Centrally Inserted External Catheters and Totally Implantable Ports for the Delivery of Chemotherapy: A Systematic Review and Meta-Analysis of Device-Related Complications

Kulkarni, Sonali P.; Wu, Olívia; Kasthuri, Ram; Moss, Jon

doi:10.1007/s00270-013-0771-3

Cited by 28 publications

(26 citation statements)

References 29 publications

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“…In other patient populations, the catheter type may contribute to the risk; for example, some studies of patients receiving PN found that the risk of CLABSI was higher in those with ports than in those with external CVCs, 6 – 8 but others have found the opposite 9 – 11 or no apparent difference 12 – 14 . Because previous studies have shown that pediatric oncology patients with ports have a much lower rate of catheter‐related complications than do those with external CVCs, the use of ports is preferred where feasible 1 , 15 – 17 . However, the effect of CVC type on the relative risk of complications in pediatric oncology patients during PN administration has not been well explored, so there is insufficient evidence to guide CVC choice in that setting 3 .…”

Section: Introductionmentioning

confidence: 99%

Catheter‐Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type

Shenep

Tanner

Sun

et al. 2016

J Parenter Enteral Nutr

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Background Long-term central venous catheters (CVCs) are essential to the care of pediatric oncology patients, but complications, such as occlusion and central line–associated bloodstream infection (CLABSI), are common. Although administration of parenteral nutrition (PN) increases the risk of complications, the effect of CVC-type on this increase is unknown. Methods This was a retrospective matched cohort study of pediatric oncology patients who received PN through subcutaneous ports or external CVCs. Complication rates were compared between CVC-types and between PN and non-PN periods using a log-negative binomial model. Results The risk of CLABSI was higher during PN than non-PN periods for children with ports (RR 39.6, 95% CI 5.0–309; 3.6 vs. 0.1 events/1000 days) or external CVCs (RR 2.9, 95% CI 1.1–7.4; 2.7 vs. 0.7 events/1000 days). The increase in risk during PN was significantly greater for ports than for external CVCs (RRR = 13.6, 95%CI 1.4–130.5). The relative increase in occlusion risk during PN was also significantly greater for ports than external CVCs (RRR 4.9, 95% CI 1.6–14.5; RR 10.0 vs. 2.0). Because of this, absolute complication rates were similar during PN. Conclusion Despite advances in supportive care, children with cancer who receive PN are at increased risk of CLABSI and occlusion. The risk increase is greatest in children with ports, with a 40-fold increase in infection risk and 10-fold increase in occlusion risk. Due to the more severe clinical consequences of port-related complications, an external CVC is preferred for children with cancer who require PN.

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Section: Introductionmentioning

confidence: 99%

Catheter‐Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type

Shenep

Tanner

Sun

et al. 2016

J Parenter Enteral Nutr

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“…A nested qualitative study in a larger RCT serves to provide in-depth, explanatory information to inform the main trial, provide additional explanatory information on the findings and to incorporate patient and service user involvement in the research. A systematic review and meta-analysis evaluating the risks of complications associated with centrally inserted external catheters compared with totally implantable Ports in patients undergoing chemotherapy showed that totally implantable Ports are superior to external catheters in terms of catheter-associated complications (3). The National Institute for Health Research Health Technology Assessment Programme has commissioned the Cancer and Venous Access (CAVA) study (4), the first RCT to compare the clinical and cost-effectiveness of three venous access devices for chemotherapy delivery; tunnelled-cuffed central catheters, peripherally inserted central catheters (PICCs) and implantable chest wall Ports (Ports).…”

Section: Introductionmentioning

confidence: 99%

Exploring Attitudes towards a Randomised Controlled Trial of Venous access Devices – a Nested Pre-trial Qualitative Study

et al. 2015

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Purpose: This pre-trial qualitative research study was carried out to explore patient and clinical staff attitudes to central venous access devices (CVADs). In addition, views about participation in a randomised controlled trial (RCT) were explored with the aim of maximising recruitment to an imminent RCT of three CVADs. Methods: Three patient focus groups (each comprising three patients) and 23 interviews with clinical staff were conducted. Interviews and focus group discussions were digitally recorded, transcribed verbatim, anonymised, uploaded to the QSR NVivo10 qualitative software programme and thematically analysed. Results: Analysis of focus group interviews revealed the added challenges that a CVAD poses to patients with cancer. Four key themes emerged: continuity of daily life, pain and discomfort, stigma (a mark of disgrace associated with certain conditions) and self-preservation. The findings show the impact of a CVAD on patients' ability to manage their condition. Clinical staff interviews highlighted several potential barriers to recruitment; a lack of equipoise (genuine clinical uncertainty as to which intervention is the most beneficial), concerns about the logistics of device insertion and a perceived requirement for education and training. Conclusions: This qualitative study raises awareness of key areas of concern to patients who need a CVAD for chemotherapy delivery. It was identified that there is a need for clearer patient information around CVADs. Additionally it allows investigators to identify barriers to recruitment in a timely manner in order to minimise the potential for conflict between the roles of carer and researcher and consequently, maximise recruitment to the RCT. Keywords: Cancer, Health professionals' attitudes, Patient attitudes, Qualitative research, Randomised controlled trials, Venous access devices. BackgroundThis paper presents the results of a nested pre-trial qualitative research study carried out to inform a randomised controlled trial (RCT) of central venous access devices (CVADs). Qualitative and quantitative research are the two main research paradigms; whilst quantitative research tends to use numerical data, qualitative research uses language data either in the written or oral form (1). The value of utilising a mixture of quantitative and qualitative methods in developing and evaluating complex interventions is highlighted in recent Medical Research Council Guidance (2) and funders increasingly expect to see a qualitative research component incorporated in a study design. A nested qualitative study in a larger RCT serves to provide in-depth, explanatory

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“…Kulkarni et al implied that there was an increased risk of infection, non-infectious complication, and complication-related device removal among patients with CIEVC compared with those with totally implantable ports albeit with some caveats. The reported risk of infection varied substantially between individual studies, and this remained the case irrespective of study type and population (1).…”

Section: Discussionmentioning

confidence: 95%

“…Centrally inserted central venous catheters (CICCs) were introduced in the 1970s and modifications like the Dacron cuff by Hickman in 1979 aided in the improvement of their durability (1). The CICCs are commonly utilized to establish a prolonged route of intravenous (IV) access in both acute or home care settings.…”

mentioning

confidence: 99%

Retrospective analysis of centrally inserted central venous catheters in low birth weight neonates: our experience with 50 cases

Yılmaz¹,

Aydın²,

Esen³

et al. 2019

Kocaeli Med J

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Centrally Inserted External Catheters and Totally Implantable Ports for the Delivery of Chemotherapy: A Systematic Review and Meta-Analysis of Device-Related Complications

Cited by 28 publications

References 29 publications

Catheter‐Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type

Catheter‐Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type

Exploring Attitudes towards a Randomised Controlled Trial of Venous access Devices – a Nested Pre-trial Qualitative Study

Retrospective analysis of centrally inserted central venous catheters in low birth weight neonates: our experience with 50 cases

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