Abstract:Most of the patients undergoing treatment for cancer require placement of a
totally implantable venous access device to facilitate safe delivery of
chemotherapy. However, implantable ports also increase the risk of deep vein
thrombosis and related complications in this high-risk population. The objective
of this study was to assess the incidence of upper-extremity deep vein
thrombosis (UEDVT) in patients with breast cancer to determine whether the risk
of UEDVT was higher with chest versus arm ports, as well a… Show more
“…3,4 As is the case with breast cancer patients, arm ports in patients who have head and neck tumours and a tracheostomy can potentially reduce infections since the access site in these latter patients is far from tracheal secretions that might facilitate cutaneous bacterial overgrowth increasing the risk of TIVAD pocket infections. [5][6][7][8] Despite these advantages, there are some concerns about a higher incidence of complications in patients with arm port devices as compared to chest ports. 2 Catheter occlusion, upper extremity deep vein thrombosis (UEDVT), skin dehiscence and needle dislocation with drug extravasation are reportedly responsible for the removal of the device in 4%-17% of patients.…”
Section: Introductionmentioning
confidence: 99%
“…2 Catheter occlusion, upper extremity deep vein thrombosis (UEDVT), skin dehiscence and needle dislocation with drug extravasation are reportedly responsible for the removal of the device in 4%-17% of patients. [6][7][8] In order to evaluate the possibility of reducing the incidence of arm TIVAD failures, the authors introduced a technical variation to the standard method of arm port placement named the peripherally inserted central catheter (PICC)-PORT technique. It consists of a percutaneous venous access through the basilic or brachial veins, which is always performed under ultrasound guidance using the micro-Seldinger technique that allows the venous catheter to be inserted in the proximal third of the upper arm, close to the axilla.…”
Background and objectives: The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. Methods: The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. Results: Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%–7.1%). With regard to the patients’ characteristics, body mass index <22.5 was the only significant risk for failure ( p = 0.027). Conclusion: The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.
“…3,4 As is the case with breast cancer patients, arm ports in patients who have head and neck tumours and a tracheostomy can potentially reduce infections since the access site in these latter patients is far from tracheal secretions that might facilitate cutaneous bacterial overgrowth increasing the risk of TIVAD pocket infections. [5][6][7][8] Despite these advantages, there are some concerns about a higher incidence of complications in patients with arm port devices as compared to chest ports. 2 Catheter occlusion, upper extremity deep vein thrombosis (UEDVT), skin dehiscence and needle dislocation with drug extravasation are reportedly responsible for the removal of the device in 4%-17% of patients.…”
Section: Introductionmentioning
confidence: 99%
“…2 Catheter occlusion, upper extremity deep vein thrombosis (UEDVT), skin dehiscence and needle dislocation with drug extravasation are reportedly responsible for the removal of the device in 4%-17% of patients. [6][7][8] In order to evaluate the possibility of reducing the incidence of arm TIVAD failures, the authors introduced a technical variation to the standard method of arm port placement named the peripherally inserted central catheter (PICC)-PORT technique. It consists of a percutaneous venous access through the basilic or brachial veins, which is always performed under ultrasound guidance using the micro-Seldinger technique that allows the venous catheter to be inserted in the proximal third of the upper arm, close to the axilla.…”
Background and objectives: The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. Methods: The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. Results: Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%–7.1%). With regard to the patients’ characteristics, body mass index <22.5 was the only significant risk for failure ( p = 0.027). Conclusion: The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.
“…Additionally, compared with Hickman catheters, we also detect a trend for lower risk of VTE in the TIVAP groups (OR = 0.75, 95% CI: 0.37-1.50), but the result was not significant (P = .413). The results were Preferred venous access site Upper-extremity vein 7,19,20,25,30,31,41,42,59,64,67,69,91 3 .029…”
Section: The Ors Of Tivap-associated Vtementioning
confidence: 99%
“…Retrospective 7,19,20,25,30,31,33,38,39,41,42,45,50,52,54,56,57,59,61,64 Port sites Chest ports 19,24,31,33,34,36,38,39,42,48,[50][51][52][53][54]57,61,64,68,[73][74][75][76] .702…”
Section: The Ors Of Tivap-associated Vtementioning
Background
Totally implantable venous access ports (TIVAPs) for chemotherapy are associated with venous thromboembolism (VTE). We aimed to quantify the incidence of TIVAP‐associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta‐analysis.
Methods
Studies reporting on VTE risk associated with TIVAP were retrieved from medical literature databases. In publications without a comparison group, the pooled incidence of TIVAP‐related VTE was calculated. For studies comparing TIVAPs with external CVCs, odds ratios (ORs) were calculated to assess the risk of VTE.
Results
In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24‐3.28), and 0.08 (95 CI: 0.06‐0.10) per 1000 catheter‐days. This risk was highest when TIVAPs were inserted via the upper‐extremity vein (3.54%, 95% CI: 2.94‐4.76). Our meta‐analysis of the case‐control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09‐0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37‐1.50). Meta‐regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs.
Conclusions
Current evidence suggests that the cancer patients with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper‐extremity veins as the insertion site.
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