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Application and comparison of different implanted ports in malignant tumor patients

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Background The current study aims to compare the application and convenience of the upper arm port with the other two methods of implanted ports in the jugular vein and the subclavian vein in patients with gastrointestinal cancers. Methods Currently, the standard of practice is placement of central venous access via an internal jugular vein approach. Perioperative time, postoperative complications, and postoperative comfort level in patients receiving an implanted venous port in the upper arm were retrospectively compared to those in the jugular vein and the subclavian vein from April 2013 to November 2014. Results Three hundred thirty-four patients are recruited for this analysis, consisting of 107 in the upper arm vein group, 70 in the jugular vein group, and 167 in the subclavian vein group. The occurrence of catheter misplacement in the upper arm vein is higher than that in the other two groups (13.1 vs. 2.9 vs. 5.4 %, respectively, P = 0.02), while the other complications in the perioperative period were not significantly different. The occurrence of transfusion obstacle of the upper arm vein group is significantly lower than that of the jugular and subclavian groups (0.9 vs. 7.1 vs. 7.2 %, P = 0.01). The occurrence of thrombus is also lower than that of other two groups (0.9 vs. 4.3 vs. 3.6 %, P = 0.03). Regarding the postoperative comfort, the influences of appearance (0 vs. 7.1 vs. 2.9 %, P = 0.006) and sleep (0.9 vs. 4.2 vs. 10.7 %, P = 0.003) are significantly better than those of the jugular and subclavian vein groups. Conclusions Compared to the jugular and the subclavian vein groups, the implanted venous port in the upper arm vein has fewer complications and more convenience and comfort, and might be a superior novel choice for patients requiring long-term chemotherapy or parenteral nutrition.
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R E S E A R C H Open Access
Application and comparison of different
implanted ports in malignant tumor
patients
Yanhong Li
, Yonghua Cai
, Xiaoqin Gan, Xinmei Ye, Jiayu Ling, Liang Kang, Junwen Ye, Xingwei Zhang,
Jianwei Zhang, Yue Cai, Huabin Hu, Meijin Huang
*
and Yanhong Deng
*
Abstract
Background: The current study aims to compare the application and convenience of the upper arm port with the
other two methods of implanted ports in the jugular vein and the subclavian vein in patients with gastrointestinal
cancers.
Methods: Currently, the standard of practice is placement of central venous access via an internal jugular vein
approach. Perioperative time, postoperative complications, and postoperative comfort level in patients receiving an
implanted venous port in the upper arm were retrospectively compared to those in the jugular vein and the
subclavian vein from April 2013 to November 2014.
Results: Three hundred thirty-four patients are recruited for this analysis, consisting of 107 in the upper arm vein
group, 70 in the jugular vein group, and 167 in the subclavian vein group. The occurrence of catheter
misplacement in the upper arm vein is higher than that in the other two groups (13.1 vs. 2.9 vs. 5.4 %, respectively,
P= 0.02), while the other complications in the perioperative period were not significantly different. The occurrence
of transfusion obstacle of the upper arm vein group is significantly lower than that of the jugular and subclavian
groups (0.9 vs. 7.1 vs. 7.2 %, P= 0.01). The occurrence of thrombus is also lower than that of other two groups
(0.9 vs. 4.3 vs. 3.6 %, P= 0.03). Regarding the postoperative comfort, the influences of appearance (0 vs. 7.1 vs. 2.9 %,
P= 0.006) and sleep (0.9 vs. 4.2 vs. 10.7 %, P= 0.003) are significantly better than those of the jugular and subclavian
vein groups.
Conclusions: Compared to the jugular and the subclavian vein groups, the implanted venous port in the upper
arm vein has fewer complications and more convenience and comfort, and might be a superior novel choice for
patients requiring long-term chemotherapy or parenteral nutrition.
Keywords: Vein port, Complication, Upper arm vein, Jugular vein, Subclavian vein
Background
The incidences of gastrointestinal cancers are increasing.
Most of the patients require long-term chemotherapy or
have to receive 5-fluorouracil-based chemotherapy. There-
fore, more and more patients need a central venous
catheter in order to protect the peripheral vein. Totally
implantable central venous ports (CVP) comprise all the
devices embedded in the subcutaneous tissue, protected
by skin. CVP with the minimum limit to daily life applies
to patients requiring long-term repeated venipuncture,
chemotherapy, parenteral nutrition support, and transfu-
sion [1].
The jugular vein and the subclavian vein are com-
monly selected with the injection base embedded under
the clavicle and chest skin. However, these two methods
carry a risk of puncture resulting to pneumothorax,
hemothorax, and artery injury [2, 3]. Currently, the
standard of practice is placement of central venous
access via an internal jugular vein approach. The arm
port is a novel implanted port method, which only
* Correspondence: Maymay0129@139.com;littleqicat@163.com
Equal contributors
Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen
University, Guangzhou, Guangdong 510655, China
© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Li et al. World Journal of Surgical Oncology (2016) 14:251
DOI 10.1186/s12957-016-1002-6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
requires selecting the basilica vein or brachial vein,
guided by vessel B ultrasonic set, for puncture by im-
proved Seldinger puncture technique in the peripher-
ally inserted central catheter (PICC) room. This
method solely requires a professional nurse for vein
therapy with PICC catheterizing qualification for op-
eration under the doctors supervision. The whole
procedure is simple and avoids occupancy of the op-
erating room. Any large cohort of patients undergoing
the new method has not been widely reported. The
current study aims to compare the operation time,
occurrence of postoperative complications, and pa-
tient comfort of the upper arm port with the other
two methods of implanted ports in the jugular vein
and the subclavian vein in patients with gastrointes-
tinal cancers.
Methods
Patients
A retrospective analysis was conducted for patients re-
ceiving implantation of three different access ports in
The Sixth Affiliated Hospital of Sun Yat-sen University,
Medical Oncology, from April 2013 to November 2014.
All of these patients were pathologically diagnosed with
gastrointestinal cancer. Follow-up starts from the day of
port implantation until the day of removal for any rea-
sons or patientsdeath. Admission criteria are as follows:
(1) all the patients should be more than 18 years, with
malignant tumor confirmed pathologically; (2) examin-
ation of the patients heart, liver, kidney, and blood
should be normal; (3) patients should have chemothera-
peutic indications without chemotherapeutic and venous
catheterization contraindications; and (4) the arm
circumference for implantation port on the arm should
be 25 cm. Exclusion criteria are as follows: (1) any
patient who has been confirmed or suspected of infec-
tion, bacteremia, or blood poisoning; (2) patients with
too small body size to accept implantation equipment;
(3) patients with chronic obstructive pulmonary disease;
and (4) patients with radiotherapy, trauma, and surgery
at the operative site. This study was approved by the in-
stitutional review board of The Sixth Affiliated Hospital,
Sun Yat-sen University (Guangzhou, Guangdong), and
written informed consent was obtained from every
participant.
Device for access port
The device for access port is 6F fine implanted port suite
manufactured by US Bard Co., Ltd. with a catheter
length of 75 cm, and the device for the jugular venous
and subclavian venous ports is 7.5F implanted access
port suite manufactured by Braun Medical Co., Ltd. with
a catheter length of 50 cm.
Implantation of access port
Implantation of access port should be conducted with
local anesthesia. Access port on the arm should be im-
planted by two professional nurses with PICC implant-
ation qualification. Basilica or cephalic vein of the upper
right arm is selected for puncture guided by the color
vessel Doppler ultrasound with improved Seldinger
puncture technique. Subsequent to catheter implant-
ation, routine chest X-ray should be examined for the
feeding of the catheter and the position of the tip. If the
catheter reverses or the tip position is abnormal, it
should be readjusted with the aid of X-rays. Under a
physicians guidance, the nurses transect the skin about
3 cm with the center of the puncture point to split the
subcutaneous tissue for the capsular bag and embed the
port foundation under the skin of the upper arm without
establishing the subcutaneous tunnel.
Jugular venous access and subclavian venous access
ports should be implanted by qualified physicians into
the right jugular vein or subclavian vein with puncture
point 2 cm below the middle point between the right
cleidomastoid sternal branch and top or right clavicle at
the clavicle angle. After implanting the catheter, a sub-
cutaneous tunnel is established on the right chest wall.
Subsequently, a routine chest X-ray film is examined for
the feeding and the catheter position.
Maintenance and follow-up of catheter
Fluid can be injected after implanting the access port.
Intact butterfly needle is used to puncture into the port
foundation after skin disinfection. Normal saline is used
to wash the catheter to detect an obstacle and subcuta-
neous seepage in the catheter. When consecutive infu-
sion is required, intact butterfly needle should be
replaced every week. Upon completion of the infusion
therapy, 10 ml heparin saline (100 IU/ml) is used to
wash the catheter. If the catheter cannot be used for
more than 4 weeks, it should be washed in the hospital
every 4 weeks. Follow-up starts from the port implant-
ation until the removal surgery, and the withdrawal date
should be treated as the final usage date of the infusion
port.
Collection of complications
Major observation indices refer to the perioperative time
of three different access ports (the date of port implant-
ation) and incidence rates of postoperative complications
by recording the types and the time of complication in-
cidence. The complications in the perioperative period
include catheter misplacement, pneumothorax, hemo-
thorax, artery injury, and failed puncture, which requires
a change of the puncture path. The postoperative com-
plications include infection, thrombogenesis, poor trans-
fusion, catheter breakage, pinch-off syndrome, seepage
Li et al. World Journal of Surgical Oncology (2016) 14:251 Page 2 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
on foundation, and foundation exposure. The investiga-
tion of postoperative comfort is carried out in a subse-
quent visit (after 15 days); nurses who do not attend this
study inquire and record the patients appearance effects,
concerns about catheter breakage, and effect on sleep
and daily life.
Statistical method
Perioperative time, postoperative complications, and
postoperative comfort level in patients receiving an im-
planted venous port in the upper arm were retrospect-
ively compared to those in the jugular vein and the
subclavian vein. The statistical software is SPSS19.0.
Statistical data is represented as a mean ± standard
deviation. ANOVA is used for mean comparison, and
LSD of post hoc inspection is used for the comparison
of two averages. Chi-squared test is used to compare the
complication incidence. P< 0.05 is considered statisti-
cally significant.
Results
General condition of the patients
The analysis recruited 344 patients, including 107 pa-
tients in the upper arm vein group, 70 in the jugular
vein group, and 167 in the subclavian vein group. Table 1
shows the clinical characteristics of patients in the three
groups, with similar basic information. In the three
groups, the average follow-up durations were 257.6 ±
134.1, 307.9 ± 134.3, and 253.4 ± 152.8 days (p= 0.03),
and seven, two, and nine patients failed the follow-up,
respectively.
Complications in ports in the perioperative period
The patients in all the groups have successfully received
port implantation. Patients in the three groups prefer
right implantation. Complications in the operation include
catheter misplacement, pneumothorax, hemothorax, ar-
tery injury, and failed puncture or catheterizing, which
requires changing puncture access. The upper vein group
should take the left upper vein access, while the jugular
and subclavian vein groups should take the subclavian ac-
cess and jugular access, respectively, because of failed
puncture or catheterizing. The incidence of catheter mis-
placement in the upper arm vein group is higher than that
of the other two groups (13.1 vs. 2.9 vs. 5.4 %, P=0.02),
while the other complications in the perioperative period
do not alter significantly, as shown in Table 2.
Postoperative complications
Table 3 shows complications after port implantation.
Any differences in the complications of foundation ex-
posure, seepage in the foundation, infection, and
thrombus among the three groups were not observed.
However, the incidence of poor transfusion in the upper
vein group is significantly lower than that in the jugular
and subclavian vein groups (0.9 vs. 7.1 vs. 7.2 %, P=
0.01), and its incidence of thrombus was also lower (0.9
vs. 4.3 vs. 3.6 %, P= 0.03); 3, 5, and 13 patients required
the removal of the port because of complications, without
any statistical significance (P=0.23).
Postoperative comfort after port implantation
The comparison of postoperative comfort shows that
the appearance concern (0 vs. 7.1 vs. 2.9 %, P= 0.006)
and the sleep influence (0.9 vs. 4.2 vs. 10.7 %, P= 0.003)
in the upper arm vein group were not significant as
compared to those in the jugular and subclavian vein
groups (Table 4).
Discussion
The current study compared the application of the
upper arm venous port, the jugular venous port, and the
Table 1 Baseline characteristics
Variable Upper vein
group
Jugular
vein group
Subclavian
vein group
Patients 107 70 167
Age (years) 54.4 ± 12.3 53.8 ± 13.0 53.0 ± 13.3
Sex
Male 64 (59.8) 41 (58.6) 104 (62.3)
Female 43 (40.2) 29 (41.4) 63 (37.7)
Primary tumor
Colon cancer 33 (30.8) 31 (44.3) 66 (39.5)
Rectal cancer 52 (48.6) 31 (44.3) 84 (50.3)
Gastric cancer 12 (11.2) 7 (10.0) 13 (7.8)
Pancreatic cancer 2 (1.9) 1 (1.4) 0 (0)
Small intestinal carcinoma 1 (0.9) 0 (0) 0 (0)
Esophageal cancer 1 (0.9) 0 (0) 3 (1.8)
Bile duct carcinoma 1 (0.9) 0 (0) 0 (0)
Hepatic carcinoma 1 (0.9) 0 (0) 0 (0)
Others 4 (3.7) 0 (0) 1 (0.6)
Follow-up duration (days) 257.6 ± 134.1 307.9 ± 134.3 253.4 ± 152.8
Data in parenthesis is a percentage
Table 2 Complications in the perioperative period
Complications Upper arm
vein group
Jugular
vein group
Subclavian
vein group
Pvalue
Catheter misplacement 14 (13.1) 2 (2.9) 9 (5.4) 0.02
Pneumothorax 0 (0) 1 (1.4) 2 (1.2) 0.50
Hemothorax 0 0 0
Artery injury 1 (0.9) 4 (5.9) 6 (3.6) 0.18
Change of puncture
access
10 (9.3) 3 (4.3) 9 (5.4) 0.31
Data in parenthesis is a percentage
Li et al. World Journal of Surgical Oncology (2016) 14:251 Page 3 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
subclavian venous port in patients with malignant
tumor. The result shows that there is no significant dif-
ference in the perioperative period among the three
groups. While the incidence of the postoperative compli-
cations in the upper arm venous group is lower, the
comfort level is higher.
Implantation of the upper arm port is conducted in
the PICC catheterizing room; hence, the catheter feeding
and tip position cannot be determined during the oper-
ation. Moreover, because the catheterizing route is elon-
gated, it is easy to mislead the feeding to the jugular
vein, thus reversing the catheter, or catheterizing deeply
into the heart to cause discomfort in the neck or precor-
dial area. Therefore, we measure the distance between
the planned puncture point and the sternum midpoint
in a preoperative routine as the reference depth of
catheterization during operation. Meanwhile, routine
inspection with a chest X-ray film is conducted to distin-
guish the catheter feeding and tip position after cathe-
terizing, rather than cutting the skin to implant the
foundation. If the catheter position is abnormal, the ad-
justment should be conducted under the X-ray machine.
Although the incidence of catheter misplacement is high
(13.1 %) in the upper arm vein group, the position can
be adjusted to normal under perspective. Also, without a
subcutaneous tunnel, the complication of poor transfu-
sion is also lower than that in the jugular and subclavian
groups (P= 0.06). The lumen of the upper arm vein is
remarkably small, such that the puncture failure rate
was reported to be 511 % [4, 5], and the ratio of chan-
ging puncture access in this group was 9.3 %. Kawamura
et al. [6] assessed the implantation of the upper arm port
in 113 patients with metastatic colorectal cancer receiv-
ing chemotherapy. All the patients received puncture
under the guidance of real-time ultrasound or radiation,
and none of them demonstrated complications in the
perioperative period; only nine patients showed postop-
erative complications (8.0 %). It was concluded that the
upper arm port exhibited favorable short- and long-term
effects.
The upper arm port access can completely avoid
severe puncture complications, such as pneumothorax
and hemothorax, and only one patient had artery injury
(0.9 %). The blind puncture was conducted in the jugu-
lar and subclavian vein groups, which is greatly influ-
enced by the experience of operators and individual
anatomic differences. Thus, the probability of pneumo-
thorax (0.33.2 %) [7, 8] and artery injury is high. The
incidence of catheter misplacement is low when choos-
ing the jugular vein as the puncture access, but is simple
to distort and narrow for the catheter to cause poor
transfusion. Since the injection foundation is embedded
on the upper wall, the catheter should be downward
feeding after turning 180° and the subcutaneous tunnel
elongated. Moreover, the tractive feeling in the neck
after the operation is obvious, lowering the comfort
level. The subcutaneous tunnel in the subclavian venous
access is short. Thus, the patients have no tractive feel-
ing in the neck. However, severe complications, such as
pneumothorax, hemothorax, mediastinum hematoma,
and pinch-off syndrome may occur in the puncture to
cause catheter breakage [9, 10]. When the catheter
passes through the interval between the clavicle and the
first rib, poor transfusion, thrombus, breakage, and per-
foration may occur, and the catheter may even rupture
because of pressure. The broken end may flow into the
heart or lung along with the blood flow to cause
arrhythmia or pulmonary embolism. In this study, three
patients had a pinch-off syndrome in the subclavian vein
group (1.8 %), including two patients requiring emer-
gency surgery for the removal of the broken end due to
catheter fracture.
In the postoperative complications, the incidence of
infection in the upper arm vein group (0.9 %) is lower
than that in the jugular vein group and subclavian vein
group. The study did not record any significant differ-
ence in the infection rates of arm port and subclavian
venous port [11, 12]. In the long-term maintenance of
ports, phlebothrombosis is another severe complication.
Patients and port implantation may increase the risk of
phlebothrombosis [13]. The retrospective study shows
that the incidence of thromboembolism related to the
Table 3 Complications after port implantation
Complications Upper arm
vein group
Jugular
vein group
Subclavian
vein group
Pvalue
Foundation exposure 2 (1.9) 1 (1.4) 0 (0) 0.23
Seepage on foundation 1 (0.9) 1 (1.4) 1 (0.6) 0.82
Thrombus 1 (0.9) 3 (4.3) 6 (3.6) 0.03
Infection 1 (0.9) 2 (2.9) 6 (3.6) 0.40
Poor transfusion 1 (0.9) 5 (7.1) 12 (7.2) 0.01
Catheter breakage 0 (0) 0 (0) 2 (1.2) 0.34
Pinch-off syndrome 0 (0) 0 (0) 3 (1.8) 0.20
Patients with pump
removal
3 (2.8) 5 (7.1) 13 (7.8) 0.23
Data in parenthesis is a percentage
Table 4 Comparison of postoperative comfort after port
implantation
Items Upper arm
vein group
Jugular
vein group
Subclavian
vein group
Pvalue
Appearance 0 (0) 5 (7.1) 5 (2.9) 0.006
Concern of catheter
breakage
3 (2.8) 4 (5.7) 18 (10.7) 0.19
Sleep influence 1 (0.9) 3 (4.2) 18 (10.7) 0.003
Influence on daily life 0 (0) 0 (0) 2 (1.1) 0.26
Data in parenthesis is percentage
Li et al. World Journal of Surgical Oncology (2016) 14:251 Page 4 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
catheter is up to 1264 %, but the anticoagulant for rou-
tine prevention is not recommended [14], even though
one study indicates that the incidence of deep venous
thrombosis in the arm port is higher than that in the
chest port [15].
The other significant advantages of the upper arm port
are that the postoperative comfort level and life quality
of patients are high. The foundation embedded in the
upper arm is concealed, and the invisibility of the punc-
ture point and operation scar in the neck and chest
renders it esthetically applicable for patients.
Moreover, in fluid replacement therapy, patients do
not require upper body undressing, which avoids embar-
rassment and discomfort, especially in women [6]. Goltz
et al. [16] found that the satisfaction and life quality of
patients receiving arm port implantation were signifi-
cantly higher than those of chest port implantation.
Compared with the forearm port, the upper arm port
has no difference in the infection rate, deep venous
thrombosis, catheter misplacement, or stoppage. The
embedded position of an upper arm port is high; short
sleeves can cover the injection foundation without the
subcutaneous tunnel, through chelidon. Therefore, we
think the patientsquality of life with the upper arm port
is better.
The limitation of this study is that the type assessment
of perioperative period and postoperative complications
in the retrospective analysis is not quite comprehensive.
Moreover, this is a study conducted by a single center,
and patients in the three groups are not randomized.
Also, the learning curve should be accomplished at an
early stage after introducing the upper arm port into the
hospital, to prevent the high incidences of catheter mis-
placement. However, few relevant studies on the upper
arm are conducted in China, but several occur abroad.
The current study provided evidence to assess the safety
of clinical application of the upper arm port.
Conclusions
In conclusion, the operation of the upper arm venous
port is safe such that severe puncture complications,
such as pneumothorax, hemothorax, and pinch-off syn-
drome, are avoided. The incidence of postoperative com-
plications is lower than that in jugular venous access
port and subclavian access port, and the discomfort level
and patientsquality of life is better. Therefore, the
upper arm venous port implantation method might be a
good choice in clinical applications.
Abbreviations
CVP: Central venous ports; PICC: Peripherally inserted central catheter
Acknowledgements
Not applicable.
Funding
The study was supported by the China National Natural Science Foundation
(No. 81472249) and a Guangzhou Scientific Grant (2014J2200059).
Availability of data and materials
None.
Authorscontributions
YL, YC, XG, and XY carried out the studies, participated in collecting the data,
and drafted the manuscript. JL, LK, JY, and XZ performed the statistical
analysis and participated in its design. JZ, YC, HH, MH, and YD helped to
draft the manuscript. All authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
This study was approved by the institutional review board of The Sixth
Affiliated Hospital, Sun Yat-sen University (Guangzhou, Guangdong), and
written informed consent was obtained from every participant.
Received: 9 May 2016 Accepted: 8 September 2016
References
1. Sonobe M, Chen F, Fujinaga T, Sato K, Shoji T, Sakai H, et al. Use of totally
implantable central venous access port via the basilic vein in patients with
thoracic malignancies. Int J Clin Oncol. 2009;14:20812.
2. Vardy J, Engelhardt K, Cox K, Jacquet J, McDade A, Boyer M, et al. Long-
term outcome of radiological-guided insertion of implanted central venous
access port devices (CVAPD) for the delivery of chemotherapy in cancer
patients: institutional experience and review of the literature. Br J Cancer.
2004;91:10459.
3. Di Carlo I, Cordio S, La Greca G, Privitera G, Russello D, Puleo S, et al. Totally
implantable venous access devices implanted surgically: a retrospective
study on early and late complications. Arch Surg. 2001;136:10503.
4. Marcy PY, Magne N, Castadot P, Italiano A, Amoretti N, Bailet C, et al. Is
radiologic placement of an arm port mandatory in oncology patients?:
analysis of a large bi-institutional experience. Cancer. 2007;110:23318.
5. Conessa C, Talfer S, Herve S, Chollet O, Poncet JL. Cephalic vein access for
implantable venous access devices. Technique and long-term follow-up.
Rev Laryngol Otol Rhinol (Bord). 2002;123:1438.
6. Kawamura J, Nagayama S, Nomura A, Itami A, Okabe H, Sato S, et al.
Long-term outcomes of peripheral arm ports implanted in patients with
colorectal cancer. Int J Clin Oncol. 2008;13:34954.
7. Kelly H, Goldberg RM. Systemic therapy for metastatic colorectal cancer:
current options, current evidence. J Clin Oncol. 2005;23:455360.
8. Lorch H, Zwaan M, Kagel C, Weiss HD. Central venous access ports placed
by interventional radiologists: experience with 125 consecutive patients.
Cardiovasc Intervent Radiol. 2001;24:1804.
9. Cho JB, Park IY, Sung KY, Baek JM, Lee JH, Lee DS. Pinch-off syndrome.
J Korean Surg Soc. 2013;85:13944.
10. Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: case report and
collective review of the literature. Am Surg. 2004;70:63544.
11. Akahane A, Sone M, Ehara S, Kato K, Tanaka R, Nakasato T. Subclavian vein
versus arm vein for totally implantable central venous port for patients with
head and neck cancer: a retrospective comparative analysis. Cardiovasc
Intervent Radiol. 2011;34:12229.
12. Bodner LJ, Nosher JL, Patel KM, Siegel RL, Biswal R, Gribbin CE, et al.
Peripheral venous access ports: outcomes analysis in 109 patients.
Cardiovasc Intervent Radiol. 2000;23:18793.
13. Sutherland DE, Weitz IC, Liebman HA. Thromboembolic complications
of cancer: epidemiology, pathogenesis, diagnosis, and treatment.
Am J Hematol. 2003;72:4352.
14. Vescia S, Baumgartner AK, Jacobs VR, Kiechle-Bahat M, Rody A, Loibl S, et al.
Management of venous port systems in oncology: a review of current
evidence. Ann Oncol. 2008;19:915.
Li et al. World Journal of Surgical Oncology (2016) 14:251 Page 5 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
15. Kuriakose P, Colon-Otero G, Paz-Fumagalli R. Risk of deep venous
thrombosis associated with chest versus arm central venous subcutaneous
port catheters: a 5-year single-institution retrospective study. J Vasc Interv
Radiol. 2002;13:17984.
16. Goltz JP, Petritsch B, Kirchner J, Hahn D, Kickuth R. Percutaneous
image-guided implantation of totally implantable venous access ports in
the forearm or the chest? A patients' point of view. Support Care Cancer.
2013;21:50510.
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... TIVADs are placed via the subclavian, external or internal jugular vein through the anterior chest wall, or via the basilic vein through the upper arm; the optimal TIVAD insertion site is controversial (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Placement in the anterior chest wall has been the preferred approach; the advantages of this route include high stability of the system and a low incidence of infection (9). ...
... However, complications associated with the operative procedure, such as pneumothorax, arterial puncture and vascular injury, occur in 0.3-15.8% of patients (9)(10)(11). For this reason, upper arm sites have been increasingly used; the placement procedure is simple with fewer operative complications, and these sites have cosmetic advantages and an absence of possible interference with radiation therapy (12)(13)(14). However, the upper arm route is associated with risk of long-term complications, including catheter-related deep vein thrombosis (CR-DVT), infectious adverse events and mechanical complications (15)(16)(17)(18). ...
... However, the present findings require confirmation by a prospective randomized study, including evaluation of the quality of life of the patients. More specifically, to the best of our knowledge, an agreement has not yet been reached on the use of prophylactic anticoagulants and antibiotics in the management of TIVAD (14). Further studies are needed to determine whether such prophylaxis reduces the incidence of long-term complications. ...
Article
Full-text available
Totally implantable vascular access devices (TIVADs) are often used to administer chemotherapy by prolonged intravenous infusion. The objective of the present study was to investigate the incidence of long-term complications and identify risk factors associated with TIVAD placement in patients with gastric cancer. A total of 121 patients with gastric cancer who had undergone 150 TIVAD placement procedures for chemotherapy or supportive care were enrolled in the present retrospective cohort study. A number of risk factors were analyzed, including age, sex, hypertension, diabetes mellitus, history of thrombosis, body mass index, disease stage, and site and purpose of TIVAD. In total, 40 TIVADs (26.7%) developed long-term complications, of which 27 (18.0%) were infections, seven (4.7%) were catheter-related deep vein thrombosis (CR-DVT), and six (4.0%) were obstructions. Chemotherapy was associated with an increased rate of infectious adverse events (odds ratio 2.925; 95% CI, 1.104-7.750; P=0.031) according to the multivariate analysis. CR-DVT occurred more frequently in upper arm ports than in chest wall ports; however, this difference was not statistically significant (7.5 vs. 0.0%; P=0.084) according to the univariable analysis. All CR-DVTs developed in the upper arm sites. Chemotherapy and the upper arm site were associated with long-term complications in patients with TIVAD. However, further studies are needed to confirm the findings of the present study and to determine the reasons for the high incidence of long-term complications in these patients.
... Three studies 29,35,38 reported the anticoagulant profiles, and results showed that thromboprophylaxis did not influence the risk for thrombosis either. In the subgroup analysis of insertion methods, only one study 31 used surgical cut-down approach in all patients, and six studies 10,[33][34][35][36]40 Notes: Low risk: 5-6 sections with "yes"; moderate risk: 3-4 sections with "yes"; high risk: ≤2 sections with "yes". employed puncture approach for all patients. ...
... 40 Moreover, arm port is especially appropriate for patients who require neck or chest radiation therapies. 40 Comparison of these quality-of-life related outcomes is of importance, however, only a limited number of studies reported these parameters, which were measured based on various evaluating methods, such as self-administered questionnaire 10,36 and quality of life score, 37,46 and nonuniformity of these measurements made these data incomparable in this study. Our study is distinctive and provides valuable information to oncology-related clinicians in that, to the best of our knowledge, this systematic review with meta-analysis is the first one to comprehensively investigate the clinical efficacies and represents the most up-to-date information with respect to chest ports and arm ports. ...
Article
Full-text available
Background Two prevailing, totally implantable venous access ports are routinely utilized in oncology: chest port or arm port. This systematic review with meta-analysis was conducted to compare safety and efficiency of the two techniques. Methods We performed evidence acquisition intensively from PubMed, Embase, and Cochrane Library. Available comparative studies that evaluated both techniques were identified. The outcomes of interest included total complication events, procedure-related infections, thrombosis, intra-operative complications, mechanical complications, conversion rate, early port removal, and operating time. Results Thirteen comparative studies including 3,896 patients (2,176 for chest ports, and 1,720 for arm ports) were identified. The present study showed that arm port was associated with higher procedure conversion rate (2.51% in chest port group and 8.32% in arm port group; odd ratios [OR] 0.27, 95% confidence interval [CI] 0.15-0.46; p<0.001), but lower incidence of intra-operative complications (1.38% in chest port group and 0.41% in arm port group; OR 2.38, 95% CI 1.07–5.29; p=0.03). There were no between-group differences with respect to total complication events, procedure-related infections, thrombosis, mechanical complications, early port removal, and operating time. Subgroup analysis of patients under 60 years revealed that no significant difference was detected in intra-operative events (1.19% in chest port group and 0.02% in arm port group, OR 2.59, 95% CI 0.74–9.08; p<0.14), indicating that age may be a risk factor for intra-operative events. Sensitivity analysis did not change conclusions of all endpoints of interest. Conclusion Arm port is associated with higher procedure conversion rate, but lower incidence of intra-operative complications, and age may be a risk factor for intra-operative events.
... Li et al, in a 344-patient series, used SCV, IJV, and upper arm vein for access. They claimed that upper arm vein had superior to both IJV and SCV approach in terms of higher success rates and lower complication rates [2]. This study was a retrospective study like many other series in the literature. ...
... We performed thoracotomy and removed the fractured catheter. This complication was reported in the literature [2,13]. Biffi also reported the cost-effectiveness of different access sites, and pointed out that subclavian vein approach was the most cost-effective method of central venous port placement and use [14]. ...
... Generally, they are clinically classified as chest ports and upper arm ports based on different port anatomical sites. 5 Recently, the upper arm TIVAD technique has been used in both largeand medium-sized hospitals in Beijing and other important coastal cities. 6 Our study intended to focus on the quality of life and satisfaction of Chinese cancer patients comparing with the two different anatomic sites for ports aiming at providing better people-oriented service. Due to lack of a unified and standardized scale, this study translated quality of life assessment, venous device-port (QLAVD-P) into Chinese version and tested its reliability and validity. ...
Article
Full-text available
Objective To translate the assessment item sets of the Canadian version of the quality of life assessment, venous device-port for breast cancer patients with chest and arm ports (i.e. different implanting sites) into Chinese version, and to conduct a test of reliability and validity for it. Methods According to the Brislin translation model, quality of life assessment, venous device-port underwent literal and back translations, and the Chinese version of quality of life assessment, venous device-port was preliminarily revised by consulting an expert and a preliminary test. A total of 270 cancer patients undergoing chemotherapy were assessed during the use of ports, and the reliability and the validity of the Chinese version of quality of life assessment, venous device-port scale were then tested. Results The scale consisted of 23 yes/no items and seven numerical rating scales. The total Cronbach’s α coefficient of the scale was 0.829, and each item ranged from 0.812 to 0.845. The item-level content validity index was 0.67–1.00, and the scale-level content validity index/average and the scale-level content validity index/universal agreement were 0.98 and 0.90, respectively. The correlation coefficient of the repeated measurement results of the scale was 0.554 ( p < 0.01). Exploratory factor analysis showed that the cumulative explained variance of five common factors was 64.197%. Conclusion The Chinese version of quality of life assessment, venous device-port scale is an effective assessment tool for quality of life with good reliability and validity in breast cancer patients with different implantation sites for totally implanted venous access devices in northern China.
Article
Full-text available
Background While vascular puncture is always performed before making port pocket in the implantation of totally implantable venous access ports (TIVAP), some surgeons preferred to make port pocket first. This study seeks to verify the safety and feasibility for the pocket-first technique. Methods The study retrospectively reviewed 447 patients who undergone TIVAP implantation from July 2017 to November 2022. All the patients were divided into two groups based on vascular puncture first or making port pocket first. The general information, operation information and post-operative complications were reviewed and analyzed. Results All the operations were performed successfully. No difference was observed in the sex, age, height, weight, BMI, port location and total complication rate between the two groups. The operation time of the Puncture Group and the Pocket Group were 46.9 ± 22.4 min and 33.8 ± 13.6 min ( P<0.00001 ). In the patients of SCV approach, the operation time between the two groups were 37.4 ± 14.8 min and 33.5 ± 10.9 min ( P<0.05 ). Multivariate analysis showed the variable BMI and first procedure were independent prognostic factors for operation time. In the cases using SCV/AxV approach the variable first procedure was the only independent prognostic factor for operation time (P = 0.002). Conclusions The pocket-first technique can be considered as a safe, feasible and convenient technique for TIVAP implantation. The time consuming is significantly shortened compared with the puncture-first technique and this advantage may be more obvious when using SCV/AxV approach.
Article
Central vein catheters (CVC) have very important role in the treatment of patients with malignant diseases. CVCs are used for the application of chemotherapy and also for the extended usage of liquids, blood and blood derivatives, antibiotics , total parental nutrition as well as for common blood analysis. Port-a-cath vein catheters are closed systems and their purpose is to provide access to the central vascular system. The use of these systems is associated with decreased possibility of infection, simple maintenance of the port that is not in use, esthetic benefit and improved mobility of patients. In our clinic 16port-a-cath vascular catheters were implanted to oncologic patients from January 2017 until 31st January 2018. There were no early complications and in 12,5% of patients late complications occurred. Subjective assessment of all the patients with implanted port-a -chat system is improved quality of life.
Article
Background: Totally implantable venous access ports (TIVAPs) are widely applied in patients who require chemotherapy, parenteral nutrition, or frequent intravenous drug infusion. Although various venous access routes are possible for TIVAP insertion, the best method remains a topic of controversy. We present a single center retrospective study of radiologically guided placement of TIVAPs through the basilic vein, with analysis of technical feasibility, patient safety, and device-related complications. Methods: We retrospectively reviewed 270 patients who received TIVAP implantation through the basilic vein from November 2013 to July 2016, under imaging guidance by an interventional radiology team at our institution. Fluoroscopic images, chest radiographs, computed tomography scans, and medical records were reviewed after port implantation. Catheter maintenance days were calculated and catheter related complications were recorded. Results: The procedural success rate was 99.3%. In total, 270 TIVAPs were implanted in 270 patients, of which 150 remained functional at the end of the study period. The total catheter maintenance days was 77543 days, and the mean catheter indwelling duration was 287 ± 207 days. In 20 (7.4%) patients, TIVAP-related complications occurred during the follow-up period, resulting in a post-procedural complication rate of 0.26incidences per 1000 catheter days. No significant relationship was observed between complications and gender (p = 0.188), age (p = 0.528), body mass index (p = 0.547), the type of primary malignancy (p=0.914), or between the left and right basilic veins (p = 0.319). Conclusion: Real-time ultrasound and fluoroscopic guidance provides a safe method for TIVAP implantation through the basilic vein, with a high technical success rate and few device-related complications.
Article
Full-text available
Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.
Article
Full-text available
For patients with a thoracic malignancy whose peripheral veins are not suitable for blood access for chemotherapy, we evaluated a totally implantable central venous access port, in which the port is implanted in the ulnar side of the arm and the catheter is introduced via the basilic vein into the superior vena cava (TIAP-BV). Twenty-five patients (21 with lung cancer, 2 with malignant pleural mesothelioma, and 2 with thymoma) receiving TIAP-BV were included. Indications, surgical complications, and long-term complications were analyzed. Indications for TIAP-BV were: chemotherapy (17 patients) and chemotherapy with parenteral nutrition (8 patients). The following surgical complications occurred: arrhythmia due to misplacement of the tip of catheter (1 patient); intraoperative conversion from the left to right arm (2 patients); and hematoma at the implantation site (1 patient). Short-term problems were: death 1 week after implantation without the use of TIAP-BV (2 patients). Long-term complications were: skin ulcer at the port site (1 patient); early removal of TIAP-BV because of port site infection (1 patient); catheter occlusion (1 patient); and venous thrombosis of basilic vein (2 patients). In the 22 patients who did not die early or have the device withdrawn early, the median duration of TIAP-BV use was 7 months (range, 1 to 20 months) without any break to the port system, leakage of drugs, or catheter-related infections. TIAP-BV can be employed for long-term use for chemotherapy and parenteral nutrition. However, a patient's expected prognosis and infectious disease status at the time of implantation surgery should be considered before the surgery proceeds.
Article
Purpose: This study aimed to compare patients' satisfaction and impact on daily life after implantation of totally implantable venous access ports (TIVAP) in the forearm and the chest. Methods: In this prospective study, 50 patients (mean age, 55.8 ± 15.4 years) received three questionnaires on days 1, 30, and 90 after implantation in the forearm (n = 25) or the chest (n = 25). Knowledge concerning device function, comfort perception, and impact of TIVAP on daily activities were evaluated. Ratings were dichotomized depending on whether statements were agreed with or contradicted. Fisher's exact test was used to determine differences between the forearm port (FP) and chest port (CP) groups. Results: There was no significant difference between the two groups with regard to unpleasant feelings (p = 0.09) and discomfort while puncturing (p = 0.06). Main fears in both groups were dysfunction and infection. The possibility of high-pressure injections via the TIVAP was rated important in both groups. More CP patients feared dislocation of their TIVAP during sleep (p < 0.05). CP patients experienced more negative perceptions while driving a car and wearing brassieres (p < 0.05) than FP patients. All patients would recommend their device. Conclusions: During certain activities, the FP device seems to be favorable, since it causes less discomfort than the CP.
Article
This study was designed to compare central venous ports (CVP) from two different routes of venous access-the subclavian vein and arm vein-in terms of safety for patients with head and neck cancer (HNC). Patients with HNC who underwent image-guided implantations of CVPs were retrospectively evaluated. All CVPs were implanted under local anesthesia. Primary outcome measurements were rates and types of adverse events (AEs). Secondary outcomes included technical success and rate and reason of CVP removal. A total of 162 patients (subclavian port group, 47; arm port group, 115) were included in this study. Technical success was achieved in all patients. The median follow-up period was 94 (range, 1-891) days. Two patients in the subclavian port group experienced periprocedural complications. Postprocedural AEs were observed in 8.5 and 22.6% of the subclavian port and arm port group patients, respectively (P = 0.044). Phlebitis and system occlusions were observed only in the arm port group. The rate of infection was not significantly different between the two groups. The CVP was removed in 34 and 39.1% of the subclavian port and arm port patients, respectively. Both subclavian and arm CVPs are feasible in patients with HNC. AEs were more frequent in the arm port group; thus, the arm port is not recommended as the first choice for patients with HNC. However, further experience is needed to improve the placement technique and the maintenance of CVPs and a prospective analysis is warranted.
Article
Venous ports are mandatory for chemotherapy in cancer patients because prolonged infusions are required. The aim of this study was to assess the safety of peripheral arm ports for chemotherapy in patients with colorectal cancer. A peripheral venous access port was placed in the upper arm in 113 consecutive patients with metastatic colorectal cancer (MCRC). All patients received modified FOLFOX (5-fluorouracil [5-FU]/l-leucovorin [LV]/oxaliplatin [L-OHP]) 6 or FOLFIRI (5-FU/LV/irinotecan hydrochloride [CPT-11]) regimens at least once via the venous access port. All patients were followed up at least once every 2 weeks. Puncture of the basilic veins was successfully completed under real-time sonographic guidance or radiographic guidance in all patients. The median operative time was 30 min. The cumulative follow-up period was 29 886 catheter days (range, 9-560 days; mean, 264 days). No procedural complications, such as pneumothorax, hemothorax, arterial puncture, or cardiovascular problems, occurred in our series. A total of nine patients (8.0%) had complications. Port-site infection occurred in six patients (5.3%; 0.20 infections per 1000 catheter-days). One patient (0.9%) had an episode of ultrasound-documented deep vein thrombosis in the ipsilateral upper extremity (0.03/1000 catheter-days). Dislocation or migration of the catheter tip occurred in two patients (0.07/1000 catheter-days). A second port was placed in six patients (5.3%) after removal of the fi rst port. Peripheral arm ports can be maintained with excellent short-and long-term outcomes. Peripheral arm ports are considered to be a good alternative to central venous ports implanted in the chest in patients with MCRC.
Article
To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data. One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data. Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant (p = 0.6). Aspiration occlusion occurred in 13 patients (11.7%). Intracatheter urokinase was infused in eight of these patients and successfully restored catheter function in all but two instances. These complication rates are comparable to or better than those reported with chest ports. Peripheral ports for long-term central venous access placed by interventional radiologists in the interventional radiology suite are as safe and as effective as chest ports.
Article
To assess safety and function of central venous port systems implanted percutaneously in the interventional radiology suite. One hundred and twenty-five consecutive ports in 123 patients were evaluated retrospectively. One hundred and twenty ports were implanted via the subclavian vein. Technical success was 100%. Fourteen patients (11.2%) experienced immediate procedural complications, all minor (pneumothorax 1.6%). During follow-up (4-343 days, mean service period 97.8 days), nine complications occurred, six of which were major. These were three port infections which led to hospitalization and port removal, one chamber penetration through the skin, and two port occlusions. Port removal as a result of complications was performed in six patients. Altogether, 20 complications occurred within a total of 11,056 days of service, which means 1.8 events per 1000 days of service. Percutaneous implantation of central venous port systems is safe and easy to perform. Complication rates of this study compare favorably with those of other radiological and surgical series.
Article
The techniques used for the implantation of totally implantable venous access devices (TIVADs) are the percutaneous approach and surgical cutdown; however, the choice is still controversial. The surgical cutdown approach may be beneficial to reduce the rate of complications. Retrospective review. A university hospital and a tertiary referral center. Patients undergoing a TIVAD implant at the First Surgical Clinic of the University of Catania in Catania, Italy, between January 1995 and December 1999, were considered for the study. All of the devices were implanted in an operating room under fluoroscopic control. The vein of choice was the cephalic vein. When the cephalic vein was not suitable for implantation, the external jugular vein or the axillary vein and its branches were used. The percutaneous approach to the subclavian vein or internal jugular vein was considered a last resort to implant a catheter. During the study period, 346 TIVADs were implanted in 344 patients. The procedure was performed with local anesthesia in 341 cases (98.5%), and only 2 patients (0.6%) required sedation for psychological reasons. Three patients (0.9%) had their TIVAD placed during a laparotomy. In 326 patients (94.2%), the devices were implanted in the cephalic vein. In the remaining cases, other veins were used with surgical cutdown. The mean time for the procedure was 15 minutes. Percutaneous access was never used, and no early mechanical complications were recorded. Only 6 patients (1.8%) in our study group had late complications (1 case of migration of the catheter, 2 cases of infection, and 3 cases of withdrawal occlusion). The catheter life ranged from 6 to 1487 days (mean time, 348 days). Our results confirm the safety, speed, and low cost of the open cutdown technique. This surgical procedure avoids both early and late complications that frequently occur with percutaneous access. Surgical cutdown should be considered the technique of choice to implant the TIVAD, especially in cancer patients.
Article
To determine the risk of deep venous thrombosis (DVT) in patients undergoing placement of central (chest) versus peripheral (arm) ports. Between January 1996 and December 2000, a total of 440 implantable chest or arm ports were placed in 422 patients. Data pertaining to the first port placed for each patient was analyzed. Ports were placed for chemotherapy (n = 415) or blood transfusion (n = 7). Subset analysis was performed, taking into consideration whether patients received prophylactic or therapeutic doses of warfarin sodium (Coumadin), to determine if there was any difference in the incidence of DVT between patients undergoing some form of anticoagulation versus those undergoing none. The medical records of these patients were reviewed to determine outcome with reference to development of DVT. In 273 chest ports placed, there were 13 (4.8%) instances of DVT; in 149 peripheral ports, there were 17 (11.4%). Censoring data on patients receiving some form of anticoagulation, the respective incidences were eight of 245 (3.3%) and 14 of 129 (10.9%). With use of Kaplan-Meier analysis and log-rank tests to examine comparisons of interest, the probability of thrombosis occurring over a period of 180 days was higher with peripheral ports irrespective of Coumadin use (P =.007 for all patients considered, P =.002 when analyzed only for those not receiving Coumadin). The difference in incidence of thrombosis for all ports between patients receiving Coumadin versus those not receiving Coumadin was not significant. Compared to chest ports, peripheral ports are associated with a significantly higher incidence of DVT.
Article
The association between malignancy and clinical thrombosis has been recognized for nearly 140 years. The purpose of this review is to examine our current understanding of thrombosis as a complication of cancer and cancer therapy. The review includes a discussion of the epidemiology, pathophysiology, diagnosis and treatment.