Vascular access by physician assistants: evaluation of an implantable peripheral port system in cancer patients.

PURPOSE To determine the ability of a physician assistant (PA) to insert, in an ambulatory setting, a peripheral subcutaneous implanted vascular-access device (VAD) and to evaluate the ability to transfer this training to a second PA. We also evaluated the performance and complications associated with this new device. PATIENTS AND METHODS The Peripheral Access System (PAS) Port catheter system (Sims-Deltec Inc, St Paul, MN) was inserted in patients who required long-term (> 3 months) vascular access for infusion therapy. RESULTS The first PA (PA-1) successfully inserted 57 of 62 devices (92%) after gaining experience with the technique in 10 patients (success rate, five of 10 [50%]; P = .003). The second PA (PA-2) was successful in eight of 10 initial attempts (80%) and 25 of 30 overall (83%). Complications were few and limited to phlebitis, thrombosis, and a low infection rate (0.2 per 1,000 catheter days). CONCLUSION PAs can be taught to insert a peripheral subcutaneous implanted VAD. This technique is transferable from one PA to another, and the device studied is appropriate for outpatient VAD programs.

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Application of implanted port systems during immunochemo- and infusion therapy in hematological patients

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.1-40 ◽

2020 ◽

pp. 47-49

Author(s):

L.M. Lukavetsky ◽

M.M. Semerak ◽

T.O. Horodyska ◽

K.B. Kotlyarchuk ◽

Z.V. Maslyak

Keyword(s):

Vascular Access ◽

Subclavian Vein ◽

Infusion Therapy ◽

Concomitant Therapy ◽

Malignant Lymphomas ◽

Short Term ◽

Hematological Patients ◽

Port Systems ◽

Port System

Background. Modern immunochemotherapy (ICT) and infusion therapy (IT) in the treatment of malignant lymphomas, further supportive and concomitant therapy require constant and reliable vascular access. Today, the hematology clinic uses both short-term and minimally invasive methods of vascular access (venipuncture, peripheral catheters) and long-term options (peripherally inserted central catheter, subclavian vein catheterization). The choice of the optimal method of access to vessels, its preservation and care, and the avoidance of complications associated with the functioning of such access require the joint efforts of many specialists. Objective. To outline the indications for the establishment, advantages and disadvantages of the use of implanted port systems (IPS) in hematological patients. Materials and methods. 8 patients with newly diagnosed malignant lymphomas and established IPS who received volumetric and long-term IT during antilymphoma treatment were observed. 7 patients were diagnosed with primary mediastinal large B-cell lymphoma (PMBCL), and 1 patient was diagnosed with Hodgkin’s lymphoma (HL). Gender distribution was the following: 7 women and 1 man. Age of patients ranged from 26 to 48 years (median – 29.8 years). Patients were implanted with one of the two IPS available on the Ukrainian market (U-port 6.6/8.4 Fr or B-Braun Celsite® ST301 6.5/8.5 Fr). Catheterization of the right or left subclavian vein was performed in the operating room using local anesthesia and under X-ray control. IPS began to be used immediately after implantation. Results and discussion. Patients who were scheduled for long-term and volumetric infusions for the treatment of malignant lymphomas, or who had problems with short-term vascular access, were suggested to have IPS. As a result 7 patients with PMBCL received ICT, which involved a continuous 96-hour infusion of antilymphoma drugs and concomitant IT, the total volume of which was 5.0-6.5 liters per day. In 2 patients before the initiation of ICT there were significant obstacles to the establishment of short-term vascular access (phlebitis, postphlebotic changes in peripheral veins), another 1 patient had similar problems after the second course of ICT. The patient with HL at the time of chemotherapy had a poor condition of peripheral veins, which did not allow their frequent and prolonged catheterization, and the mode of application of antilymphoma drugs (every 2 weeks, 12 injections) made it inexpedient to catheterize the subclavian vein. Eventually, the presence of IPS has greatly simplified the permanent vascular access and care for the port system itself. In all of our patients, IPS ensured the continuity of the infusion and the planned volume. In the intercourse period, IPS did not require special care: patients followed their normal lifestyle, including taking a shower. Subsequently, in the long term (up to 24 months) IPS appeared to be functionally complete and with regular care (every 2-4 weeks) allowed for maintenance and concomitant therapy. One patient had a hematoma in the pocket area of the reservoir of the port system, which resolved spontaneously. No infection around the port area and no cases of catheter induced sepsis were observed. To date, IPS has been removed without complications in 5 patients, one continues ICT, and in another one IPS was decided not to be removed. Conclusions. The use of IPS in hematological patients has shown its benefits in long-term and large-scale ICT and IT regimens to ensure persistent, multiple and safe access to blood vessels. The use of IPS is also indicated for patients with vascular lesions, venous diseases or their unsatisfactory condition. The medical staff avoids the constant search for “working vessels” for the placement of peripheral catheters or special care for the central catheter. IPS provides the opportunity to conduct initial, supportive and concomitant therapy for months with minimal care for vascular access. Complications during the installation and operation of IPS are extremely rare and minor. IPS placement can be considered an integral part of ICT and IT in the hematological practice.

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Safety and efficacy of the port-catheter systems during intensive intravenous chemotherapy in patients with multidrug-resistant tuberculosis and tuberculosis with extended resistance

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-257-258 ◽

2020 ◽

pp. 257-258

Author(s):

Yu.O. Senko

Keyword(s):

Venous Access ◽

Multidrug Resistant ◽

Infusion Therapy ◽

Port Catheter ◽

Intravenous Chemotherapy ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Port Systems ◽

Port System

Background. Yu-Port (“Yuria-Pharm”) is an implanted system for long-term infusions. This system allows multiple access to vessels for parenteral administration of drugs, fluids and nutrient solutions. Objective. To describe the safety and efficacy of the port-catheter systems during intensive intravenous chemotherapy in patients with multidrug-resistant tuberculosis (TB) and TB with extended resistance. Materials and methods. Analysis of the literature on this issue. Results and discussion. Prolonged venous access is required in case of long-term infusion therapy or chemotherapy, as well as with the use of drugs that irritate the veins. Routine methods of vascular access have a number of disadvantages: the needle of the system damages the vessel with each injection; infusion cannula should be replaced every 3-5 days; the central venous catheter cannot be installed permanently (on average, for 1 week). Therefore, port systems consisting of a titanium port and a vascular catheter have long been used for long-term venous access. When installing the port system, the catheter is in the vein, the port is under the skin, and the needle is brought out. The advantages of the Yu-Port system include a large silicone membrane, fluid flow rate of 5 ml/s, compatibility with magnetic resonance imaging, and the absence of latex and polyvinyl chloride. The Yu-Port package contains installation instructions and all the necessary tools. The silicone membrane allows repeated piercing only with a special Yu-Port needle or the included needle. After the puncture, the membrane is tightened, because due to a special sharpening needle does not tear the membrane material, but pushes it apart. Jugular or subclavian access is most often used to install ports. The advantages of using port systems in chemotherapy include low traumaticity, painless injections, no discomfort, ease of drug administration and blood sampling for analysis, lower risk of developing phlebitis, long use duration (several years). Our own experience with port systems (56 patients in 2019-2020) showed significantly fewer premature treatment terminations due to side effects than in the group of standard infusion therapy (12.50 % vs. 22.6 %). Conclusions. 1. Port systems consisting of a titanium port and a vascular catheter have long been used for long-term venous access. 2. The advantages of using port systems in chemotherapy include painless injections, no discomfort, ease of drug administration and blood sampling for analysis, lower risk of phlebitis, long use duration. 3. In patients who need long-term or multicomponent chemotherapy, for example, in multidrug-resistant TB, it is advisable to use port systems.

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Improved methods for venous access: the Port-A-Cath, a totally implanted catheter system.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.4.596 ◽

1986 ◽

Vol 4 (4) ◽

pp. 596-603 ◽

Cited By ~ 74

Author(s):

S Strum ◽

J McDermed ◽

A Korn ◽

C Joseph

Keyword(s):

Venous Access ◽

Intravenous Therapy ◽

Infusion Chemotherapy ◽

Maintenance Schedule ◽

Access System ◽

Care Protocol ◽

Catheter System ◽

Continuous Infusion Chemotherapy ◽

Improved Methods

We prospectively evaluated the performance and rate of long-term complications with the Port-A-Cath (PAC), a totally implanted vascular access system. Two catheter styles were evaluated, a small-bore (SB) catheter (0.51-mm diameter) and a large-bore (LB) catheter (1.02-mm diameter), in conjunction with the use of a strict catheter care protocol. The PAC performed well, and with both SB and LB systems, no significant extravasation, skin necrosis, hematoma, septum damage or leakage, or subcutaneous portal infections occurred after 7,240 days of implantation and 1,435 days of use. Complications with the PAC system consisted of catheter occlusion (seven patients, 21.5%) and one instance of possible catheter infection (3.1%). Occlusions were limited to patients implanted with the SB catheter (seven of 16, 43.8%), and five of the seven (71.4%) occurred in patients receiving continuous infusion chemotherapy and/or total parenteral nutrition. Patency of the PAC system was maintained using a regular flushing schedule once every 30 days, a significant advantage compared with the daily maintenance schedule required with externally placed venous catheters. The results of this study suggest that the PAC system can provide a safe and reliable method for venous access in patients requiring intermittent or prolonged intravenous therapy.

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Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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Impact of the COVID-19 pandemic: a perspective from industry

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa187 ◽

2020 ◽

Vol 22 (Supplement_P) ◽

pp. P56-P59

Author(s):

Nick E J West ◽

Wai-Fung Cheong ◽

Els Boone ◽

Neil E Moat

Keyword(s):

Care Delivery ◽

Models Of Care ◽

Medium Term ◽

Change Models ◽

New Device ◽

Supply Chain Logistics ◽

Cardiovascular Patients ◽

Medical Crisis ◽

Device Industry

Abstract The global COVID-19 pandemic has led to unprecedented change throughout society.1 As the articles in this supplement outline, all segments of the broader cardiovascular community have been forced to adapt, to change models of care delivery, and to evolve and innovate in order to deliver optimal management for cardiovascular patients. The medtech/device industry has not been exempt from such change and has been forced to navigate direct and indirect COVID-associated disruption, with effects felt from supply chain logistics to the entire product lifecycle, from the running of clinical trials to new device approvals and managing training, proctoring and congresses in an increasingly-online world. This sea-change in circumstances itself has enforced the industry, in effect, to disrupt its own processes, models and activities. Whilst some of these changes may be temporary, many will endure for some time and some will doubtless become permanent; one thing is for sure: the healthcare ecosystem, including the medical device industry, will never look quite the same again. Although the pandemic has brought a short- to medium-term medical crisis to many countries, its role as a powerful disruptor cannot be underestimated, and may indeed prove to be a force for long-term good, given the accelerated innovation and rapid adaptation that it has cultivated.

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An update on antithrombotic therapy in atrial fibrillation patients in long-term ambulatory setting after percutaneous coronary intervention: where do we go from here?

Expert Opinion on Pharmacotherapy ◽

10.1080/14656566.2021.1937119 ◽

2021 ◽

Author(s):

Jacopo Marazzato ◽

Paolo Verdecchia ◽

Michele Golino ◽

Federico Blasi ◽

Matteo Crippa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Antithrombotic Therapy ◽

Coronary Intervention ◽

Ambulatory Setting ◽

Percutaneous Coronary

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Patient characteristics predict patency of early-cannulation arteriovenous grafts

Scientific Reports ◽

10.1038/s41598-021-87750-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

David B. Kingsmore ◽

Karen S. Stevenson ◽

S. Richarz ◽

Andrej Isaak ◽

Andrew Jackson ◽

...

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Vascular Access ◽

Demographic Data ◽

Univariate Analysis ◽

Patient Characteristics ◽

Peripheral Vascular ◽

Arteriovenous Grafts ◽

One Year

AbstractThere is a new emphasis on tailoring appropriate vascular access for hemodialysis to patients and their life-plans, but there is little known about the optimal use of newer devices such as early-cannulation arteriovenous grafts (ecAVG), with studies utilising them in a wide variety of situations. The aim of this study was to determine if the outcome of ecAVG can be predicted by patient characteristics known pre-operatively. This retrospective analysis of 278 consecutive ecAVG with minimum one-year follow-up correlated functional patency with demographic data, renal history, renal replacement and vascular access history. On univariate analysis, aetiology of renal disease, indication for an ecAVG, the number of previous tunnelled central venous catheters (TCVC) prior to insertion of an ecAVG, peripheral vascular disease, and BMI were significant associates with functional patency. On multivariate analysis the number of previous TCVC, the presence of peripheral vascular disease and indication were independently associated with outcome after allowing for age, sex and BMI. When selecting for vascular access, understanding the clinical circumstances such as indication and previous vascular access can identify patients with differing outcomes. Importantly, strategies that result in TCVC exposure have an independent and cumulative association with decreasing long-term patency for subsequent ecAVG. As such, TCVC exposure is best avoided or minimised particularly when ecAVG can be considered.

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