Long term venous access using a totally implantable drug delivery system in patients with cystic fibrosis and bronchiectasis

Ball, Adrian; Duncan, F R; Foster, F.J.; Davidson, T.; Watkins, Rebecca; Hodson, Margaret E.

doi:10.1016/s0954-6111(89)80076-9

Cited by 26 publications

(16 citation statements)

References 7 publications

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“…The mean age at insertion of the first device was younger here than in most other studies [2][3][4][5][6][7][8][9][10] but similar to that in the study by DEEROJANAWONG et al [11] and older than in the series of CASSEY et al [12]. Most of the patients had the devices inserted while on intensive intravenous therapy for pulmonary infection or antibiotic prophylaxis.…”

Section: Discussionsupporting

confidence: 82%

“…It would be of interest to manage a large scale prospective study evaluating factors favouring thrombosis before the insertion of central venous catheters. In this study, long-term maintenance of TIVADs, when not in use, was based mainly on heparin; this seems to be the standard method for maintaining line patency [5][6][7][8][10][11][12][13]. Counterpressure was used by ESSEX-CATER et al [13] and BURDON et al [10], and in 20% of cases in the present series.…”

Section: Discussionmentioning

confidence: 69%

“…Since then, only a few retrospective studies have been published, involving cohorts of between nine [2] and 115 [3] children or adults, with follow-up ranging from 2-13 yrs. A summary of previous studies in CF patients [3][4][5][6][7][8][9][10][11][12] is presented in table 3. The multicentre retrospective study over 9 yrs is the largest to date, with 1,205 catheter-yrs.…”

Section: Discussionmentioning

confidence: 99%

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Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients

Munck

Malbezin²,

Bloch³

et al. 2004

Eur Respir J

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The use and complications of totally implantable vascular access devices (TIVADs) were examined during multiple courses of antibiotics in cystic fibrosis (CF) patients.This retrospective study involved 36 CF centres. Risk factors for removal and septicaemia were sought by survival analysis of censored data. Multivariate Cox models were constructed with removal or septicaemia as the event and the characteristics of TIVADs as explanatory variables.TIVADs (n=452) were implanted in 315 patients. The mean functional time per device was 32¡25 months. Long-term complications occurred with 188 devices (42%); they consisted mainly of occlusion (21%, requiring removal in 77%), infection (9.3%, requiring removal in 85%; septicaemia in 7.3%; rate 0.3 per 1,000 days, Candida in 66%), and vascular thrombosis (4.7%, removal in 58%). Multivariate survival analysis showed that removal, whatever the reason, was associated with polyurethane (versus silicone) and routine use of the device for blood sampling (versus never). No risk factors, including heparin lock, were identified for septicaemia or for removal for obstruction.Totally implantable venous access devices appear to be safe and reliable for longterm intermittent venous access. Although retrospective, this study suggests that the characteristics of the material and blood sampling are risk factors for removal. Chronic infections in patients with cystic fibrosis (CF), especially after colonisation by Pseudomonas aeruginosa, require repeated courses of intravenous antibiotics. Increasing problems with peripheral venous access may indicate implantation of a central venous access.Relative to external central catheters, totally implantable vascular access devices (TIVADs) facilitate long-term maintenance, permit almost unlimited physical activity, and improve the patient9s self-image, which is especially important for children and young adults. Nevertheless, TIVADs are associated with a number of complications. Previous studies of these devices in CF patients have involved small groups. The experience of 36 CF centres over a period of 9 yrs is reported here, based on systematic review of the implantation procedure, use, long-term maintenance and complications. Materials and methods PatientsThe medical charts of 315 CF patients who underwent one or more TIVAD procedures between January 1990 and December 1998 were reviewed. The patients were treated in 36 CF centres. A chart was sent to a corresponding physician in each CF centre who collected the data for all the patients treated in their centre. Data analysed included patient age, P. aeruginosa colonisation, surgical reports (TIVAD model, insertion site, procedure, prophylactic antibiotics, immediate complications), TIVAD use (courses of antibiotics, parenteral nutrition, lipid infusion, blood sampling), long-term maintenance (heparin, physiological sera, counter-pressure), longterm complications (catheter occlusion, vascular thrombosis, infection, discomfort, catheter rupture, displacement or disconnection, aestheti...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients

Munck

Malbezin²,

Bloch³

et al. 2004

Eur Respir J

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“…TIVAD have been well accepted by patients, but early reports recognized a number of complications with their use [2][3][4][5][6]. Previous reports have usually described complications in one or two types of TIVAD at each centre.…”

mentioning

confidence: 99%

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

Rodgers¹,

Liddle²,

Nixon³

et al. 1998

Eur Respir J

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The introduction of totally implantable venous access devices (TIVAD) has provided a solution to difficult venous access in patients with cystic fibrosis. Early reports have, however, recognized a number of complications with their use. We report our experience with five devices used over 8 yrs with regard to complications and patient attitudes. Patients' notes were reviewed to record the details of TIVAD insertion, duration of function, and complications. In January 1996 the surviving 30 patients were surveyed on their attitudes to TIVAD and complications by written questionnaire. Sixty one ports were implanted in 42 patients (aged 16-47 yrs) between June 1988 and January 1996, giving a total of 1,510 patient-months' experience. The duration of function ranged from 2 weeks to 6 yrs. Survival analysis showed that the median survival of ports was 53 months, 42 out of 61 (69%) had not failed in service at the end of follow-up or patient death. Twenty-three complications occurred in 19 patients. These included: line occlusion (10 patients), venous thrombosis (4), difficult access (3), infection (2), cellulitis (1), inversion of port chamber (2) and pneumothorax (1). The questionnaire showed that patients had strong views on the positioning of their port. Lifestyle issues included interference with seatbelts (8 patients), sport (4), clothing (2), sexual relations (2) and cosmetic appearance (15). Complication rates were similar to those in other studies, although infection rates and salvage of an occluded port were lower. The survey highlighted a number of lifestyle issues, with cosmetic appearance deemed unsatisfactory by half of the patients. However, the majority (28 out of 30) believed their totally implantable venous access devices to be a better alternative to cannulae or long lines.

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“…Case report 1 A 32 year old woman with cystic fibrosis required an indwelling venous catheter. In March 1990 a totally implanted catheter was inserted under local anaesthesia into the left subclavian vein.…”

mentioning

confidence: 99%

Spontaneous migration of totally implanted venous catheter systems from subclavian into jugular veins.

Roblin

Porter

Knight

1994

Thorax

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Long term venous access using a totally implantable drug delivery system in patients with cystic fibrosis and bronchiectasis

Cited by 26 publications

References 7 publications

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients

Totally implantable venous access devices in cystic fibrosis: complications and patients' opinions

Spontaneous migration of totally implanted venous catheter systems from subclavian into jugular veins.

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