Early and late complications of totally implantable venous access devices

Summary. Background: To retrospectively evaluate the success rates, peri-interventional, early and late complications and patient satisfaction associated with power-injectable totally implantable venous access devices (TIVAPs). Patients and methods: Between April 2011 and March 2016, a total of 1,203 TIVAPs were implanted in 1,169 patients. Ultrasound-guided, fluoroscopically controlled implantation was performed through the subclavian or internal jugular vein. The systematic analysis focused on the rate of successful port implantations, the frequency of peri-interventional, early and late complications and on how the experience of the implanting radiologist impacts these parameters. Additionally, a standardized questionnaire was administered to the 102 study patients in a telephone interview to survey their subjective rating of the port implantation. Results: 99.5 % of TIVAPs were implanted successfully. In 4 out of 6 patients, the implantation was repeated successfully at a later time. Complication rates were 1.4 % (0.0512/1.000 catheter days) for peri-interventional, 2.9 % (0.081 per 1,000 catheter days) for early and 8.3 % (0.2288 per 1,000 catheter days) for late complications. The radiologist’s experience level and vein selection did not have a significant impact. Most peri-interventional complications (82.4 %) were of minor severity. The early (61.5 %) and late (65.6 %) complications were more frequently of major severity. Interventions to manage complications comprised port explanation in 46.9 %, conservative therapy in 17.4 % and interventional therapy in 12.2 %. At 1 and 3 months after port placement, the majority were satisfied or very satisfied with the interventional port implantation. Conclusions: Ultrasound-guided, fluoroscopically controlled implantation of TIVAPs is a safe procedure with low complication rates, high success rates and high patient satisfaction.

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Complications of totally implantable venous access devices: experience with 852 Moroccan cancer patients

International Surgery Journal ◽

10.18203/2349-2902.isj20180961 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1171

Author(s):

Aziz Bazine ◽

Mohamed Fetohi ◽

Akram Traibi ◽

Fouad Atoini ◽

Walid Bakzaza ◽

...

Keyword(s):

Cancer Patients ◽

Venous Access ◽

Late Complications ◽

Military Hospital ◽

Published Data ◽

Cervical Hematoma ◽

Chemotherapy Administration ◽

Solid Malignancies ◽

The Military ◽

Venous Access Devices

Background: Totally implantable venous access devices (TIVADs) provide easy vascular access in cancer patients for chemotherapy administration, blood products, parenteral nutrition and blood sampling. However, they are associated with several complications which can be divided into early and late. The aim of the present study was to evaluate the various complications related to TIVADs in a single center in Morocco.Methods: This was a retrospective, observational, descriptive study conducted at the Medical Oncology Department of the Military Hospital Moulay Ismail in Meknes, Morocco, during a 6-year period, between January 1st, 2011 and December 31st, 2016. Author included all patients older than or equal to 18 years, with solid malignancies who had TIVAD placement for chemotherapy.Results: A total 852 TIVADs were placed. There were 92 complications (10.8% of patients). Early complications included 16 (1.9%) cases of pneumothorax and 12 (1.4%) cases of arterial puncture with a cervical hematoma. Infection was the most common late complications (2.8%), followed by thrombosis (1.8), extravasations of cytotoxic drugs (1.3%), mechanical dysfunction of the catheter (1.3%) and skin necrosis (0.3%).Conclusions: The results of the analysis confirm the safety and tolerability of TIVADs for chemotherapy administration in Moroccan patients, with similar rates of early and late complications compared to the published data.

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In defense of the use of peripherally inserted central catheters in pediatric patients

The Journal of Vascular Access ◽

10.1177/1129729820936411 ◽

2020 ◽

pp. 112972982093641

Author(s):

Alessandro Crocoli ◽

Simone Cesaro ◽

Monica Cellini ◽

Francesca Rossetti ◽

Luca Sidro ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Late Complications ◽

Central Venous ◽

Central Venous Access Device ◽

Peripherally Inserted Central Catheters ◽

Non Invasive ◽

Venous Access Device ◽

Central Catheters ◽

Venous Access Devices

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

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Totally Implantable Venous Access Devices – 20 Years' Experience of Implantation in Cystic Fibrosis Patients

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x321684 ◽

2008 ◽

Vol 90 (8) ◽

pp. 679-684 ◽

Cited By ~ 27

Author(s):

T James Royle ◽

Ruth E Davies ◽

Mark X Gannon

Keyword(s):

Cystic Fibrosis ◽

Life Span ◽

Central Venous Access ◽

Venous Access ◽

Late Complications ◽

Electronic Patient Records ◽

Tertiary Referral Centre ◽

Fluoroscopic Control ◽

Venous Access Devices

INTRODUCTION Totally implantable venous access devices (TIVADs) are widely used to provide long-term, central venous access for antibiotic delivery in cystic fibrosis patients. However, few studies have demonstrated long-term follow-up with large cohorts. PATIENTS AND METHODS This is a retrospective review of TIVADs implanted in cystic fibrosis patients by vascular surgeons at a tertiary referral centre, using an open venous cut-down technique, from March 1986 to July 2006. The cephalic vein was preferentially chosen for line placement, in the deltopectoral groove, under fluoroscopic control. TIVAD performance (life-span or survival) and complications were evaluated. Data were extracted by review of a local database (data collated prospectively since 1986), with supplementation from electronic patient records and medical notes. RESULTS In total 165 TIVADs in 109 patients (34 males, 75 females) were reviewed. Median survival was 1441 days (range, 6–4440 days). Cumulative patency was 146,072 catheter-days. No immediate intrathoracic complications (pneumothorax, haemothorax, nerve injury) occurred. There were 3 early and 82 late complications, namely: occlusion (33 TIVADs; median age 510 days), infection (23 TIVADs; median 376 days), leakage (16; median 283 days), pain or discomfort (6), venous thrombosis (5), extravasation/skin necrosis (1), vegetation in right atrium (1). Overall incidence of complications was 0.58 per 1000 catheter-days. CONCLUSIONS This study concurs with others that TIVADs are safe and effective, with a favourable life-span in cystic fibrosis patients if well looked after in a specialist centre. Complications of infection, leakage and occlusion do occur. Using an open, venous cut-down technique with fluoroscopic control avoids any immediate intrathoracic complications.

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The removal and morphology of intact biofilms from implanted venous access devices

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100141470 ◽

1995 ◽

Vol 53 ◽

pp. 1020-1021

Author(s):

M.A. Gregory ◽

G.P. Hadley

Keyword(s):

Patient Selection ◽

Surgical Oncology ◽

Venous Access ◽

Common Procedure ◽

Indwelling Catheters ◽

Careful Patient ◽

Novel Method ◽

The Subject ◽

Vascular Catheters ◽

Venous Access Devices

The insertion of implanted venous access systems for children undergoing prolonged courses of chemotherapy has become a common procedure in pediatric surgical oncology. While not permanently implanted, the devices are expected to remain functional until cure of the primary disease is assured. Despite careful patient selection and standardised insertion and access techniques, some devices fail. The most commonly encountered problems are colonisation of the device with bacteria and catheter occlusion. Both of these difficulties relate to the development of a biofilm within the port and catheter. The morphology and evolution of biofilms in indwelling vascular catheters is the subject of ongoing investigation. To date, however, such investigations have been confined to the examination of fragments of biofilm scraped or sonicated from sections of catheter. This report describes a novel method for the extraction of intact biofilms from indwelling catheters.15 children with Wilm’s tumour and who had received venous implants were studied. Catheters were removed because of infection (n=6) or electively at the end of chemotherapy.

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Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650254 ◽

1996 ◽

Vol 75 (02) ◽

pp. 251-253 ◽

Cited By ~ 264

Author(s):

Manuel Monreal ◽

Antoni Alastrue ◽

Miquel Rull ◽

Xavier Mira ◽

Jordi Muxart ◽

...

Keyword(s):

Cancer Patients ◽

Upper Extremity ◽

Statistical Significance ◽

Central Venous Access ◽

Venous Access ◽

Bleeding Complications ◽

Fisher Exact Test ◽

Central Venous ◽

True Incidence ◽

Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

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Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180817125036 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-49

Author(s):

Basant K. Puri ◽

Anne Derham ◽

Jean A. Monro

Keyword(s):

Bloodstream Infection ◽

Antibiotic Treatment ◽

Central Venous Access ◽

Case Series ◽

Bloodstream Infections ◽

Venous Access ◽

Host Cells ◽

Central Venous ◽

Intravenous Antibiotic ◽

Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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A Psychometric Validation of the Decisional Conflict Scale in Italian Cancer Patients Scheduled for Insertion of Central Venous Access Devices

Anticancer Research ◽

10.21873/anticanres.14571 ◽

2020 ◽

Vol 40 (10) ◽

pp. 5583-5592

Author(s):

MARIA ROSARIA ESPOSITO ◽

ASSUNTA GUILLARI ◽

FRANCESCO GIANCAMILLI ◽

TERESA REA ◽

MICHELA PIREDDA ◽

...

Keyword(s):

Cancer Patients ◽

Central Venous Access ◽

Venous Access ◽

Decisional Conflict ◽

Psychometric Validation ◽

Central Venous ◽

Decisional Conflict Scale ◽

Venous Access Devices ◽

Conflict Scale

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An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion

The Journal of Vascular Access ◽

10.1177/11297298211023275 ◽

2021 ◽

pp. 112972982110232

Author(s):

Sonia D’Arrigo ◽

Maria Giuseppina Annetta ◽

Mauro Pittiruti

Keyword(s):

Venous Thrombosis ◽

Real Time ◽

Venous Access ◽

Central Venous ◽

Safe Method ◽

Central Venous Port ◽

Catheter Malfunction ◽

Bubble Test ◽

Current Guidelines ◽

Venous Access Devices

Persistent withdrawal occlusion is a specific catheter malfunction characterized by inability to withdraw blood through the device while infusion is maintained. The main causes are fibroblastic sleeve and tip malposition (associated or not to venous thrombosis around the tip). All current guidelines recommend infusing vesicant/antiblastic drugs through a central venous port only after assessment of blood return. In PWO, blood return is impossible. We have recently started to assess the intravascular position of the tip and the delivery of the infusion in the proximity of the cavo-atrial junction utilizing transthoracic/subxiphoid ultrasound with the ‘bubble test’. We found that this is an easy, real-time, accurate and safe method for verifying the possibility of using a port for chemotherapy even in the absence of blood return, as it occurs with persistent withdrawal occlusion.

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