Brachial insertion of fully implantable venous catheters for chemotherapy: complications and quality of life assessment in 35 patients

Abstract

Objective To prospectively evaluate the perioperative safety, early complications and satisfaction of patients who underwent the implantation of central catheters peripherally inserted via basilic vein.Methods Thirty-five consecutive patients with active oncologic disease requiring chemotherapy were prospectively followed up after undergoing peripheral implantation of indwelling venous catheters, between November 2013 and June 2014. The procedures were performed in the operating room by the same team of three vascular surgeons. The primary endpoints assessed were early postoperative complications, occurring within 30 days after implantation. The evaluation of patient satisfaction was based on a specific questionnaire used in previous studies.Results In all cases, ultrasound-guided puncture of the basilic vein was feasible and the procedure successfully completed. Early complications included one case of basilic vein thrombophlebitis and one case of pocket infection that did not require device removal. Out of 35 patients interviewed, 33 (94.3%) would recommend the device to other patients.Conclusion Implanting brachial ports is a feasible option, with low intraoperative risk and similar rates of early postoperative complications when compared to the existing data of the conventional technique. The patients studied were satisfied with the device and would recommend the procedure to others.

Infection of totally implantable venous access devices: A review of the literature

“…12,17,19 The use of port for PN also increases the risk of TIVAD-related infections, possibly because of PN itself, since both lipids and amino-acids favor bacterial colonization and biofilm formation or also because of the more frequent manipulations of the line associated with this kind of treatment. 25,38,61,67,69 As regards the site of port placement, insertion at the chest (chest-port) and in the upper limb (PICC-port) share an identical risk of infectious complications, 70 while ports placed with a femoral venous access (groin ports) have a higher infection risk. 20,71 The obsolete technique of venous cannulation by venous cut-down is also associated with a very high risk of infection and is discouraged by the Centers for Disease Control and Prevention (CDC) guidelines.…”

Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment

“…Irrespective the site of port placement, chest or upper limb, there is an identical risk of infectious complications [ 30 ]. The incidence of BSI in tunnelled CVC (1,8–7,9 per 1000 catheter days) is highly dependent on study population and CVC usage [ 31 ].…”

Comparison between Internal Jugular and Upper Arm Peripheral Veins Approach in Insertion of Totally Implantable Central Venous Ports

“…Risks associated with catheter fracture between the clavicle and the first rib (pinch-off syndrome) also appear to be reduced by the use of this technique. 4 Devices with the reservoir implanted in the arm offer an interesting alternative for patients with gross tumors or exposure to radiation therapy in cervical and/ or anterior chest regions which contraindicate the port implantation in the conventional position, avoiding femoral vein catheterization, greatly associated with infectious complications. Another possible advantage of the brachial port insertion includes better cosmetic results, avoiding scars in more exposed and visible regions.…”

“…The potential benefits that justify a more detailed study of this technique include reducing the risk of intraoperative complications such as arterial injury, pneumothorax or hemothorax, noninterference in breast imaging, easier access to puncture, better cosmetic results and better quality of life. 4…”