A totally implantable venous access device (TIVAD) abandoned for 5 years is re-accessed normally: A case report and literature review

2021 ◽  
pp. 112972982110396
Author(s):  
Jiaobo He

Regular flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. In this case report, a 73-year-old male patient received radical resection for rectal carcinoma in January 2010. A TIVAD was implanted in 2014 and a total of 12 rounds of chemotherapy of FOLFIRI was completed in 2015. During the period from 2015 to 2020, the patient never used or conducted the monthly infusion port flushing because of the inconvenience, the COVID-19 pandemic, and so on. On 18th April 2020, the patient was admitted to the radiotherapy department of Yiwu Central Hospital. The nurse evaluated the TIVAD upon admission, finding that the skin around the reservoir was normal without any sign of infection as erythema or induration of the skin overlying the implantable port but there was intraluminal occlusion of the devices. In order to re-access the catheter, discussion of a MDT was performed and several days of unremitting efforts were tried. Gratifyingly, the patient’s port was re-accessed successfully without any adverse reactions. This is a rare infusion port that has not been used and maintained for 5 years. For the port that has not been used and maintained for a long time up to 5 years, the medical staff should not give up easily. During the COVID-19 pandemic, prolonging the flushing interval of TIVADs can be an optimal clinical strategy without negative outcomes.

2019 ◽  
Vol 20 (5) ◽  
pp. 563-566 ◽  
Author(s):  
Fumito Saijo ◽  
Mitsuhisa Mutoh ◽  
Joho Tokumine ◽  
Odaka Yoshinobu ◽  
Hikaru Hama ◽  
...  

Background: Totally implantable venous access devices are valuable tools for total parenteral nutrition, chemotherapy, and long-term intravenous therapy. However, late catheter fracture is a well-known complication of totally implantable venous access device, particularly in Groshong silicone catheter. Recently, a specific type of totally implantable venous access device made with Groshong silicone has been introduced to facilitate power injection of contrast medium for enhanced computed tomography. Cases description: We reported three cases of catheter fracture in power-injectable Groshong silicone totally implantable venous access device. From May 2012 to August 2014, 66 patients underwent power-injectable Groshong silicone totally implantable venous access device implantation at our institution, with a median follow-up of 20.1 (range 0.2–58.1) months. The catheters in all patients were inserted into the internal jugular vein under ultrasound guidance and were connected to the port implanted in the upper chest through the subcutaneous tunnel. Chemotherapy was administered using these routes. Fractures of all three cases specifically showed a torn catheter section: smooth surface on one side, and a rough edge on the other side of the catheter, suggesting that long-term repeated stretch force may be related with the mechanism of fracture. Conclusion: Totally implantable venous access devices with Groshong silicone catheters, if inserted via the internal jugular vein, have a potential risk for late catheter fracture.


2018 ◽  
Vol 19 (3) ◽  
pp. 230-242 ◽  
Author(s):  
Fulvio Pinelli ◽  
Elena Cecero ◽  
Dario Degl’Innocenti ◽  
Valentina Selmi ◽  
Rosa Giua ◽  
...  

Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient’s quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients’ morbidity and mortality—both in the hospital or outpatient setting—and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device–related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device–related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device–related infections.


Author(s):  
Adriana Toro ◽  
Elena Schembari ◽  
Emanuele Gaspare Fontana ◽  
Salomone Di Saverio ◽  
Isidoro Di Carlo

Abstract Aim Even though TIVADs have been implanted for a long time, immediate complications are still occurring. The aim of this work was to review different techniques of placing TIVAD implants to evaluate the aetiology of immediate complications. Methods A systematic literature review was performed using the PubMed, Cochrane and Google Scholar databases in accordance with the PRISMA guidelines. The patient numbers, number of implanted devices, specialists involved, implant techniques, implant sites and immediate complication onsets were studied. Results Of the 1256 manuscripts reviewed, 36 were eligible for inclusion in the study, for a total of 17,388 patients with equivalent TIVAD implantation. A total of 2745 patients (15.8%) were treated with a surgical technique and 14,643 patients (84.2%) were treated with a percutaneous technique. Of the 2745 devices (15.8%) implanted by a surgical technique, 1721 devices (62.7%) were placed in the cephalic vein (CFV). Of the 14,643 implants (84.2%) placed with a percutaneous technique, 5784 devices (39.5%) were placed in the internal jugular vein (IJV), and 5321 devices (36.3%) were placed in the subclavian vein (SCV). The number of immediate complications in patients undergoing surgical techniques was 32 (1.2%) HMMs. In patients treated with a percutaneous technique, the number of total complications were 333 (2.8%): 71 PNX (0.5%), 2 HMT (0.01%), 175 accidental artery punctures AAP (1.2%) and 85 HMM (0.6%). No mortality was reported with either technique. Conclusion The percutaneous approach is currently the most commonly used technique to implant a TIVAD, but despite specialist’s best efforts, immediate complications are still occurring. Surgical cut-down, 40 years after the first implant, is still the only technique that can avoid all of the immediate complications that can be fatal.


2020 ◽  
pp. 112972982093641
Author(s):  
Alessandro Crocoli ◽  
Simone Cesaro ◽  
Monica Cellini ◽  
Francesca Rossetti ◽  
Luca Sidro ◽  
...  

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.


2020 ◽  
Vol 8 (9) ◽  
pp. 1631-1634
Author(s):  
Morgan M. Sandelski ◽  
Cyrus C. Rabbani ◽  
Michael G. Moore ◽  
Michael W. Sim

2003 ◽  
Vol 12 (4) ◽  
pp. 210-214 ◽  
Author(s):  
Wolfram Schummer ◽  
Claudia Schummer ◽  
Christoph Schelenz

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Marlene Biermayr ◽  
Barbara Brunner ◽  
Kathrin Maurer ◽  
Rudolf Trawoeger ◽  
Ursula Kiechl-Kohlendorfer ◽  
...  

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