port placement and also when deciding whether or not to revise a port with a catheter that has been inadvertently cut short.

3:48 PM; Abstract No. 129 - Feasibility of barbed suture for incision closure in implantable chest ports

body. Regression analysis was performed to determine if there were statistically significant relationships between catheter tip migration distances and innominate vein angles, internal jugular vein access locations, subcutaneous pocket locations, number of catheter lumens and various patient demographics. Results: The range of catheter tip migration distances for the entire population was -4.01 to 9.97 cm with a mean of 1.49 cm 1.97. There was a statistically significant positive relationship between catheter tip migration distance and age (P1⁄40.0319), body mass index (BMI) (P1⁄40.0244), innominate vein angle (P1⁄40.0028) and dual compared to single lumen ports (P1⁄40.0199). Whereas port pocket location, venous access site, gender and number of days between initial placement and follow-up radiograph did not demonstrate statistical significance. Conclusion: Increased age, increased BMI, increased innominate vein angle and dual vs single lumen ports predict increased positional catheter tip migration for left internal jugular subcutaneous central venous ports. This information can be useful during initial port placement and also when deciding whether or not to revise a port with a catheter that has been inadvertently cut short.

Comparison of subcutaneous central venous port via jugular and subclavian access in 347 patients at a single center

The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method.

Complications of implantable venous access devices in patients with sickle cell disease

Implantable venous access devices (VADs) are used in sickle cell disease (SCD) for patients with poor venous access to facilitate chronic blood transfusions and manage acute complications. We attempted to define the frequency of bloodstream infections (BSI) and thrombosis in adults and children with SCD and VADs. We performed a single-institution, retrospective review of VAD-associated infection and thrombosis in patients with SCD. Thirty-two patients (median age 20 years, range, 1-59) had 86 VADs placed (median, 2.7 VADs per patient, range, 1-7) with a total of 41,292 catheter days (median, 1,376 days; range, 323-3,999). Mean catheter lifespan in adults (691 days ± 123) was not significantly higher than children (614 days ± 154). A total of 66 VAD-associated BSI (1.59 infections per 1,000 catheter days) occurred in 17 of 32 (53%) patients. Children with VADs had fewer BSI (3 of 10; 30%) than adults (14 of 22; 64%, P = 0.08). 24 catheter-associated thromboses (0.49 thromboses per 1,000 catheter days) occurred in 10 of 32 (41%) of patients. Children also had fewer VAD-associated-thrombosis (1 of 10; 10%) than adults (9 of 22; 40%, P = 0.08). In conclusion, the use of VADs in SCD was linked to a significant rate of infection and thrombosis.

Use of “high flow” Totally Implantable Central Venous Access Ports for Myeloablative Conditioning Followed by Allogeneic Stem Cell Transplantation: a Prospective Study.

Abstract 4648 ObjectivesA central venous access is always necessary for the management of patients receiving myeloablative conditioning followed by allogeneic stem cell transplantation (SCT). Tunnelled, cuffed silastic catheters are the device of choice for these patients. To our knowledge, there are no prospective studies investigating the use of totally implantable central venous access ports (TIAP) in patients receiving myeloablative conditioning followed by allogeneic SCT. The aim of this prospective study was to investigate the usefulness of a new “high flow” single lumen port device in these patients. <>Methods: Between December 2007 and July 2009, patients with haematological malignancies received a TIAP prior to allogeneic SCT. All patients received the same type of port [silicone, 10 French, high flow rate (3100ml/h), Reference 40010, Laboratoires Perouse, Ivry le Temple, France]. All devices were inserted under local anesthesia through direct puncture of the right subclavian vein using the Seldinger technique. A chest X-ray was always obtained to document correct positioning. All infusions, including the graft itself and all blood drawings, were performed via the port. Port-related bloodstream infection was defined according to Infectious Disease Society of America guidelines. All patients were examined by ultrasonography in case of clinical signs of thrombosis and systematically after discharge. ResultsForty six TIAP were placed in 46 patients [median age: 25 years (20-41 years); 20 female and 26 male], and remained in place for a cumulative duration of 9756 days in situ (range 30-560 days). No pneumothorax occurred. Port-related bloodstream infection occurred in 2 cases (candida parapsilosis and staphylococcus aureus) [2/46, 4.3% ; 0.2 event per 1000 days]. These ports were removed. No port-related thrombosis occurred. No port-related deaths were observed.In conclusion, the use of “high flow” totally implantable ports has resulted in a good option for long-term access to central veins and delivery of myeloablative conditioning followed by allogeneic SCT, in spite of severe neutropenia and increased risk of sepsis in this category of patients. Although multicentre randomized clinical trials are needed to define the optimal device in this clinical setting, the results of this prospective study support the wider use of TIAP in patients receiving myeloablative conditioning followed by allogeneic SCT. Disclosures:No relevant conflicts of interest to declare.

Outcomes associated with different intraperitoneal chemotherapy delivery systems in advanced ovarian carcinoma: A single institution's experience

Background Despite increasing use of intraperitoneal chemotherapy the optimal delivery strategy and regimen remain undetermined. Catheter-related complications have been reported in 3–34% of cases across a number of platforms and port styles, but few data compare different catheters directly. We sought to evaluate the complication rate of two separate intraperitoneal chemotherapy port delivery systems used within a single practice. Methods We reviewed the medical records of all patients who underwent port placement in our practice (two surgical centers) from January, 2006 through October, 2008. Data extracted included: demographics, medical co-morbidities, port type, timing of placement, intraoperative procedures, reasons for discontinuation of IP chemotherapy, and number of completed cycles. Results We identified 85 patients who had intraperitoneal ports placed. Four patients were excluded from this analysis: 2 declined chemotherapy and 2 were treated at other institutions and follow-up data was insufficient. Fifty-two (64%) of the 81 patients analyzed had a fenestrated port placed, and 29 (36%) had single lumen ports. In 67 cases (83%) the port was placed at the time of initial cytoreductive surgery. In 14 patients (17%) it was placed as a secondary event. The groups were well matched for age, stage, BMI, and medical co-morbidities though the group with single lumen catheters had more antecedent surgeries. We observed no significant difference between patients with single lumen or fenestrated ports with regard to: number of intraperitoneal treatments, catheter-related complications, hematologic outcomes, and rates of discontinuation. Conclusions A low rate of catheter-related complications is observed with both systems. The majority of discontinuations were due to hematologic complications and did not appear to be intrinsic to catheter choice.

Complications and management of long-term central venous access catheters and ports

Although prolonged venous access devices (PVADs) are used in case prolonged intravenous therapy is required, implantation and use of these devices is associated with complications. The purpose of this study was to evaluate perioperative and long-term complications associated with PVADs and the management of these complications. A retrospective review was undertaken of 225 PVADs implanted in 217 patients from February 1993 to June 2004. This included 144 single-lumen port infusion systems, 49 single-lumen Hickman catheters and 32 double-lumen Groshong catheters. The PVADs were inserted using either the percutaneous Seldinger method (n=183) or cutdown access to the subclavian vein (n=42). Indications for placement were as follows: chemotherapy in 66.2% of patients, drug-infusion treatment in 31.6% of patients and total parenteral nutrition in 2.2% of patients. Perioperative complications occurred in 13 patients (5.7%): catheter malposition in seven patients (3.1%), pneumothorax in three patients (1.3%), hemorrhage in two patients (0.9%) and catheter embolization in one patient (0.4%). Long-term complications appeared in 15 patients (6.6%): infection in five patients (2.2%), thrombosis in three patients (1.3%), extravasation in three patients (1.3%), and catheter fracture in four patients (1.8%). The fractured fragments were removed by the Amplatz snare device. In 10 patients (4.4%) only were PVADs removed prior to completion of the intended therapy. Indications for removal were catheter infection in five patients (2.2%) and catheter fracture in five patients (2.2%). PVAD implantation is associated with some risk of serious perioperative and long-term complications. Care of the catheter and the patient should be maintained with the proper and immediate evaluation of the perioperative and long-term complications.

Single-Lumen Subcutaneous Ports Inserted by Interventional Radiologists in Patients Undergoing Chemotherapy

Subcutaneous ports are commonly used for vascular access in patients with cancer undergoing chemotherapy. To determine the incidence of catheter-related infection and to assess the efficacy of catheter salvage in subcutaneous ports. We retrospectively reviewed 300 subcutaneous single-lumen chest ports inserted by interventional radiologists in 294 patients between December 1, 1995, and November 15, 1997, at the Cleveland Clinic Foundation, Cleveland, Ohio. The number of days that the catheter remained in situ, infection rate, treatment, and outcome of infection were determined. Two hundred ninety-four patients had a total of 79 748 catheter-days. Vascular access for chemotherapy was the indication for 95% of the subcutaneous ports placed. Seventeen catheters (5.7%) developed 20 episodes of noninfectious complications resulting in the removal of 6 ports. Seventeen patients (5.7%) developed catheter-related infections (2.1/10 000 catheter-days) including 10 episodes of catheter-related bacteremia (1.2/10 000 catheter-days). The most common organism isolated was Staphylococcus aureus. A total of 15 of the 17 infected catheters were removed. Salvage was attempted in 6 patients in whom 4 catheters were eventually removed due to recurrent bacteremia (2 patients) and persistent local infection (2 patients). One of the 10 patients with catheter-related bacteremia developed septic arthritis. There were no complications associated with attempted catheter salvage. Subcutaneous single-lumen ports inserted by interventional radiologists in patients undergoing chemotherapy have low complication rates but infections remain the leading cause of catheter loss. Antibiotic therapy without catheter removal is unlikely to eradicate catheter-related bacteremia.