An evaluation of the long-term complications associated with totally implantable venous access in oncology patients

Objectives: The aim of this study was to examine long-term complications developing in venous port catheters inserted in oncological patients. Patients and methods: A total of 205 oncology patients (124 males, 81 females; mean age: 50.1±22.3 years; range, 6 months to 90 years) in whom vascular port catheters were inserted between March 2015 and April 2020 were retrospectively analyzed. The first preference for port catheter application was the right internal jugular vein. If failed, the contralateral internal jugular vein was used. The procedure was carried out in the operating room with ultrasound (US) guidance under general anesthesia. All patients were evaluated in terms of pneumothorax, catheter orientation, and kinking and malposition after the procedure. Results: A total 219 vascular ports were inserted in 205 patients. The indication for port catheter insertion was the receipt of long-term chemotherapy. Catheters were changed in four patients due to infection and in five patients due to catheter migration. The sites of catheter migration were the right atrium in two, the right ventricle in one, the main pulmonary artery in one, and the right pulmonary artery in one patient. Conclusion: Port catheter insertion under US guidance is a well-designed procedure which can be performed with low complication rates by an experienced surgeon in an aseptic environment. Even if complications develop, they can be usually successfully treated in most cases.

P1357SODIIUM BICARBONATE CAN REPLACE THE HEPARIN AS “CATHETER LOCK SOLUTION” OF CENTRAL CATHETERS (CVC) FOR HEMODIALYSIS (HD)?

Background and Aims The CVC often faces thrombosis and/or infection and currently there are no interventions that guarantee the efficiency of the CVC and the absence of bacterial infections. Recently Adel S. El-Hennawy et al. NDT, 2019, have shown that the use of sodium bicarbonate as “catheter lock solution” (SBCLS) in HD patients has a local anticoagulant effect and reduces the frequency of thrombosis and infections. Therefore, we wanted to use SBCLS in the management of our dialysis patients who needed HD treatment through CVC. Method The study included n. 15 HD patients (8M and 7F) with a CVC (see tab.1), whose CVC were previously medicated with heparin or citrate. At the time of the introduction of the SBCLS, patients showed no signs of CVC thrombosis or bacteremia; 2 patients had previously had haemorrhagic complications, 3 had malfunctioning thrombotic CVC. The observation period was 2379 days (mean 158 ± 50). Upon the conclusion of HD treatment, each port of all two-port catheters was flushed and locked with 10 mL of SBCLS (NaHCO3 at 8.4% -pH 7-8.5) and approximately 2 mL of the injected solution remained locked within the catheter. One patient who was allergic to heparin was included in the study. Results At the end of the study, only 3 patients had thrombotic problems with CVC and none had infections. However, none of the enrolled patients had to replace the CVC. The treatment was well tolerated by all patients who did not present complications. Conclusion In our short and brief experience, SBCLS has proved effective and safe in the prevention of thrombosis and infection of CVC. SBCLS appears to be an effective alternative to heparin and citrate in the management of CVC in the absence of bleeding complications. Finally SBCLS is a valid medical solution in patients allergic to heparin.