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

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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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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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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Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter‐Days

Journal of Parenteral and Enteral Nutrition ◽

10.1002/jpen.1939 ◽

2020 ◽

Cited By ~ 1

Author(s):

Paolo Cotogni ◽

Baudolino Mussa ◽

Claudia Degiorgis ◽

Antonella De Francesco ◽

Mauro Pittiruti

Keyword(s):

Parenteral Nutrition ◽

Prospective Study ◽

Cancer Patients ◽

Central Venous Access ◽

Venous Access ◽

Home Parenteral Nutrition ◽

Complication Rates ◽

Central Venous ◽

A Prospective Study ◽

Venous Access Devices

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Early and late complications of totally implantable venous access devices

Journal of Surgical Oncology ◽

10.1002/jso.2930440112 ◽

1990 ◽

Vol 44 (1) ◽

pp. 52-54 ◽

Cited By ~ 29

Author(s):

Kevin J. Grannan ◽

Philip H. Taylor

Keyword(s):

Venous Access ◽

Late Complications ◽

Venous Access Devices

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Power-injectable totally implantable venous access devices – analysis of success and complication rates of ultrasound-guided implantation and a patient satisfaction survey

VASA ◽

10.1024/0301-1526/a000802 ◽

2019 ◽

Vol 48 (6) ◽

pp. 524-530

Author(s):

Julia Kunz-Virk ◽

Karsten Krüger

Keyword(s):

Patient Satisfaction ◽

Venous Access ◽

Late Complications ◽

Subjective Rating ◽

Complication Rates ◽

Safe Procedure ◽

Success Rates ◽

Ultrasound Guided ◽

Port Implantation ◽

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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Potential Value of Vitamin E in Cancer Patients with Venous Access Devices

Journal of the Association for Vascular Access ◽

10.2309/java.13-2-4 ◽

2008 ◽

Vol 13 (2) ◽

pp. 71-73

Author(s):

Cynthia Chernecky ◽

Denise Macklin ◽

Katherine Nugent ◽

Jennifer Waller

Keyword(s):

Vitamin E ◽

Focus Groups ◽

Cancer Patients ◽

Venous Access ◽

Therapeutic Use ◽

Patients With Cancer ◽

Potential Value ◽

Venous Access Devices

Abstract Background: Vitamin E has antiplatelet, fibrinolytic and endotoxin properties that may help avoid the problems of occlusion or inability to withdraw blood from port VADs. Purpose: Disseminate information about the non-traditional therapeutic use of vitamin E associated with care of Venous Access Devices (VAD) in patients with cancer. Methodology: In-person focus groups. Sample of 22 cancer patients who had port Venous Access Devices (VAD). Findings: Fourteen percent (N = 3) of patients felt that taking vitamin E, 400 -800 IU per day orally, in capsule form, avoided the problems of occlusion or inability to withdraw blood from their current VAD. Practice Implications: The effects of vitamin E on occlusion and inability to withdraw blood in caring for patients who have port VADs, requires further investigation.

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Availability of totally implantable venous access devices in cancer patients is high in the long term: a seven-year follow-up study

Supportive Care in Cancer ◽

10.1007/s00520-020-05871-6 ◽

2020 ◽

Author(s):

Latif Volkan Tumay ◽

Osman Serhat Guner

Keyword(s):

Cancer Patients ◽

Great Majority ◽

Venous Access ◽

Seldinger Technique ◽

Significant Independent Predictor ◽

Important Place ◽

Venous Access Devices ◽

Over Time

Abstract Purpose Totally implantable venous access devices (TIVADs) currently have an important place in medical oncology practice; however, their long-term availability deserves further investigation, since they are usually required by patients for prolonged periods. This study aimed to evaluate long-term availability of TIVADs in adult cancer patients, in conjunction with complication/removal rates over time and associated risk factors during 7-year follow-up. Methods A total of 204 adult cancer patients who underwent TIVAD placement via subclavian vein using the Seldinger technique were included in this study. Medical data and catheter follow-up records were investigated retrospectively. Complications and port removals due to complications were evaluated over time. Results During median 21.9 (range, 0.7–82.9) months of follow-up, great majority of the patients did not require catheter removal due to complications (91.7%). During a total follow-up of 183,328 catheter days, 20 (9.8%) patients had complications with an incidence of 0.109 cases per 1000 catheter days and 18 (8.8%) of them required TIVAD removal (0.098 cases per 1000 catheter days). Most device removals due to complications (15/18, 83.3%) occurred within the first 24 months. Multivariate analysis identified left-sided device location as the only significant independent predictor of short device availability (OR, 3.5 [95% CI, 1.1–11.1], p = 0.036). Conclusion TIVADs in cancer patients appear to be safe and their availability appears to be high in the long term. A decision for early removal might be revisited. Opting for the accustomed side (right side in the present study) for implantations seems to be associated with better outcomes.

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