Totally implantable venous catheters for chemotherapy: experience in 500 patients

Abstract

CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2%) catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use), 11 obstructions (0.06/1000 days of catheter use) and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use). Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.

Totally implantable venous access port systems and risk factors for complications: A one-year prospective study in a cancer centre

“…The overall incidence of complications in our study (16.1%) was similar to those reported after TIVAPS implantation in cancer patients by Wolosker et al [13] [10] in the case of internal jugular vein access (7.6%), Hartkamp et al [7] reporting a higher rate (25.2%). As in other studies, [7,9,11,13,14] the main complication observed in our study was infection, occurring in 5.3% of patients and accounting for half the total number of premature device removals.…”

“…As in other studies, [7,9,11,13,14] the main complication observed in our study was infection, occurring in 5.3% of patients and accounting for half the total number of premature device removals.…”

“…In our study, the vein catheterised was predominantly either the external jugular vein or the cephalic vein, these veins similarly being the principal site of TIVAPS insertion in the studies reported by Wolosker et al [13] and Hsieh et al [11], respectively. The overall complication rate did not differ significantly according to the vein accessed.…”

Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience

“…Landmark-mark based punctures of the subclavian vein in particular were associated with increased rates of pneumothorax (11,(13)(14)(15)(16)(17). In addition, infection rates were lower for ultrasound-guided approaches with the Seldinger technique (1.1-8.8%) (3,11,13,18,19) compared with surgical cut-down (0.8-16.3%) (10,(20)(21)(22)(23)(24)(25). Moreover, the radiological technique does not require general anesthesia and is cost effective (26).…”

Vena Cava Filters in Cancer Patients: Experience With 50 Patients

“…The relationship between neoplasia and venous thromboembolism is well established, either through the presence of related risk factors (chemotherapy, 1,2,3,4,5,6 hormone therapy, [5][6][7] immobilization, 5 implantation of venous catheters, 4,8,9,10 extrinsic compression of deep veins 5 ), or because of a possible condition of hypercoagulability that has still not been completely explained. 4,6,11 Around 15% of neoplasic patients may present thromboembolic phenomena, and these are the second major cause of death among these patients.…”