Wound Healing Failure Following Venous Access Chest Port Placement Associated with Ramucirumab Therapy

We report on a patient who was referred for port implantation with a two-chamber pacemaker aggregate on the right and total occlusion of the central veins on the left side. Venous access for port implantation was performed via left side puncture of the horizontal segment of the anterior jugular vein system (AJVS) and insertion of the port catheter using a crossover technique from the left to the right venous system via the jugular venous arch (JVA). The clinical significance of the AJVS and the JVA for central venous access and port implantation is emphasised and the corresponding literature is reviewed.

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Ultrasound-Guided Arm Ports: Indications, Techniques, and Management

Journal of the Association for Vascular Access ◽

10.1016/j.java.2014.11.001 ◽

2015 ◽

Vol 20 (1) ◽

pp. 26-31 ◽

Cited By ~ 3

Author(s):

Pierre Yves Marcy ◽

Alexis Lacout ◽

Juliette Thariat ◽

Andrea Figl ◽

Jacques Merckx

Keyword(s):

Venous Access ◽

Us Guidance ◽

Vein Access ◽

Chest Port ◽

Anatomic Variants ◽

Access Technique ◽

Central Catheters ◽

Venous Access Devices ◽

Port Catheters

AbstractPurpose: Various venous access devices are available, including peripheral venous lines, peripherally inserted central catheters lines, and subcutaneous port catheters. The latter provides medium-to long-term venous access and includes medical devices that can be inserted either on the chest (chest ports) or in the arm (arm ports). We report the techniques, dedicated indications, and main complications of arm port insertion using the ultrasonography (US) guidance method.Methods: Tips and tricks of percutaneous real-time US-guided vein access technique in the arm are reviewed, and a brief literature review is reported.Results: Technical feasibility is almost 99%. US guidance allows depiction of anatomic variants, reduces the number of failed attempts, and increases the technical access rate compared with venography-guided access. Comparison of arm ports to chest ports reveals a higher global complication rate. We also report typical (mechanical) complications and dedicated indications, including contraindications to chest port insertion and selected patients for whom chest ports are not possible (eg, those with breast, head, and neck cancer; obesity; cosmesis; and requiring upright position).Conclusions: Arm port insertion under US guidance is safe and effective, and has dedicated indications.

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Chemotherapy port placement in breast cancer patients in a resource constrained setting: hurdles and outcomes

International Surgery Journal ◽

10.18203/2349-2902.isj20211422 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1439

Author(s):

Navin Rajendra Kasliwal ◽

Satish Sonawane

Keyword(s):

Venous Access ◽

Marrow Transplant ◽

Solid Cancer ◽

Breast Cancers ◽

Breast Cancer Patients ◽

Port Placement ◽

Solid Malignancy ◽

Long Term Follow Up ◽

Life Threatening

Background: Safe long-term venous access is essential in cancer undergoing chemotherapy, bone marrow transplant or supportive management in some conditions. Implanted devices are of choice here but under-utilised. Our review focuses on evaluating the reasons for this underutilisation so as to promote the use of chemo port in specific situations.Methods: 245 patients undergoing port placement in a socio-economically constrained zone were analysed with regard to multiple clinical, social and logistical parameters and long-term follow-up assessed.Results: Solid malignancy was the most common indication for port placement followed by hemato-lymphoid cancers. Breast cancers are the commonest solid cancer for Port placement. In our evaluation patients having chemotherapy ports were less worried about the upcoming chemo procedures because of the ease of IV access, resulting in better compliance and quality of life. Cost of the device and absence of expertise for placement and handling were the primary reasons for reluctance of port placement. Port related complications were few, not life threatening, and insignificant in the long term.Conclusions: Placement of a Chemotherapy port is a technique with an easy learning curve and a good safety profile. Procedural and long term complications are few and acceptable. Costs are acceptable in the long term and are beneficial to the patient. This method to needs to be promoted in patients needing long-term venous access. Adequate training will promote acceptance and use of the chemo-port. Clinicians should adopt and offer this for all indicated patients.

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Placing a Jugular Port Without Direct Percutaneous Jugular Vein Access

10.1093/med/9780199986071.003.0043 ◽

2018 ◽

Author(s):

Michael Rush ◽

Cynthia Toot Ferguson ◽

S. Lowell Kahn

Keyword(s):

Site Selection ◽

Jugular Vein ◽

Venous Access ◽

High Rate ◽

Technical Success ◽

Small Incision ◽

Venous Circulation ◽

Vein Access ◽

Chest Port ◽

Low Rate

A traditional subcutaneous port requires creation of a subcutaneous reservoir for the port and a separate small incision at the point of venous access, most commonly the internal jugular vein. The catheter of the port is tunneled from the port reservoir to the venous access incision and placed centrally through a peel-away sheath. Placing a subcutaneous jugular port without direct percutaneous jugular vein access is a skill that can be employed by the interventional radiologist and is described in this chapter. Considerations for site selection, accessing venous circulation, and appropriate placement of the port reservoir are described. This method of implanting a subcutaneous chest port has a high rate of technical success and low rate of complications.

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Risk Factors of Infection and Role of Antibiotic Prophylaxis in Totally Implantable Venous Access Port Placement: Propensity Score Matching

CardioVascular and Interventional Radiology ◽

10.1007/s00270-019-02255-0 ◽

2019 ◽

Vol 42 (9) ◽

pp. 1302-1310 ◽

Cited By ~ 6

Author(s):

Nariman Nezami ◽

Minzhi Xing ◽

Matthew Groenwald ◽

Douglas Silin ◽

Nima Kokabi ◽

...

Keyword(s):

Risk Factors ◽

Propensity Score ◽

Antibiotic Prophylaxis ◽

Propensity Score Matching ◽

Venous Access ◽

Port Placement ◽

Access Port ◽

Venous Access Port

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Percutaneous versus Cut-Down Technique for Indwelling Port Placement

The American Surgeon ◽

10.1177/000313481708301214 ◽

2017 ◽

Vol 83 (12) ◽

pp. 1336-1342

Author(s):

Mario Matiotti-neto ◽

Mariam F. Eskander ◽

Omidreza Tabatabaie ◽

Gyulnara Kasumova ◽

Lindsay A. Bliss ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Operative Time ◽

Venous Access ◽

Interquartile Range ◽

Implantation Failure ◽

Port Placement ◽

Oncologic Patients ◽

Percutaneous Catheterization ◽

Venous Access Devices

The superiority of surgical cut-down of the cephalic vein versus percutaneous catheterization of the subclavian vein for the insertion of totally implantable venous access devices (TIVADs) is debated. To compare the safety and efficacy of surgical cut-down versus percutaneous placement of TIVADs. This is a single-institution retrospective cohort study of oncologic patients who had TIVADs implanted by 14 surgeons. Primary outcomes were inability to place TIVAD by the primary approach and postoperative complications within 30 days. Multivariate analysis was performed by logistic regression. Secondary outcomes included operative time. Two hundred and forty-seven (55.9%) percutaneous and 195 (44.1%) cephalic cut-down patients were identified. The 30-day complication rate was 5.2 per cent: 14 patients (5.7%) in the percutaneous and nine (4.6%) in the cut-down group. The technique was not a significant predictor of having a 30-day complication (odds ratio = 0.820; 95% confidence interval 0.342–1.879). Implantation failure was observed in 16 percutaneous patients (6.5%) and 28 cut-down patients (14.4%) (adjusted odds ratio for cephalic vs cut-down = 2.387; 95% confidence interval 1.275–4.606). The median operative time for percutaneous patients was 46 minutes (interquartile range = 35, 59) versus 37.5 minutes (interquartile range = 30, 49) for cut-down patients(P < 0.0001). Both the percutaneous and cut-down technique are safe and effective for TIVAD implantation. Operative times were shorter and the odds of implantation failure higher for cephalic cut-down. As implantation failure is common, surgeons should familiarize themselves with both techniques.

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