port implantation
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2021 ◽  
Vol 17 (2) ◽  
pp. 104-110
Author(s):  
Jisu Lee ◽  
Sung Mo Hur ◽  
Zisun Kim ◽  
Cheol Wan Lim

Purpose: Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications.Methods: Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients’ clinical data was performed to investigate catheter days and complications of TIVAPs.Results: Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10–457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054–1.414; P = 0.008).Conclusion: This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.


2021 ◽  
Vol 10 (24) ◽  
pp. 5759
Author(s):  
Jarosław Janc ◽  
Marek Szamborski ◽  
Artur Milnerowicz ◽  
Lidia Łysenko ◽  
Patrycja Leśnik

The vascular access port implantation procedure can be performed using the venesection method by inserting a catheter into the cephalic vein in the region of the deltopectoral groove. This method eliminates the need for catheter tunneling. An alternative method to infiltration anaesthesia for port implantation may be a modified pectoral nerve block type II (PECS II). This study aimed to evaluate the effectiveness of modified PECS II for vascular access port implantation using cephalic vein venesection. This retrospective observational study was conducted at the 4th Military Clinical Hospital in Wroclaw, Poland. A group of 114 patients underwent the modified PECS II block and additional cutaneous infiltration anesthesia at the incision line. Pain intensity was assessed on the NRS scale measured intraoperatively at four points. The QoR-15 questionnaire was used to assess patient satisfaction during the first 24 h after surgery. The operator’s condition assessment score was used to assess surgical conditions and operator comfort. The analysis showed that the median pain intensity during vascular port implantation was 0. A statistically significant difference in pain intensity was demonstrated between the specialist’s group and the resident’s group at the second and third measurement points (p < 0.008; p < 0.012). The mean value on the QoR-15 scale was 132. There was a significant difference between the pain scores of the groups. The mean score in the pain position in the specialist’s group was 18 points and in the resident’s group, it was 19 points (p < 0.029). In conclusion, the present study revealed that the modified PECS II block is an effective and safe method of anesthesia for Port-A-Cath implantation.


Author(s):  
Saskia Witting ◽  
Maja Ingwersen ◽  
Thomas Lehmann ◽  
René Aschenbach ◽  
Niklas Eckardt ◽  
...  

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0253818
Author(s):  
Ching-Feng Wu ◽  
Jui-Ying Fu ◽  
Tsai-Yang Hsieh ◽  
Chi-Tsung Wen ◽  
Sheng-Yueh Yu ◽  
...  

Introduction The catheter is the only intravascular portion of an implanted port and plays a crucial role in catheter related complications. Both polyurethane and silicone are biocompatible materials which are utilized for catheter manufacturing, but their correlation to complications remains controversial. The aim of this study was to try to analyze the relationship between catheter materials and complications. Materials and methods A total of 3144 patients who underwent intravenous port implantation between March 2012 and December 2018 at Chang Gung Memorial Hospital, Linkou, Taiwan were recruited. Of these, 1226 patients received silicone catheter port implantation and 1679 received polyurethane catheter ports. Case matching was done prior to analysis and catheter related complications and cumulative complication incidence for each group were compared. Results Intergroup differences were identified in entry vessel (p = 0.0441), operation year (p < 0.0001), operation method (p = 0.0095), functional period (p < 0.0001), patient follow up status (p < 0.0001), operating time for vessel cutdown (p < 0.0001) and wire assisted approach (p = 0.0008). Stratified by specific entry vessel, no statistical difference was found in complication rate or incidence between the silicone and polyurethane groups. We further compared the cumulative complication incidence of the silicone and polyurethane groups, and also found no statistical difference (p = 0.4451). Conclusion As long as external stress forces generated by surrounding structures and focused on potential weak points are avoided, both silicone and polyurethane materials provide sufficient structural stability to serve as reliable vascular access for patients.


2021 ◽  
Vol 17 (1) ◽  
pp. 15-22
Author(s):  
Se-Beom Jeon ◽  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Yong-Soon Chun ◽  
Jeong-Heum Baek

Purpose: This study aimed to investigate the clinical outcomes after totally implantable access port (TIAP) implantation performed by general surgery residents in patients with colorectal cancer.Methods: A total of 291 consecutive patients who underwent TIAP implantations were evaluated. The patients were divided into threegroups: second-, third-, and fourth-grade residents.Results: The mean follow-up was 22.1 months (range, 1–87 months). The total times of operation, puncture, and cannulation decreased as the resident grade increased (P<0.001). Early complications significantly decreased with higher resident grades (P=0.039). The non-use of ultrasonography and non-use of C-arm were identified as independent risk factors for complications. Resident grades between second and third (P=0.005) and between second and fourth (P=0.041) were identified as independent risk factors for optimal tip position.Conclusion: TIAP implantation can be safely and effectively performed by residents. Low-grade residents were associated with early complications.


2021 ◽  
Vol 11 (5) ◽  
pp. 344
Author(s):  
Ching-Feng Wu ◽  
Jui-Ying Fu ◽  
Chi-Tsung Wen ◽  
Chien-Hung Chiu ◽  
Ming-Ju Hsieh ◽  
...  

Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.


2021 ◽  
Author(s):  
Kristina Ernst ◽  
Carolin Bärtels ◽  
Nikolaus de Gregorio ◽  
Florian Ebner ◽  
Fabienne Schochter ◽  
...  

Abstract Background: The implantation of a subcutaneous implantable venous access device in patients with a gynecological cancer disease could be necessary because of different causes, e.g. application of chemotherapy or parenteral nutrition in case of advanced cancer. 4 years after implementation of the Seldinger-technique in the subclavian vein as standard way of port-catheter-implantation at department of gynecology at the University-Hospital in Ulm a retrospective analysis of complication-rates was performed to define internal standards for this procedure. Methods: Between 01/2014 and 07/2018 we reviewed all patients who received a port implantation at the gynecological department. The standard way of port-implantation used in this cohort was Seldinger-technique. All Data assessed were used anonymously. Patients-characteristics, tumor-entity, surgical and anesthesiological management, morbidity and port catheter associated complications (thrombosis, infections etc.) were analyzed. Results: A total of 638 were included. The implantation was performed in Seldinger-technique. Port catheter implantation was successfully performed in 96.6%. The implantation on the left subclavian vein significantly showed a higher rate of success than in the right subclavian vein (98.2% vs. 95.3%, p=0,036). Significant higher rates of associated thromboses was found in patients with a port implantation on the left side (5.9% vs. 2.0%; p=0.036). Obesity (BMI ≥ 30 kg/ m2) leads to a significant higher rate of venous misplacements (p=0.027). Compared to local anesthesia and analgosedation, general anesthesia leads to a significant lower rate of perioperative complications (20.3% vs. 22.4% vs. 13.1%; p=0.014). Perioperative application of antibiotics seems to reduce postoperative infection rates, even if the results are not significant. Conclusion: Seldinger-Technique is an efficient way for port-implantation. Especially patients with a high potential of complications, like obesity with BMI >30kg/m², or other risk factors, the left subclavian vein should be preferred, as well as general anesthesia. Perioperative application of antibiotics (e.g. single-shot antibiotics) should be considered. Trial registration: retrospectively registered


2021 ◽  
pp. 112972982098735
Author(s):  
Emre Can Çelebioğlu ◽  
Mehmet Sadık Bilgiç

Background: Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. Methods: This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. Results: Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients ( p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 ( p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] ( p > 0.05). Conclusions: The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.


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