Venous Port Research Articles

Silver-Mixed Port Reduces Venous Access Port Related Infection Rate Compared to Non-Silver-mixed Port: A Single-center Retrospective Analysis

PurposeTotally implantable venous access ports (TIVAPs) are increasingly used as safe and convenient central venous access devices. However, several TIVAP-related complications occur, with port/catheter infection being most common. Silver-mixed ports have recently been introduced in anticipation of reducing TIVAP infection. This study aimed to investigate the efficacy of this device in reducing port infection by examining groups with and without silver-mixed devices.Materials and MethodsFrom April 2017 to July 2022, silver-mixed ports (S group) and non-silver-mixed port group (NS group) were reviewed at our institution. The incidence of TIVAP-related infections, patient characteristics, and bacteriological data were evaluated. Univariate and multivariate analyses were used to evaluate risk factors for TIVAP-related infection.ResultsA total of 607 patients (S group, n = 203; NS group, n = 404) were enrolled. The rates of TIVAP-related infection were 3.0% (n = 6) and 7.7% (n = 31) in the S and NS groups, respectively. The incidence of total infection per 1000 catheter-days were 0.114 and 0.214 the S and NS groups, respectively. In the entire group, the rates of infection were 6.1% (n = 37) and the incidence of total infection per 1000 catheter-days was 0.187. Univariate and multivariate analyses revealed a significantly lower TIVAP-related infection rate in S group than NS group (p = 0.0216, odds ratio = 2.88 confidence interval: 1.17–7.08). No gram-negative rods were detected in the S group as port infection.ConclusionSilver-mixed port may be feasible in preventing port infection.Level of evidence.Level 3, Local non-random sample.

Health-related quality of life in patients with solid tumors receiving implantable venous access ports for chemotherapy: A prospective randomized controlled trial

PurposeImplantable venous access ports are widely used in patients receiving chemotherapy, but there is still scarce evidence about any patient-reported outcome measures. This prospective randomized controlled trial examined the impact on patients’ quality-of-life following the placement of an implantable port device for long-term chemotherapy treatment. MethodA total of 120 chemotherapy naïve adult outpatients scheduled to receive chemotherapy (duration ≥12 weeks) for solid tissue tumors in a single academic oncology unit were randomly allocated (n = 60 in each arm) between radiologically guided insertion of an implantable venous access port (PORT arm) or standard repeated peripheral venous access (Control arm). Health-related quality-of-life scores (HRQoL) were assessed with the EQ-5D-5L and the oncology-specific EORTC QLQ-C30 (version 3.0) questionnaires at baseline, 3- and 6-months post randomization. Non-parametric tests were applied and differences between medians (Δ) are reported because of skewed-left HRQoL data. ResultsBaseline clinical and demographic characteristics were well balanced between the two groups. There were no complications during insertion and no infection or device failure in the PORT subjects through the 6-month follow-up. The functional and symptom scales of the EORTC QLQ-C30 questionnaire were similar between both study arms at all time intervals. The EORTC QLQ-C30 global health status was significantly improved in the PORT subjects both at 3 months (Δ: 8.3 out of 100; P = 0.04) and 6 months follow-up (Δ: 16.7 out of 100; P = 0.003). Changes in EQ-5D-5L scores were significantly improved at 6 months in the PORT arm compared to control (Δ: 0.074 out of 1; P = 0.01). ConclusionsImplantable venous access ports may confer significantly improved patient-reported quality-of-life benefits in patients receiving chemotherapy for solid tissue tumors.

SAT141 A Case Of Non-islet Cell Tumor Hypoglycemia Which Was Ameliorated By Pazopanib Treatment

Abstract Disclosure: N. Yamamoto: None. M. Yamamoto: None. N. Kiyota: None. Y. Inaba: None. K. Kanie: None. S. Urai: None. M. Suzuki: None. Y. Sasaki: None. Y. Oi: None. Y. Tsujimoto: None. Y. Motomura: None. Y. Ohmachi: None. H. Bando: None. G. Iguchi: None. M. Nagao: None. I. Fukuda: None. H. Fukuoka: None. W. Ogawa: None. Introduction: Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome caused by insulin-like growth factor II (IGF-II) hypersecretion from the tumors. It is characterized by incompletely processed big IGF-II with potent insulin-like activity. We present a case of NICTH complicated with solitary fibrous tumor (SFT) which was ameliorated with the administration of pazopanib, a multi-targeted tyrosine kinase inhibitor. Clinical Case: A 57-year-old man went into a coma and was hospitalized. His plasma glucose levels were 26 mg/dL, and he regained consciousness after glucose administration, leading to a diagnosis of hypoglycemic coma. Moreover, a contrast-enhanced CT scan showed multiple tumors in his liver and right kidney. He was referred to our hospital for further management. After 5 hours of fasting, he had a cold sweat, and his plasma glucose levels dropped to 32 mg/dL with suppressed serum insulin levels of 0.2 U/mL. Serum 3-hydroxybutyrate levels were as low as 21 μmol/L, and plasma glucose levels increased to 83 mg/dL after glucagon administration, suggesting an agent mimicking insulin. Percutaneous liver biopsy was performed, and the tumors were diagnosed with SFT. Immunoblotting for his serum showed big IGF-II, leading to a diagnosis of NICTH, and hypoglycemia due to hypersecretion of IGF-II. Due to multiple metastases, surgery was not indicated and pazopanib was administered. Hypoglycemia during the night was prevented by glucose infusion through the central venous port, and he was discharged. Three months later, when he was re-hospitalized for thrombophlebitis of the right jugular vein, hypoglycemia did not occur even after 10 hours of fasting and CT scan showed the necrotic change of the tumor. Two weeks later of pazopanib discontinuation due to the thrombogenic adverse effect, hypoglycemia recurred accompanied by the tumor enlargement. When the anticoagulation therapy regressed the thrombosis and pazopanib was re-administered, hypoglycemia improved reproducibly and remained stable for more than 2 years although the tumor showed gradual progression. Conclusion: This is the first case in which pazopanib was effective in suppressing NICTH associated with SFT. Presentation: Saturday, June 17, 2023

Percutaneous Transcatheter Retrieval of Central Venous Port Fragments in Pediatric Patients; A Single-center Experience From the Pediatric Cardiology Department.

Split/fracture and embolization of central venous/shunt catheters are rare but serious complications in children. Percutaneous retrieval of intravascular foreign bodies is an important minimal invasive treatment. This study is aimed to represent our largest pediatric sample experience till now of 17 years from a single institution. Another aim is to compare the results regarding the removal or leaving in place of embolized or ruptured intravascular or cardiac venous catheter parts in children. A total of 26 cases were included in this study. Any pediatric patient with normal coagulation parameters and a fractured catheter fragment was included in this study. Other intravascular foreign bodies related to interventional devices and/or pacemaker/implantable cardiac defibrillator leads were excluded from this study. Twenty-six patients, of whom 25 had oncologic diseases and 1 had a ventriculoatrial shunt, were included. The median age was 83.5 months (between 20 mo and 18 y) at treatment.Superior vena cava (9 cases), followed by the right atrium (5 cases), were the most two common sites of embolization for cardiovascular foreign bodies. The success rate of percutaneous retrieval was 92.3% in all patients. There were neither complications nor deaths. The retrieval technique revealed a predisposition for extraction through the femoral vein (96.1%) and using snare techniques (100%). Additional catheters like pigtail, National Institutes of Health, or ablation catheters were used for stabilization in selective cases in which the permanent central venous fragments stuck to the vessels. A tractional maneuver and capturing the ruptured material in the middle were other trick points for successful retrieval. Patients were asymptomatic in 76.9% of cases (20/26). Percutaneous retrieval of cardiovascular foreign bodies is a reasonable, safe, and effective way in children when the catheter fragments are free and mobile. It should be considered the preferred treatment option instead of surgery. In patients where catheter fragments are stuck and are adherent to vessels, it could be left, and followed up by anticoagulation. Novel techniques accompanied by an experienced team could be helpful in difficult cases.

A Retrospective Analysis of Venographic Images of a Central Venous Port without Blood Return and Its Usable Period.

Objective In routine practice, central venous ports without blood return (CVPWBRs) are common. However, very few studies have reported on the viable period of CVPWBR use. We therefore investigated this period by retrospectively analyzing the venographic images of CVPWBRs. Methods We examined patients' venography through the CVPs at the point when they became CVPWBRs for the first time and analyzed the reasons for becoming CVPWBRs. For patients with minor complications of CVPs or normal venographic findings, we used the Kaplan-Meier method to evaluate the period for which such CVPWBRs could be used. Patients or Materials Eighty-four patients with malignancy whose CVPs became CVPWBRs for the first time between July 31, 2015, and March 12, 2020, were included. Results Nine (10.7%) patients had major complications that made the CVPs unusable. Thirty-three (39.3%) patients had minor complications, and the remaining 42 (50.0%) had normal venographic findings. For the 75 patients with minor complications or normal venographic findings who continued to use their CVPWBRs, the Kaplan-Meier method estimated that 25% of complications that might make it unusable would occur within 1,273 days. Conclusion There are two learning points in our study. First, venography is needed when the CVP becomes a CVPWBR for the first time due to the high risk, and second, CVPWBRs can be used for a relatively long period in patients without major complications. It is necessary to develop an appropriate follow-up management method for CVPWBRs in prospective studies.

Effect of skinfold thickness on arm venous access port in cancer patients.

Currently, skinfold thickness in studies on arm venous access ports and the effect of venous access port application are unknown. A total of 256 cancer patients who underwent primary venous access port placement in the Fourth Hospital of Hebei Medical University from September 2022 to March 2023 were selected as the study subjects. Two hundred fifty-six patients were divided into normal skinfold thickness group and high skinfold thickness group according to skinfold thickness. The success rate of primary catheterization of arm venous port catheterization, catheterization operation time, catheterization length and incidence rate of adverse reactions were compared. There was no significant difference in the basic data between the two groups. There was no significant difference in the success rate of primary catheterization between the two groups (p>0.05), the catheterization operation time in the normal skinfold thickness group was significantly lower than that in the high skinfold thickness group (p<0.05), the total length of the implanted catheter in the normal skinfold thickness group was significantly lower than that in the high skinfold thickness group (p<0.05), and the incidence of adverse reactions in the normal skinfold thickness group was significantly lower than that in the high skinfold thickness group (p<0.05). In cancer patients, skinfold thickness can significantly affect the application effect of arm venous port, and normal skinfold thickness for arm venous port has shorter operation time, total length of implanted catheter and lower incidence of adverse reactions.

Value of a novel Y-Z magnetic totally implantable venous access port in improving the success rate of one-time needle insertion.

A totally implantable venous access port (TIVAP) is a commonly used intravenous infusion device for patients receiving chemotherapy or long-term infusion therapy. To improve the success rate of one-time insertion of the Huber needle, we developed a novel Y-Z magnetic TIVAP (Y-Z MTIVAP), which we produced using three-dimensional printing technology. The Y-Z MTIVAP includes a magnetic port body and a magnetic positioning device. For testing, we established four venous port implantation models using the two types of TIVAPs and two implantation depth ranges (≤5 mm and >5 mm). Twenty nurses performed Huber needle puncture with the four models, and we recorded the number of attempts required for successful needle insertion, the operation time, and the operator's satisfaction. The success rate for one-time needle insertion with the Y-Z MTIVAP was significantly higher than that with the traditional TIVAP at either depth range (100% vs. 75% at ≤5 mm, p = 0.047; 95% vs. 35% at >5 mm, p < 0.001). With increasing implantation depth, the success rate for one-time insertion was significantly reduced with the traditional TIVAP (75% at ≤5 mm vs. 35% vs. >5 mm, p = 0.025), but the success rate with the Y-Z MTIVAP was not significantly affected (100% vs. 95%, p = 1.000). The operation time with the Y-Z MTIVAP was significantly shorter than that with the traditional TIVAP at either depth range (both p < 0.001), and 90% of operators reported that the Y-Z MTIVAP was superior to the traditional TIVAP. The theoretical design of Y-Z MTIVAP is feasible, and the preliminary in vitro simulation experiment shows that it can significantly improve puncture success rate and shortened operation time.

Application of wireless energy transmission technology into central venous ports with light-emitting diodes.

Implantable central venous (CV) ports are widely used for chemotherapy and parenteral nutrition. Generally, CV ports are used safely; however, some patients suffer from drug leakage around the port septum due to mispuncture. Therefore, we developed a CV port that is visible under the skin. We created a prototype of a CV port using a 3D printer. Three red light-emitting diodes (LEDs) were attached around the septum that made the puncture site visible by applying wireless energy transmission technology using electromagnetic resonance. The CV port was implanted under the skin of pork rose meat. The thickness of the skin of pork loin was measured. Fifteen medical doctors participated in the study to visually confirm the lighted CV port. The visibility of the center of the septum with and without lights was scored 0 as non-diagnostic; 1, slightly visible; 2, well visible; and 3, obviously visible. The visibility with or without lights was assessed. The relationship between the years of experience and the visibility score was assessed. The Wilcoxon test was used for statistical analysis. LEDs were easily transmitted through the skin of pork rose meat. The median visibility scores with or without lights were 2 (range, 1-3) and 3 (range, 1-3), respectively (p = 0.005). No significant relationship was found between experience and visibility score (p = 0.289). CV ports with LEDs can be easily recognized compared with those without LEDs. This technique may contribute to medical safety by improving its visibility to avoid mispuncture.

Catheter misplacement from an implantable central venous access port into the internal thoracic vein: a case description.

Catheter misplacement from an implantable central venous access port into the internal thoracic vein: a case description.

THE EFFECTS OF CANCER’S METASTATIC STATUS AND CHEMOTHERAPY ON TOTALLY IMPLANTABLE VENOUS ACCESS PORT PATENCY AND PORT-RELATED VENOUS THROMBOEMBOLIC EVENTS

Objective: Totally implantable venous access port (TIVAP) is of great importance as a vascular access route in the treatment of cancer patients. In this study, we retrospectively researched the effects of cancer types, metastases, chemotherapeutic drugs, and intervention sites on port patency and TIVAP-related venous thromboembolism (VTE).&#x0D; Method: Demographics, cancer types, metastases, vascular access sites, chemotherapy drugs, TIVAP patency and TIVAP related complications were evaluated in 297 patients who had TIVAP implanted and 37 patients who underwent removal in our clinic between 2017-2021.&#x0D; Results: TIVAP implanted 297 patients were followed-up for a mean 17.7±16.6 months. TIVAPs were removed in 37 patients due to infection 14 (4.7%), occlusion 8 (2.7%), VTE 9 (3%), malposition 1 (0.3%), and treatment completion 10 (3.3%). TIVAPs of 270 (90.9%) patients were found to be usable for an average of 18.5±17.1 months. Complications of VTE, occlusion, infection and malposition developed in a total of 71 (23.9%) patients. In the comparison of develepment of these complications according to the presence of metastasis in patients, it was found to be that they were significantly higher in metastatic patients (47-27.9%/24-18.6%, p

Replacement of implantable venous access port and nursing management for a patient with port exposure on the upper arm

Replacement of implantable venous access port and nursing management for a patient with port exposure on the upper arm

Risk factors and prognostic significance of infection of totally implantable vascular access port in solid tumor patients: A prospective cohort study

ObjectivesTotally implantable venous access ports (TIVAP) are devices mainly used to deliver antineoplastic chemotherapies, of which the insertion may be complicated by TIVAP-related infection (TIVAP-RI). This study aims to provide data on the risk factors for TIVAP-RI and its influence on patient prognosis. Patients and methodsProspective observational study including adult patients with solid tumors, in whom a TIVAP was inserted to deliver antineoplastic chemotherapy between January 2018 and October 2019. Factors associated with TIVAP-RI and one-year mortality were determined using multiple logistic regressions. ResultsMore than a thousand (1014) patients were included, among whom 48 (4.7%) presented with TIVAP-RI. Gram-positive cocci and Gram-negative bacilli represented 51% and 41% of the pathogens isolated, respectively. Young age (odds ratio [OR] 0.67; 95% Confidence Interval [0.53–0.83] per 10-year increase), WHO performance status ≥ 1 (OR 3.24 [1.52–7.79]), chemotherapy administration in the month before TIVAP placement (OR 2.26 [1.17–4.26]), and radiation therapy of the homolateral chest wall (OR 3.28 [1.51–6.67]) were independently associated with TIVAP-RI occurrence. During the year following TIVAP insertion, 287 (28%) patients died. TIVAP-RI was not associated with one-year mortality (OR 1.56 [0.75–3.19]). ConclusionTIVAP insertion in adult patients with solid tumors is associated with a low infection rate, which did not influence one-year mortality. In addition to young age and impaired health status, TIVAP insertion in the month following initiation of the antineoplastic chemotherapy and TIVAP insertion in an irradiated area are two newly reported preventable TIVAP-RI risk factors.

Adoption of nanoparticle micro-infusion valve in venous port access for tumor patients and self-care analysis.

It aimed to discuss the adoption of nanoparticle micro-infusion valves in the totally implantable venous access port (TIVAP) of tumor patients and analyze the self-care of patients after surgery. A total of 189 tumor patients who received TIVAP chemotherapy were selected from the day chemotherapy outpatient department of the Second People's Hospital of Lianyungang City from June to October 2021. The questionnaire survey was conducted to collect and analyze the general information about the patients and the patient's self-care ability. All the surveys and analyses were performed using a general information questionnaire, self-care competence scale, self-management efficacy scale, social support scale, and self-rating anxiety scale. Moreover, the nanoparticle micro-infusion valve was prepared, and its characterization, in vitro drug release, and cytotoxicity were studied. The self-management ability of patients was concentrated in the middle and high levels. Marital status, education level, and economic status all had a great impact on the patient's self-care ability. The infusion of dithiothreitol (DTT) increased the drug release of the nanoparticle micro-infusion valve. When pH=5.0, the drug-loaded nanoparticle micro-infusion valve release amount was greater than when pH=7.4. When pH=5.0 and pH=7.4, the cell survival rates under the drug-loaded nanoparticle micro-infusion valve were both lower than that without drug loading. Nanoparticle micro-infusion valves can specifically identify tumor cells, and have good adoption prospects in TIVAP implantation in tumor patients. Gender, marital status, education level, etc. all affected the self-care ability of patients.

Postprocedural Patient Instructions for Central Venous Ports and Biliary Tubes: Assessment of Clinical Benefit and Impact on Quality of Life

BackgroundThis study aimed to demonstrate that despite their potentially significant impact on patient quality of life (QOL), many postprocedural practices for central venous port (CVP) placement, biliary tube (BT) placement, and BT change may not be evidence-based. MethodsA mixed-methods, institutional review board–approved, cross-sectional survey was conducted to assess impact of written postprocedural instructions on QOL in patients who underwent CVP placement and BT placement or change at a single center between April 2018 and May 2020, followed by a targeted literature search for evidence pertaining to the instructions patients noted were most detrimental to QOL. ResultsFifty seven of 840 (6.8%) of contacted CVP patients and 52/166 (31.3%) of contacted BT patients participated in the study. Four instructions (one from CVP and three from BT) were identified as having greater negative than positive responses based on a seven-point Likert scale of impact on QOL: the CVP instruction related to avoiding repetitious movements of the arm, while the BT instructions related to avoiding sleeping on the tube, submerging in water, and daily dressing changes. A Medline database literature search did not demonstrate substantial evidence supporting the implementation of these instructions postprocedurally. DiscussionInstructions regarding avoiding repetitious movements of the arm, sleeping on the BT, and changing the dressing daily have no evidence-based clinical benefit on outcomes and have a negative impact on patient QOL. Due to risk of antibiotic-resistant infection (e.g., Pseudomonas) from showering or swimming, BT submersion should be avoided.

Effect of lidocaine spray on relieving non-coring needle puncture-related pain in patients with totally implantable venous access port: a randomized controlled trial

PurposePatients with the placement of a totally implantable venous access port (TIVAP) commonly suffer from pain caused by inserting a non-coring needle. At present, lidocaine cream and cold spray are extensively used for pain management, but they are complex to manage in busy medical environments and developing countries. The lidocaine spray combines the analgesic effect of lidocaine cream and the rapid onset of cold spray, which can effectively alleviate the pain related to non-coring needle puncture in patients with TIVAP. This randomized-controlled trial aimed to explore the effectiveness, acceptability, and safety of lidocaine spray in relieving the pain of non-coring needle puncture in patients with TIVAP.MethodsA total of 84 patients who were hospitalized in the oncology department of a Grade III Level-A hospital in Shanghai from January 2023 to March 2023 and were implanted with TIVAP and required non-coring needle puncture were selected as the study subjects. The recruited patients were randomly assigned to the intervention group and the control group (n=42). Before routine maintenance, the intervention group received lidocaine spray 5 min before disinfection, while the control group received water spray 5 min before disinfection. The main clinical outcome was pain, and the degree of puncture pain in both groups was evaluated using the visual analogue scale.ResultsThere were no significant differences between the two groups in age, gender, educational level, body mass index, port implantation time, and disease diagnosis (P>0.05). The pain score in the intervention and control groups was 15.12±6.61mm and 36.50±18.79mm, respectively (P<0.001). There were 2 (4.8%) patients with moderate pain in the intervention group and 18 (42.9%) patients with moderate pain in the control group (P<0.001). In the control group, 3 (7.1%) patients reported severe pain. The median comfortability score for the two groups of patients was 10, but there was a difference between the two groups (P<0.05) because the intervention group tilted to the right. The successful puncture rate of the first time puncture had no difference between the two groups, both being 100%. Moreover, 33 patients (78.6%) in the intervention group and 12 patients (28.6%) in the control group reported that they would choose the same spray for intervention in the future (P<0.001). During the 1 week of follow-up, 1 patient in the intervention group developed skin itching (P>0.05).ConclusionsThe local use of lidocaine spray in patients with TIVAP is effective, acceptable, and safe to alleviate the pain caused by non-coring needle puncture.Trial registrationChinese Clinical Trial Registry (registration number: ChiCTR2300072976)

Procedural Utilization and Productivity of Advanced Practice Providers in Private and Academic Interventional Radiology

PurposeComparative data on Advanced Practice Providers (APPs) in interventional radiology (IR) is helpful to understand APP utilization in different practice settings. Materials and MethodsA 60-question survey was distributed to 3159 IRs on the Society of Interventional Radiologists Doctor Finder, with 357 responses (11.3% response rate). Respondents represented 258 practices, 100 (39%) academic interventional radiology (AIR), and 158 (61%) private practice interventional radiology (PPIR), in 40 states. ResultsAPPs generated on average 2442 ± 1824 work Relative Value Units/APP group/year (n = 42), with no significant differences between practice models (p = .31). Most APPs did not work weekends (74%, n = 189) or take overnight call (90%, n = 190). The most reported procedures by APPs included paracentesis/thoracentesis (93%), venous access peripherally inserted central catheter placement (63%), and fluoroscopy-guided lumbar puncture (57%). AIR APPs were more likely to perform venous tunneled catheter placement (p = .003) and venous access port placement (p = .003), whereas PPIR APPs were more likely to perform joint injections (p < .001) ConclusionSelf-reported data from PPIR and AIR groups shows that APPs perform a myriad procedure with variation between practice models.

Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version).

The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.

Comparison of Short-Term Infectious Rates Related to Implantable Venous Port Placement With and Without Prophylactic Antibiotic Administration

Abstract The purpose of this study is to determine the rate of short-term central line-associated bloodstream infections (CLABSI) related to port placement in patients who received prophylactic intravenous antibiotics compared with those who did not receive prophylactic antibiotics. A retrospective review of 545 consecutive patients who underwent implantable port placement at Mayo Clinic, Rochester, Minnesota, from May 2020 to June 2021 was conducted. A total of 270 patients underwent port placement with prophylactic antibiotics administration. A total of 275 patients underwent port placement without the administration of antibiotics. The rate of short-term or 30-day CLABSI in both groups was reviewed. Indications for port placement included vascular access for chemotherapy and need for long-term vascular access for intravenous hydration, intravenous immunoglobulin infusion, electroconvulsive therapy, and photophoresis. Short-term infections occurred in a total of 3 of 545 patients (0.55%). Rate of short-term infection in patients who had port placement without prophylactic antibiotics was 2 of 275 (0.72%). Rate of short-term infection in patients who underwent port placement with prophylactic antibiotics was 1 of 270 (0.37). All 3 patients presented with bacteremia and were treated with port explantation and intravenous antibiotics. Overall, 30-day CLABSI in 545 patients who underwent port placement was 0.55%. There was no significant difference in the rate of short-term infections in the group who received prophylactic antibiotics (0.37%) compared with patients who did not receive any preprocedural antibiotics (0.72%).

Cephalic Vein Cut-Down Method for Totally Implantable Venous Access Ports: A Single-Institution Experience

The widespread use of chemotherapies has increased the need for totally implantable venous access ports (TIVAPs). Previously, the subclavian puncture approach with the landmark technique was the most used implantation method; however, it has been related to early complications, such as pneumothorax, hemothorax, and arterial puncture. Therefore, a safer implantation method is required. This study aimed to assess the safety and efficacy of the cephalic vein cut-down method used in our institution. Patients who underwent TIVAPs implantation using the cephalic vein cut-down method as the first choice between January 1, 2018, and December 31, 2020, were included in this study. We retrospectively evaluated the technical success rates, operation times, and early complications. This study included 221 adult patients (men, 129; women, 92), with a mean age of 68±11 years. The mean body mass index (BMI) was 21±4 kg/m2. A total of 213 patients (96.4%) had malignant tumors that required chemotherapy. The mean postoperative follow-up period was 659±442 days (range, 5-1698 days). A total of 127 patients (57.5%) died during the follow-up period. The technical success rate was 86.4% (191/221). There were 30 failures, 24 of which were converted to the subclavian vein puncture approach. The mean operation time was 53±21 minutes. Early complications were observed in 4 (1.8%) patients, corresponding to an incidence of 0.028 complications/1,000 catheter-days. One patient had an unintended arterial puncture; however, it was not a result of the cephalic vein cut-down method, but a secondary result of the subclavian vein puncture. No complications of pneumothorax, hemothorax, or arterial puncture was observed with the cephalic vein cut-down method. This study showed that the cephalic vein cut-down method for TIVAPs had an acceptable success rate and fewer early complications than the conventional puncture techniques.

Dual ultrasound-guided totally implantable venous access ports via the right internal jugular vein in pediatric patients with cancer: a preliminary experience in a single institution

ObjectiveTo assess the efficacy and safety of dual ultrasound-guided (DUG) totally implantable venous access port (TIVAP) implantation (namely, using ultrasound-guided percutaneous puncture with transesophageal echocardiography-guided catheterization) via the right internal...