Vascular Port Research Articles

Długoterminowe, implantowane systemy dostępu żylnego typu „port” — doświadczenia własne

Implantable venous access ports are essential for patients requiring chronic venous access. The aim of this study was to determine securities, risks of complications and patients' satisfaction with using a port system. Between April 2008 and May 2013, 220 consecutive patients (mean age: 53 ± 12 years; 155 female) were enrolled into this observational, single-centre study. 65 patients who received a port system were asked to complete a questionnaire with the aim of evaluating the patient's satisfaction and quality of life. First vena subclavia and later internal jugular were the most frequently used for venous access. Among serious complications, three cases (1.5%) of pneumothorax were observed. Technical difficulties of cannulation were observed in 12 cases (5.6%). In the late period, functional complications, defined as 'easy injection, impossible aspiration' at port access, affected more than 25% of the patients. Implantation of vascular ports is a safe procedure, and serious complications are rare. In the evaluated group, complications connected with the complete functioning of ports were observed. Among responders, more than 90% of patients reported high overall satisfaction.

Frequent Accesses to Totally Implanted Vascular Ports in Pediatric Oncology Patients are Associated with Higher Infection Rates

Totally implanted vascular (TIVA) ports are used in children for repeated blood samples or intravenous treatments. We have recently published a prospective evaluation of surgical incidents and early complications associated with these devices. This work is the final part of the same study, assessing late complications over a follow-up of 2 yrs. From January 2006 to January 2008, children older than 1 yr of age with a diagnosis of solid or blood cell malignancy were included. Insertion technique and care of the device were standardized. Every manipulation was prospectively recorded by specialized nurses. Obstruction was documented clinically. When bacteremia was suspected, routine central and peripheral blood cultures were drawn. Forty-five consecutive patients were enrolled in the study. Mean age at the time of the procedure was 8.5 yrs. There was no catheter-related infection within the first 4 weeks post-surgery. No device had to be removed because of infection or obstruction during follow-up. Frequent accesses to the port (=3 per day over a 10-day period) were associated with an 8-fold risk of infection. Insertion and use of TIVA devices were frequently associated with complications. No device had to be removed because of infection or obstruction over the follow-up period, although no prophylactic antibiotic agent was used. Restrictive use of antibiotics may prevent opportunistic infection. Frequent access to the device was significantly associated with line infection (odds ratio=8.43). No risk factor was identified for obstruction which occurred at a rate of 5.3 per 10,000 accesses.

SU-GG-T-473: Dose Uncertainty Due to High-Z Materials in Clinical Proton Beam Therapy

Purpose: In proton therapy, high‐Z materials, such as dental alloys, sternal reconstruction plates, prosthesis, and metallic ports, can introduce significant dose perturbations. Our objective is to quantify the high‐Z induced dosimetry uncertainty in clinical proton beams. Method and Materials: Dose perturbations from one titanium vascular port and a steel injection port of a breast expander were studied. An extended CT‐electron density (ED) curve for MVCT was obtained with an RMI CT phantom and metal plates (Al, Sn, Ti, Pb). Measurements taken with a 2D ion chamber array placed at different depths downstream from the high‐Z‐solid water interface were compared with dose calculations on the XiO treatment planning system based on both the MVCT and kVCT images. The Monte Carlo code FLUKA was used to verify accuracy of inhomogeneity corrections in the pencil beam algorithm. Dose perturbation factor (DPF) was defined as the ratio of the doses with and without the high‐Z material. Results: For MVCT, the CT‐ED relationship is linear from lung to lead. There are considerable dose enhancement (>10%) near the high‐Z interface due to secondary electrons from the metallic port. DPF as large as 20% was observed within the spread‐out Bragg peak. MVCT images provided more accurate delineation of the metallic object compared to kVCT, which tends to overestimate the water equivalent thickness of the metal object, resulting in shallower proton depth than its actual value. The DPF calculated from MVCT planning agrees with the measured results within 10%. Results from Monte Carlo calculations are comparable to results from XiO although there are small differences. Conclusions: Understanding dose uncertainty induced by high‐Z material is very important in proton therapy. MVCT based treatment planning may be preferred with an extended CT‐ED curve. Difference between measured and calculated dose distribution shall be quantified.

Safety concerns related to use of unapproved needles for accessing implantable venous access devices

Implantable venous access devices (IVADs) are commonly used in patients who require frequent apheresis procedures, such as patients with sickle cell disorders undergoing serial red blood cell (RBC) exchange and patients requiring prolonged photopheresis therapy. In such subjects, IVADs are used to facilitate repeated vascular access over extended periods of time.1 Access of these devices is typically performed using a specialized “noncoring” or Huber needle. The noncoring adaptation of a Huber needle is a slight inward curve of the needle tip designed to prevent the needle from “coring” the plastic septum or roof of a vascular port. Huber needles are recommended by IVAD manufacturers for use with their ports, both to prolong the life of the port and to protect the catheter from occlusion by a septum core.

Novel Devices for Wound Closure in Interventional Radiology

Wound closure issues are not as common in the field of interventional radiology when compared with other surgical fields, such as plastic surgery or dermatology. A common exception to this rule involves the placement and removal of chest wall vascular ports. This article reviews newer wound closure devices such as skin adhesives and closure film.

Anaesthesia for craniotomy in a child with cardiac disease

Background: Children with congenital heart disease (CHD) may present for non-cardiac surgery. Their anaesthetic management depends on their pre-morbid pathology. Aim: To report the anaesthetic management of a patient with congenital heart disease for a non-cardiac surgery. Case report: Craniotomy for evacuation of an intracerebral abscess was performed on a 4-year-old female child with severe congenital ventricular septal defect (VSD). Induction was with halothane, nitrous oxide and oxygen using a Mapleson F breathing circuit. Endotracheal intubation was performed after a second dose of suxamethonium was administered. Muscle relaxant was maintained using atracurium. Spontaneous ventilation was resumed at the end of operation, after a repeat reversal of muscle paralysis. Lesson: The pathophysiology of CHD alters cardiovascular dynamics and therefore the uptake and distribution of anaesthetic agents Keywords : Congenital heart disease, Anaesthesia, Pulmonary vascular pressure Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 126-129

Effects of diet and time of the day on serum and CSF leptin levels in Osborne-Mendel and S5B/Pl rats.

To characterize the effects of dietary fat on the diurnal variation in serum and cerebrospinal fluid (CSF) leptin levels in Osborne-Mendel (OM) and S5B/Pl rats and quantitate the dose response to lower doses of leptin administered into the third cerebral ventricle. Rats were fitted with implanted vascular ports or third ventricular cannulas and fed either laboratory chow or one of two semipurified high-fat or low-fat diets. Leptin and insulin were measured by immunoassay. Serum leptin and insulin levels were positively correlated and had similar patterns of diurnal change. CSF leptin and insulin also had diurnal rhythms, with a peak at 7:00 am, but the diurnal oscillations of leptin and insulin were significantly lower in the S5B/Pl rats than the OM rats. Thus, the ratio of CSF to serum leptin was significantly higher in the S5B/Pl rats than in the OM rats. Dietary fat had no effect on these diurnal patterns. There was a right shift in the dose response to leptin in the OM rats compared with the S5B/P1 rats. S5B/P1 rats treated with leptin had higher signal transduction and translation (STAT-3) mRNA levels compared with pair-fed or saline injected S5B/P1 rats. Hypothalamic suppressors of cytokine signaling mRNA levels were not statistically different between the groups. The higher CSF-to-serum leptin ratio in the S5B/P1 rats, the enhanced suppression of food intake and body weight with leptin injections, and the higher STAT-3 activity in these animals suggest that S5B/P1 rats are more sensitive to leptin than OM rats.

Effect of a β-3 agonist on food intake in two strains of rats that differ in susceptibility to obesity

Context: β-3 Agonists acutely reduce food intake, but the mechanism is not well understood. Objective: To evaluate the effect of a β 3 agonist on food intake in two strains of rats that differ in their sensitivity to becoming obese while eating a high-fat (HF) diet. Methods: Male Osborne–Mendel (OM) and S5B/Pl (S5B) rats were treated with a β 3-adrenergic agonist (CL 316,243) at 8 weeks of age, after an adaptation to either an HF (56% fat energy) or a low-fat (LF; 10% fat energy) diet that was equicaloric for protein (24% energy). Ad-lib-fed rats were injected intraperitoneally with CL 316,243, at doses of 0.03, 0.1, 0.3, 1.0 or 3.0 mg/kg, or with vehicle at the beginning of the dark cycle. Food intake was measured at 1, 3, 6 and 24 h after injections. Results: The β 3 agonist CL 316,243 significantly decreased food intake at all timepoints in both strains of rats eating both diets. However, this inhibition of food intake was significantly greater in the S5B rat. CL 316,243 significantly decreased serum leptin and serum glucose in both the OM and the S5B rats, and again, the inhibition was greater in the S5B rat. Whereas CL 316,243 increased serum insulin levels in the OM rat, it decreased them in the S5B rat on an LF diet. In a second experiment, chow-fed rats were implanted with vascular ports into the jugular vein and allowed to recover. When CL 316,243 was injected into the animals that were fasted overnight, rats of both strains significantly increased their serum insulin at 30 min, but the increase was much more pronounced in the S5B rat. Serum glucose was decreased significantly at both the 30- and 60-min timepoints in the OM rat and at 30 min in the S5B rat. Conclusion: These experiments demonstrate that a β 3 agonist (CL 316,243) has a much greater effect in a strain of rats that resist fat-induced obesity.

1079-77 Late angiographic patency of the magnetic vascular port (MVP®) system for coronary artery anastomosis

1079-77 Late angiographic patency of the magnetic vascular port (MVP®) system for coronary artery anastomosis

Experience using a New Vascular Port Access Device for Hemodialysis: Preliminary Clinical Results

A new subcutaneous device (Dialock(R), Biolink Corp, Middleboro, MA) provides vascular access to patients who require hemodialysis. The device consists of a port implanted in a subcutaneous pocket in the thoracic area 10 cm below the clavicle. Interdialytic patency is maintained using a priming antithrombotic solution. The device was implanted in 10 outpatients under local anesthesia, and immediately used for he-modialysis. The catheters have been used up to now for a total of 1,480 days ( 24- 248 days), the average being 4.8 months (1-8 months). Survival rate of Dialock (R)was 100% at 8 months. During this period, the device achieved prescription hemodialysis blood flow rates averaging 250-300 ml/min with a venous pressure of 180 +/- 25 mmHg. Malpositioning of the catheters due to their excessive length was observed in the first three patients and led to the repositioning of the catheters' distal tips under local anesthesia. Secondary and delayed hematoma surrounding the Dialock(R)device were observed in 2 patients one or two days after insertion. In one case, a hematoma was surgically removed under local anesthesia. Antibiotic therapy was administered for safety and prophylactic reasons. In one patient spontaneous catheter fracture and distal tip embolization occurred on the 49th day after repositioning. Percutaneous radiological retrieval of the catheter fragment was performed. No infection of the Dialock (R)device occurred and only one episode of bacteremia was observed. Blood cultures were positive for Staphylococcus epidermidis . Infection was cured by appropriate systemic antibiotic therapy combined with gentamicin and sodium citrate lock. The device was well accepted by patients and staff. The Dialock (R)device catheter offers a new vascular alternative for dialysis that deserves further long-term study. In particular, the confidence of structural materials should be tested.

A randomized, prospective trial of conventional vascular ports vs. the vortex “clear-flow” reservoir port in adult oncology patients

A randomized, prospective trial of conventional vascular ports vs. the vortex “clear-flow” reservoir port in adult oncology patients

Dialock: Pilot Trial of a New Vascular Port Access Device for Hemodialysis

Dialock: Pilot Trial of a New Vascular Port Access Device for Hemodialysis

Costoclavicular pinching: a complication of long‐term central venous catheters: A report of three cases

In the course of 1994-1995 we found three nearly identical cases involving fracture of polyurethane catheters from subcutaneous implantable vascular ports. This resulted in complications: leakage of drugs and infusions and thereby soft tissue damage. The leakage occurred in the costoclavicular space in all instances. We assume that the catheters have been subjected to repeated pinching, resulting in material fatigue. In order to eliminate the risk of this serious complication, the subclavian route should be avoided and preference given to the approach via the internal jugular vein.

Management of malignant ascites with a vascular port

A 15 year old with severe malignant ascites, refractory to medical management, was treated with a venous port. This proved to be an effective way to control the ascites and was easily placed under local anesthesia, with little risk or discomfort to the patient.