Major long-term complications in 1,422 permanent venous access devices

Sariego, Joaquin; Bootorabi, Baktash; Matsumoto, Teruo; Kerstein, Morris D.

doi:10.1016/s0002-9610(05)80520-3

Cited by 47 publications

(15 citation statements)

References 12 publications

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“…In our experience, as in other reports [9,10], the main indication for implanting the PVAD was for oncological disease (Table 3). …”

Section: Discussionsupporting

confidence: 82%

“…These devices have unquestionably not only reduced the discomfort to patients, but also facilitated the work of the medical team looking after them. The indications for totally implantable vascular accesses are becoming more and more extensive, though their main indication is still for antiblastic treatments [9,10]. But creating a medium-to long-term central venous access means connecting a system equipped with a reservoir to a major vessel, such as the superior vena cava, via puncture of the jugular or subclavian veins, or cutdown of a peripheral tributary to the central neck veins, such as the cephalic or basilic veins.…”

Section: Late Complicationsmentioning

confidence: 99%

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Immediate and long-term complications of prolonged-venous-access devices (PVAD): A comparison between surgical cutdown and percutaneous techniques

Sarzo¹,

Finco²,

Savastano³

et al. 2011

Int J Angiol

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There is currently still no consensus regarding the best technique for implanting prolonged-venousaccess devices (PVAD). One hundred ninety-six patients underwent surgical PVAD positioning using an all-surgical cutdown approach to the cephalic vein (CV). When surgical cannulation proved impossible, the patient was converted to percutaneous positioning. A retrospective analysis was performed on the difference between these two techniques. Among the 196 patients who underwent the surgical insertion of a PVAD, 23 (11.7%) were converted to percutaneous cannulation. For the surgical cannulation group, the median operating time was 35 minutes vs the 52.5 minutes needed for the percutaneous cannulation group. The median time of fluoroscopy amounted to eight seconds for the surgical cannulation group vs 18 seconds for the percutaneous cannulation group. Complications were observed in 23/196 patients (11.7%): 9/23 patients (39.1%) developed infections. Deep venous thrombosis was observed in 4/23 patients (17.4%). Pneumothorax and arterial hematoma developed in 5/23 patients (21.7%), all cases of percutaneous placement. PVAD malfunction was observed in 3/23 patients (13.0%). We concluded that surgical cutdown is faster than the percutaneous approach and safer for both patient and surgeon, involving a shorter time of exposure to radiation and reducing the risk of infection.

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“…In our experience, as in other reports [9,10], the main indication for implanting the PVAD was for oncological disease (Table 3). …”

Section: Discussionsupporting

confidence: 82%

Section: Late Complicationsmentioning

confidence: 99%

Immediate and long-term complications of prolonged-venous-access devices (PVAD): A comparison between surgical cutdown and percutaneous techniques

Sarzo¹,

Finco²,

Savastano³

et al. 2011

Int J Angiol

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“…The incidence of CVD-related infection in the present study was comparable to that in other reported studies (19)(20)(21)(22). In the present study, both increased d-dimer and low APC ratio were shown to be associated with risk of bacteremia.…”

Section: Discussionsupporting

confidence: 90%

Relationship Between Activated Protein C Resistance and Central Venous Device-Related Complications

Keung

Cobos

Barber

et al. 1997

Clin Appl Thromb Hemost

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We studied the relationship between activated protein C (APC) resistance and the central venous devices (CVD)-related complications in 61 cancer patients (44 females 'and 17 males, median age 50 years, 71 CVD) from November 1994 to November 1995. Two patients (3.3%) had APC resistance, i.e., APC ratio < 2. Twelve episodes of bactercmia, 8 site infections, 31 cases of CVD dysfunction requiring urokinase (UK), and 3 CVD-retated thromboses were noted. With Cox's proportional hazard models, low APC ratios and high d-dimer levels were significantly associated with CVD-related bacteremia (p = 0.0207 and 0.0210). Such an association was not observed with site infection and CVD dysfunction. The incidence of thrombosis was too low to be analyzed. However, one patient with APC resistance developed subclavian vein thrombosis, leading to eventual removal of the catheter. The prevalence of APC resistance in cancer patients and its association with bacteremia are discussed. Key Words : Activated protein C resistance—Central venous catheters—Bacteremia— Catheter site infection—Thrombosis. Activated protein C (APC) resistance was recently discovered to be the most common inherited cause ' of a hypercoagulable state, accounting for 20-60% patients with deep vein thrombosis (1-6). It has also been associated with arterial thrombosis (7-10), although such an association has been a matter of controversy (11)(12)(13)(14). More than 95% of APC resistance cases are due to a point mutation in clotting factor V with arginine 506 to glutamine, termed factor V L,eiden (4;5;25}: Central venous devices (CVD) are widely used in cancer patients, and CVD-related infections and thromboses are not uncommon. We report a study of the relationship between APC resistance and CVD-related complications in cancer patients. PATIENTS AND METHODSCancer patients who had CVD in situ and were followed at the Southwest Cancer Center from November 1994 to November 1995 were included in the study. Patients who had CVD placed before November 1994 were studied retrospectively. APC resistance assays were subsequently performed. Patients who had CVD placed during the study period were prospectively monitored. These patients had an APC resistance assay, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, fibrin degradation product (FDP), and d-dimer levels performed within 2 weeks of CVD placement. In addition, the following data were obtained from the medical records: age, sex, histological types and stage of the cancer, dates and sites of CVD placement, CVD subtypes, dates of onset of CVD-related complications (definitions provided herein), CVD removal, and the reason for CVD removal. CVD placement and care ~ . All CVD were placed in the operating room under local anesthesia by highly experienced surgeons. All patients were instructed on the care of their CVD by experienced registered nurses. The care of all CVD was standardized by our hospital policy.

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“…The management of catheter-related bacteraemia has changed during the last decade. Inititally, patients were treated with appropriate antibiotics and removal of the catheter, but recent data indicate that patients can safely be treated with appropriate antibiotics alone without catheter removal [15], especially in cases having coagulase-negative staphylococcal infections [12]. A high rate of sterilization of ports (70%) is reported: in the study performed by Groeger et al [16], 25 SIPs out of 26 treated with specific antibiotics for bacteraemia or fungaemia were sterilized without removal.…”

Section: Discussionmentioning

confidence: 99%

Complications of Subcutaneous Infusion Port in the General Oncology Population

Ballarini¹,

Intra²,

Ceretti³

et al. 1999

Oncology

106

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Subcutaneous infusion ports (SIPs) represent a valid method for long-term chemotherapy. The SIPs have several advantages over other methods of venous access: they are easy to implant under local anaesthesia, have less discomfort for the patients, allow low costs, can be implanted in day hospital, and can be managed ambulatorily. However, SIPs have delayed complications, frequently related to clinical conditions of the neoplastic patients, and immediate complications, often due to the placement technique. From March 1992 to March 1997 we placed, under local anaesthesia and under fluoroscopic control, 102 SIPs in 99 general oncology patients for long-term chemotherapy (88% solid, 12% haematological tumours). The percutaneous venous access devices were in the subclavian vein in 96% of the cases and in the internal jugular vein in 4% of them. Immediate complications were: 1 haemopneumothorax, which required thoracic aspirations and two blood transfusions, 1 loop of the tunneled part of the catheter without alterations in SIP function, and 1 left jugular thrombosis in a patient with subclavian veins already thrombosed. The venous access was in the subclavian vein in the first 2 cases, and it was not necessary to suspend the therapeutic program. In the third instance, implanted in jugular vein, it was necessary to remove the SIP. Delayed complications were: 1 necrosis of the skin over the port, 1 infection of subcutaneous pocket, 2 infections of the system, 1 catheter deconnection, and 3 catheter ruptures with embolization of the catheter tip. The SIPs were removed in all cases but 1 in whom infection was successfully treated by appropriate antibiotic therapy. Embolization of the catheter required removal from the pulmonary artery under fluoroscopic guidance in the cardiac catheterization laboratory. In conclusion, infection and thrombosis are the two major complications of SIP in general oncology patients. In these cases it is not necessary to remove systematically the system, but a cor rect therapy (antibiotic, fibrinolytic agents) can be utilized with good results. The catheter rupture is often due to the wear over the costoclavicular angle. The interventional radiology is the method of choice in the treatment of the catheter embolization by rupture or dislocation. The experience of the surgical and nursing staff is probably the most important factor in decreasing the total rate of complications.

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Major long-term complications in 1,422 permanent venous access devices

Cited by 47 publications

References 12 publications

Immediate and long-term complications of prolonged-venous-access devices (PVAD): A comparison between surgical cutdown and percutaneous techniques

Immediate and long-term complications of prolonged-venous-access devices (PVAD): A comparison between surgical cutdown and percutaneous techniques

Relationship Between Activated Protein C Resistance and Central Venous Device-Related Complications

Complications of Subcutaneous Infusion Port in the General Oncology Population

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