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PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy


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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.
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The Journal of Vascular Access
1 –7
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Article reuse guidelines:
DOI: 10.1177/1129729819884482
J VA e Journal of
Vascular Access
Totally implantable vascular access devices (TIVADs),
also named ports, are widely used in cancer patients to
facilitate the infusion of intravenous chemotherapy (CT),
fluid supplementation and long-term supportive care.
Historically, TIVADs have been implanted into the ante-
rior chest wall accessing the subclavian or the internal
jugular vein.1–3 More recently, peripheral insertion of arm
TIVADs has become more widespread as an alternative to
chest wall TIVADs in an attempt to reduce complication
PICC-PORT totally implantable vascular
access device in breast cancer patients
undergoing chemotherapy
Sergio Bertoglio1,2 , Ferdinando Cafiero2, Paolo Meszaros3,
Emanuela Varaldo1,2, Eva Blondeaux4, Chiara Molinelli4 and
Michele Minuto1,2
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.
Venous access device, totally implantable vascular access device, peripherally inserted central catheter, complications,
breast cancer, chemotherapy
Date received: 6 August 2019; accepted: 27 September 2019
1 Department of Surgical Sciences (DISC), University of Genova,
Genova, Italy
2 General Surgery Unit 1, Department of Surgery, IRCCS Ospedale
Policlinico San Martino, Genova, Italy
Breast Surgical Unit, Department of Surgery, IRCCS Ospedale
Policlinico San Martino, Genova, Italy
4 Oncologia Medica Unit 2, Department of Medical Oncology, IRCCS
Ospedale Policlinico San Martino, Genova, Italy
Corresponding author:
Sergio Bertoglio, Department of Surgical Sciences (DISC), University of
Genova, Largo Rosanna Benzi 10, 16132 Genova, Italy.
884482JVA0010.1177/1129729819884482The Journal of Vascular AccessBertoglio et al.
Original research article
2 The Journal of Vascular Access 00(0)
rates and improve the patients’ level of satisfaction. In par-
ticular, in female patients with breast cancer, the absence
of an additional scar on the chest and the easier access to
the port without the need to bare the chest represent a sig-
nificant cosmetic and psychological advantage.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.5–8
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 occlu-
sion, 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.6–8
In order to evaluate the possibility of reducing the inci-
dence 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. The catheter is then tunnelled up to a pocket
in order to position the chamber located on the medial sur-
face of the mid-arm. The rationale for this surgical
approach variation to traditional arm port placement is
based on catheter insertion into a vein of larger calibre at
the proximal third of the upper arm. This may reduce the
probability of UEDVT as it respects an optimal catheter-
to-vein ratio.9–11 Moreover, tunnelling the catheter from
the insertion site to a port chamber located in the mid third
of the arm is consistent with the zone insertion method
(ZIM) principles for PICCs that indicate this area, called
the ‘green zone’, as the optimal one in order to prevent
PICC complications.12
This study was carried out to report the overall compli-
cations and failures of PICC-PORTs in female patients
with breast cancer undergoing chemotherapy.
Material and methods
This prospective cohort study was conducted at the
Policlinico San Martino Hospital, Genova (Italy), and
includes 209 PICC-PORT implants in adult female patients
with breast cancer requiring neo-adjuvant or adjuvant
chemotherapy (as indicated by our Institutional Breast
Cancer Unit) between 1 March 2017 and 1 March 2018.
The study followed the principles of the Helsinki
Declaration and was approved by the institutional review
board. Informed consent was obtained and signed by all
patients. The study reports the PICC-PORT outcomes of
all patients.
Study design and patients’ characteristics
This study aims to analyse the PICC-PORT outcomes in a
series of female breast cancer patients undergoing chemo-
therapy and takes advantage of the fact that all PICC-
PORT implants were unselected and consecutive. All
patients were outpatients receiving chemotherapy at fixed
intervals of time according to protocol schedules for dif-
ferent stages of breast tumours.
PICC-PORT implantation was in accordance with insti-
tutional protocols. Upper limb oedema, previous UEDVT
of the selected arm for the implant, and chronic renal fail-
ure with dialysis fistula were considered exclusion criteria
for PICC-PORT implantation.
A specific data base with data extracted from hospital
records was created to collect details on: demographics,
tumour stage, type of chemotherapy (i.e. neo-adjuvant or
adjuvant treatment), chemotherapy schedule, body side
and vein of insertion, body mass index (BMI) and catheter-
to-vein ratio, duration of the PICC-PORT, perioperative
complications, UEDVT, catheter-related bloodstream
infection (CRBSI), local infection, occlusion, catheter dis-
lodgement or malfunction. Follow-up lasted 12 months
and data collection terminated on 1 March 2019.
PICC-PORT implantation and maintenance
Implantation and maintenance were always performed by
the same physicians and nurses belonging to the PICC
team following evidence-based institutional protocols in a
dedicated surgical ward for vascular access placement
under local anaesthesia with maximal barrier and antisep-
sis precautions. The PICC-PORT was inserted in the
upper-arm of the unaffected breast cancer body side.
Percutaneous access was always performed under ultra-
sound guidance at the proximal third of the arm in the ‘yel-
low zone’ according to the PICC ZIM.12 Tourniquets were
never used to stop venous flow (Figure 1). The accessed
vein was always measured in order to obtain (whenever
possible) a catheter-to-vein ratio 0.33.10,11,13,14 Catheter
tip location in the distal third of the superior vena cava was
assessed by fluoroscopy or ECG. A subcutaneous pocket
for port reservoir placement was obtained 3–5 cm distal to
the vein access in the mid third of the arm with a 15–20
mm cutaneous access in the so-called ‘green zone’.12 The
catheter was then tunnelled and connected to the reservoir
that was located in the subcutaneous pocket. Surgical
wound closure was performed by a running suture using a
4-0 monofilament absorbable suture. Prophylaxis for cath-
eter-related UEDVT was not routinely adopted as per cur-
rent guidelines.15,16 Implanted ports consisted of a low
profile, reduced-size titanium chamber attached to a power
Bertoglio et al. 3
injectable thermoplastic polycarbonate-urethane (PUR) 5F
catheter (Health PORT Minimax 5F, Plan1 Health, Udine,
Care and maintenance of the devices was assigned to a
specialized PICC team of oncology nurses in accordance
with institutional protocols. The PICC-PORT reservoir
was always accessed by a 22 G × ¾ in non-coring needle.
Before needle insertion, the skin was always cleaned with
2% chlorhexidine gluconate (CHG) in a 70% isopropyl
alcohol solution. Flushing and locking of PICCs was per-
formed using prefilled 10 mL normal saline syringes by
the pulsatile method [10]. Non-accessed PICC-PORTs
underwent this procedure every 2 months.
Study endpoints
The primary endpoint was time to PICC-PORT failure
requiring device removal.
The onset and frequency of complications (i.e. UEDVT,
CRBSI, local skin infection, occlusion, catheter malfunc-
tion or drug extravasation) was reported as the secondary
outcome measure.
Definitions. The study population included adult female
cancer patients with breast cancer who were eligible for
neo-adjuvant or adjuvant chemotherapy.
Chemotherapy was defined as the use of intravenous
and/or oral chemotherapeutic regimens in accordance with
institutional protocols for different types and stages of
breast cancer.
Local skin infection was defined by the presence of
erythema and/or tenderness over the pocket of the reser-
voir and along the tunnelled catheter to the vein access,
with fever and regardless of the presence of purulent
CRBSI was defined according to the Infectious Diseases
Society of America guidelines:15
Isolation of the same micro-organism in the periph-
eral blood and PICC cultures;
A threefold difference in paired quantitative cul-
tures of blood samples drawn from the PICC-PORT
and a peripheral vein;
Culture positivity in blood collected from the PICC-
PORT 2 h before positive cultures in peripheral
blood samples.
Catheter-related UEDVT was assessed by ultrasound
examination showing the presence of a thrombus with par-
tial or complete vein occlusion.
Drug extravasation was defined by the presence of
oedema, erythema, pain and tenderness without any signs
of local infection.
Catheter occlusion was defined as the inability to infuse
normal saline solution despite the manual pressure per-
formed on the piston of a 10 mL syringe.
Statistical analysis
In the data analysis, descriptive variables are presented as
percent values. Statistical comparison was performed by
chi-square test analysis or Fisher’s exact test, or T-test
where appropriate. p values < 0.05 were considered sig-
nificant. Multivariate analysis was not performed on the
variables describing the possible risk factors associated
with postoperative complications due to no statistically
significant p values being observed in the univariate
model, with the exception of the BMI variable, and no spe-
cific interaction between the variables based on known
biological plausibility.
Time to PICC-PORT risk of failure was analysed using
standard survival techniques. One-year risk of failure was
computed from the day of PICC implantation to the day of
removal due to PICC-PORT failure. Cumulative 1-year
risk of failure was computed using the Kaplan–Meier
product limit estimator and was compared using a univari-
ate proportional hazard (PH) semi-parametric model,
which allowed to estimate univariate hazard ratios with
their 95% confidence interval (CI) and to assess the statis-
tical significance of the observed differences. In the analy-
ses, p < 0.05 was considered statistically significant.
STATA/SE 11.0 (Statacorp LP 2009) and SPSS 20 (IBM
SPSS Statistics, ed. 20, 2014) statistical software were
used for all analyses.
Over a 12-month period, 418 consecutive, unselected adult
female breast cancer patients were implanted a PICC-
PORT device for adjuvant and neo-adjuvant chemotherapy
Figure 1. PICC-PORT insertion technique; venous access in
the ZIM technique ‘yellow zone’ with the catheter tunnelled
as far as the subcutaneous pocket for the reservoir in the ZIM
‘green zone’.
4 The Journal of Vascular Access 00(0)
at the IRCCS Policlinico San Martino in Genoa. The
inserted PICC-PORTs accounted for a total of 94,935 cath-
eter days; median length of observation was 215 days
(range, 25–365). PICC-PORTs were removed from all
patients at the end of the chemotherapy.
Patients’ baseline characteristics are shown in Table 1.
Patients below 50 years of age represented the majority of
PICC-PORT insertions (47%). Body mass index ranged
between 22.5 and 25 in 40% of patients. Over one half of
patients (54%) had AJCC-TNM Stage II breast cancer; the
majority of patients (83%) received adjuvant chemother-
apy treatment, and the association of epirubicin, cyclo-
phosphamide and taxanes represented the most commonly
used chemotherapy schedule (84%). Most PICC-PORTs
(60%) were inserted in the right side and into the basilic
vein (85%). The mean size of the accessed vein was 6.2
mm (range, 4.7–10.9) and a catheter-to-vein ratio 0.33
was obtained in the majority (93%) of procedures. No
perioperative complications were observed except for tem-
porary subcutaneous ecchymosis in the arm lasting from 3
to 7 days which occurred in 125 (30%) subjects; ecchymo-
sis was perceived by patients as a minor nuisance more
than a complication
Three hundred and seventy-four PICC-PORTs (89%)
were removed without failure at the end of the patient’s
chemotherapeutic programme and 17 were left in place
following the physician’s decision. Kaplan–Meier cumula-
tive 1-year risk for failure was 3.6% (95% CI, 1.3%–7.1%)
(Figure 2).
Table 2 analyses the frequency of complications and
failures. Complications occurred in 29 PICC-PORTs
(6.9%), and 11 (2.6%) were eventually removed due to
Local pocket infection with PICC-PORT avulsion
occurred in four patients (0.9%) and median time to
removal was 114 days with an infection rate of 0.012 per
1000 catheter days. Catheter occlusion requiring removal
arose in three (0.7%) PICC-PORTs and median time to
removal was 196 days. CRBSI was seen in two (0.5%)
PICC-PORTs, both of which were removed, and median
time to removal was 189 days with a local infection rate of
0.016 per 1000 catheter days. Unexpected drug extravasa-
tion occurred in six subjects (1.4%), two of whom under-
went PICC-PORT removal (0.5%) at a median time of 107
days. Symptomatic UEDVT was observed in 10 (2.4%)
PICC-PORTs, but none of them were removed. Median
time to UEDVT-related symptoms was 78 days and all
patients received low-molecular-weight heparin which
was maintained the whole time the PICC-PORT was in
use. No pulmonary embolisms were observed. One case
each of skin dehiscence and port leakage occurred (0.5%),
though without PICC-PORT removal. Difficulty drawing
blood developed in 72 (17.2%) patients.
The risk of PICC-PORT failure based on the patient’s
characteristics is reported in Table 3. Age, body side of
implant, vein of insertion, catheter-to-vein ratio, stage of
cancer, type of chemotherapy (i.e. neo-adjuvant or adju-
vant treatment) and chemotherapy schedule were not pre-
dictive of failure. The only relevant risk factor we found
for PICC-PORT failure was BMI < 22.5 (p = 0.027).
Central venous catheters (CVCs) are commonly used for
adjuvant chemotherapy delivery in breast cancer patients.
There is no evidence to routinely recommend a specific
type of CVC for all patients since the choice is mainly
influenced by the expected duration of treatment, the type
of chemotherapy, the patient’s compliance and the ability
to provide care and maintenance of the device.17–19
For decades chest TIVADs have been considered a
standard of care for i.v. chemotherapy.2,3,5 Despite their
safety and efficacy, some issues have been raised over
their use. In particular, for female breast cancer patients
eligible for adjuvant chemotherapy, the invasive procedure
Table 1. Patients’ characteristics.
Patients’ characteristics Total (n = 418)
<50 197 47.12
50–59 85 20.33
>60 136 32.53
Body mass index
<22.5 134 32.05
22.5–25 166 39.71
>25 118 28.22
Breast cancer stage
Stage I 192 45.93
Stage II 226 54.06
Type of chemotherapy
Adjuvant treatment 348 83.25
Primary chemotherapy 70 16.74
Chemotherapy schedule
EC/taxanes 352 84.21
Taxanes/trastuzumab 66 15.78
Access side
Right side 250 59.80
Left side 168 40.19
Access site
Basilic vein 354 84.68
Brachial/axillary vein 64 15.31
No. of vein access attempts
1 attempt 388 92.82
2 attempts 30 7.17
Catheter-to-vein size ratio
0.33 392 93.77
0.33 26 6.22
EC: epirubicin and cyclophosphamides.
Bertoglio et al. 5
and the cosmetic impact of the residual skin scar on the
anterior thoracic wall often represent negative fea-
tures.4,19–22 The use of TIVADs inserted in the arm or fore-
arm has grown steadily over the years. Although having
similar indications to chest TIVADs, there is the percep-
tion that arm port implantation is an easier and less inva-
sive procedure. Despite these advantages, to date arm ports
have not been fully adopted in clinical practice because of
the higher late complication rates leading to failure and
avulsion of the device. The majority of these complica-
tions are attributable to infections and thrombosis.
Bodner et al.5 reported arm port failure rates of up to
18% in a series of 109 patients. More recently, on a larger
series of 433 patients, Mori et al.6 demonstrated a 19% late
postoperative complication rate of arm ports and a 16%
rate of avulsion due to failure.
A national Japanese survey by Shiono et al.7 showed an
overall incidence of complication rates of 7.3% and 5.2%
in forearm and arm implanted ports, respectively. The
majority of reported complications in these studies were
infections and venous thromboses. Tippit et al.8 recently
showed that the use of arm ports in breast cancer patients
is responsible for a 9.5% incidence of UEDVT, almost five
times higher than what is observed for traditional chest
TIVADs, with a relative risk of 4.76 (p < 0.005). Reports
in the literature would appear to indicate a somewhat
higher incidence of complications and failures of arm ports
as compared to chest ports, with infections and DVT being
mainly responsible for these results.2,9,23 When PICCs
were used in cancer patients undergoing chemotherapy,
the overall complications were found to be equal to or
even higher than what is reported for arm ports and ranged
from 6% to 20%.10,14,24
This study aims to evaluate the use of the PICC-PORT
surgical approach as a standard insertion method for
TIVADs in the proximal upper limb of women with breast
cancer as a possible alternative to traditional arm ports in
order to reduce complications and failures.
PICC-PORTs were removed due to failure before the
end of treatment in 3.8% of patients. The overall failure
rate is consistent with the ranges previously reported for
chest TIVADs (1.5%–8%).2,3,23–25 On the contrary, failure
rates were lower than those reported for arm TIVADs,
which range from 5% to 20%.10,14,24
Symptomatic UEDVT was the main reason for PICC-
PORT removal and accounted for more than one-third
(2.4%) of all failures. These results were consistent with
those reported in large literature series of oncologic
patients bearing mid- or long-term central venous access
devices for chemotherapy delivery.2,3,23 It is noteworthy
that studies in which PICCs were implanted solely in
oncologic patients showed a slightly higher incidence of
UEDVT, ranging from 4% to 50%.2,3,24–26
In our study, all the PICC-PORTs with UEDVT were
rescued by implementing low-molecular-weight heparin,
thus allowing the devices to be used until the end of chem-
otherapy, and thereby preventing unnecessary removal. In
our opinion, the low incidence of UEDVT in our patients
with PICC-PORTs is attributable to two main factors.
First, the use of the micro-Seldinger technique together
with the ultrasound-guided technique guaranteed little
trauma to the venous wall during the catheter insertion
procedure. Second, venous access performed in Dawson’s
‘yellow zone’ of the proximal third of the upper limb
allowed us to respect an optimal catheter-to-vein ratio
<0.33 in 93% of cases. The incidence of other factors
resulting in failure (i.e. catheter occlusion, CRBSI, pocket
infection, skin dehiscence, drug extravasation and drug
leakage) was consistent with literature reports. Median
dwell time for any failure was always >100 days, thus
supporting the efficacy of our vascular access management
institutional protocols.
This is relevant when compared to previous literature
reports with PICCs and arm TIVADs in oncologic patients
in whom the dwell time to failure was notably shorter.5,10,13
Figure 2. Kaplan–Meier curve for PICC-PORT cumulative
1-year risk of failure.
Table 2. Frequency of complications and removal of 209
observed PICC-PORTs.
Type of complication Total
Port removal
due to failure
Catheter occlusion 3 0.7 3 0.7
PICC-PORT CRBSI 2 0.5 2 0.5
Pocket infection 4 1 4 1
Skin dehiscence 2 1.0
Drug extravasation 6 1.4 2 0.5
Drug leakage 2 0.5
Total 29 6.9 11 2.6
CRBSI: catheter-related bloodstream infection; UEDVT: upper extrem-
ity deep vein thrombosis; PICC: peripherally inserted central catheter.
Multiple complications in the same subject were counted only once.
6 The Journal of Vascular Access 00(0)
To the best of our knowledge, this is the first report of
long-term outcomes regarding the PICC-PORT technique
in patients with early stages of breast cancer who received
neo-adjuvant or adjuvant chemotherapy. The study has
several strengths: it was a prospective study in which only
early stage breast cancer patients undergoing chemother-
apy were enrolled: in order to minimize the selection bias
all patients were unselected and consecutive. PICC-PORT
insertion and maintenance were performed by the same
staff in accordance with established institutional protocols,
and adequate median length of follow-up was available
(215 days). Nevertheless, there are some limitations. First
of all, the study was only carried out on breast cancer
patients and the results may not be representative of all
cancer patients. Second, patients were not routinely
screened for DVT in the absence of symptoms, thus
excluding asymptomatic patients from PICC-PORT out-
come evaluations. Third, the concomitant use of anticoag-
ulants or anti-platelets was not assessed and this could in
some manner influence the reported incidence of UEDVT.
In conclusion, our study has some implications for
patients with early stage breast cancer eligible for chemo-
therapy. Safe vascular access is without exception needed
and physicians are always required to consider the risks
and benefits of selected vascular access devices (i.e. tun-
nelled catheters, PICCs or TIVADs). If the choice is a
TIVAD, the use of a PICC-PORT would appear to be safe
and reliable. Its easy implantation, low risk of complica-
tions and the excellent cosmetic result, even after removal
at the end of chemotherapy, are strengths that support their
widespread use as a possible alternative to traditional chest
and arm TIVADs. Further studies are needed to assess the
use of PICC-PORTS in other clinical settings.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship and/or publication of this
The author(s) received no financial support for the research,
authorship and/or publication of this article.
Sergio Bertoglio
Table 3. Risk of failure based on the patients’ characteristics.
No. of
No. of
1-year cumulative
incidence of failure % (SE)
<50 197 6 6.0 (3.0) 0.478
50–59 85 3 3.9 (2.8)
60+136 2 2.6 (2.5)
Body mass index
<22.5 134 7 7.6 (4.1) 0.027
22.5–25 166 0 0 (0)
>25 118 4 5.5 (3.1)
Side of implant
Right 250 6 3.9 (2.2) 1
Left 168 5 3.2 (2.5)
Site of implant
Basilic vein 354 7 3.8 (1.4) 0.107
Brachial vein 64 4 10.5 (6.4)
Catheter-to-vein ratio
0.33 392 11 5.8 (1.8) 1
>0.33 26 0 0 (0)
Disease stage
Stage I 192 7 8.0 (3.2) 0.147
Stage II 226 4 1.9 (1.4)
Type of CT
Adjuvant 348 11 4.7 (2.0) 0.357
Neoadjuvant 35 0 0 (0)
CT Schedule
EC + TAX 352 8 3.5 (1.9) 0.361
TAX + Her 66 0 0 (0)
CT: chemotherapy; EC: epirubicin and cyclophosphamides; TAX: taxanes; Her: trastuzumab; SE: standard error.
aTwo-tailed Fisher’s exact test.
Bertoglio et al. 7
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... Interestingly, in the present study, female patients had a mean port-a-cath survival time 9.25 times shorter than males, regardless of the other variables studied. The increasing use of fully implantable arm vascular access devices for breast cancer patients requiring chemotherapy has led to a higher risk of complications and failures and, in particular, upper limb deep vein thrombosis, reducing the average survival of these catheters 16 . This fact corroborates the findings of the present ...
... Implementing more rigorous care packages and greater adherence to aseptic techniques have substantially reduced infection rates 17 . Moreover, the peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy administration that achieves similar clinical outcomes to traditional long-term vascular access devices 16 . ...
... 7 8 In recent years, to a lesser extent, the impacts of TIVADs on the quality of life, satisfaction and tolerability have been assessed through some quantitative surveys. [9][10][11] What is more, previous research showed that kinesiophobia, the fear of limb movement after TIVAD implantation, was common in patients with cancer, and it was closely related to the subjective experience of daily activities. 12 ...
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Objectives The upper arm infusion ports have been proven to be advanced and safe, but the experience from the perspective of patients is lacking. This study explored the indwelling experience and coping strategies of upper arm infusion ports in patients with cancer. Design Qualitative exploratory study. Setting This study was conducted between May 2021 and August 2021 at a level III-A general hospital in Shanghai, China. Participants The participants, who are patients with cancer implanted with the upper arm infusion ports, included 10 women and 6 men, and the average age was 54.4±8.3 years old. Methods Data were selected from semistructured in-depth interviews and analysed by thematic analysis. Results There were 10 descriptive topics and 4 analytical topics in 2 parts. The indwelling experience includes positive experience (treatment benefit, life convenience) and negative experience (physical discomfort, social anxiety, psychological distress). Coping strategies include emotional-focused strategies (self-acceptance, avoidance and self-protection) and problem-focused strategies (information seeking, functional exercise and remove as soon as possible). Conclusion The infusion port in the upper arm is beneficial to the safety and quality of life of patients with cancer. At the same time, there are challenges in physical, psychological and social adaptation. Patients respond with some measures, but obstacles may arise during implementation.
... When expanding the skin, the inclined plane of the needle is exposed by 1/2, and then the needle stops when it touches the skin after expanding the skin. It is convenient to operate, easy to control the strength, easy to send the sheath, and the success rate of one-time sheath feeding is high [26][27][28][29]. ...
Objective: To investigate the clinical value of modified skin expansion in peripherally inserted central venous catheter (PICC) catheterization under the guidance of B-ultrasound in gastrointestinal cancer patients with chemotherapy. Methods: In this retrospective study, 60 gastrointestinal cancer patients with chemotherapy were included and divided into an experimental group (treated with modified skin expansion in PICC catheterization under the guidance of B-ultrasound) and a control group (treated with the longitudinal skin expansion in PICC catheterization under the guidance of B-ultrasound). The bleeding volume, pain score, success rate of one-time PICC catheterization and the incidence of complication were compared between the two groups. Results: The modified skin expansion in PICC catheterization under the guidance of B-ultrasound had obvious effect on gastrointestinal cancer patients with chemotherapy. The VAS scores were significantly lower after PICC catheterization in the experimental group compared with the control group (P < 0.05). The success rate of one-time PICC catheterization in the experimental group was significantly higher than that in the control group. Moreover, the incidence of complication and massive bleeding during puncture and 24 hours after puncture was significantly lower in the observation group compared with that in the control group. Conclusions: Modified skin expansion in PICC catheterization under the guidance of B-ultrasound in gastrointestinal cancer patients with chemotherapy can improve the success rate of one-time sheath delivery, effectively reduce the amount of blood leakage after catheterization, reduce patients' pain and reduce the incidence of complications.
... Implantable venous infusion port is an infusion device that can be placed subcutaneously and indwelled for a long time. [1,2]. Compared with peripheral venous catheterization and indwelling needle intravenous infusion, the incidence of local redness, drug extravasation and other adverse reactions is reduced, and the safety is high, and there is less damage to the lining of patients' blood vessels [3,4].And has that advantage of convenient operation, reduced puncture frequency, convenient maintenance and the like. ...
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Objective: To explore the application effects of chain nursing process in the nursing of elderly inpatients with implantable venous infusion port. Methods: 81 elderly inpatients who were treated with implantable venous infusion port in the hospital were selected between February 2018 and December 2021, and they were divided into the routine group (given routine nursing of implantable venous infusion port, n = 40) and the study group (given chain nursing process intervention on the basis of the routine group, n = 41) according to the random number table method. The patients in both groups were intervened for 1 month. The catheter-related indicators and incidence rates of adverse events (drug extravasation, local hematoma, infusion port blockage, catheter-related infection) were compared between the two groups of patients. Generalized Anxiety Disorder 7-item scale (GAD-7) and Athens Insomnia Scale (AIS) were used to compare the psychological states of the two groups before and after intervention, and Newcastle Satisfaction with Nursing Scale (NSNS) was adopted to compare the nursing satisfaction of patients before and after intervention. Results: After intervention, the catheter maintenance operation time in the study group was shorter than that in the routine group (P < 0.05), and there were no significant differences in the accidental extubation rate and re-intubation rate between the two groups (P > 0.05). The incidence rate of adverse reactions of 2.44% in the study group was lower than 15.00% in the routine group (P < 0.05). After intervention, the scores of GAD-7 and AIS in the two groups were reduced compared with those before intervention, and the above scores in the study group were lower than those in the routine group (P < 0.05). Before intervention, there were no significant differences in the NSNS scores between the two groups (P > 0.05). After intervention, the NSNS scores in the study group were higher than those in the routine group (P < 0.05). Conclusion: Chain nursing process can help to enhance the maintenance quality of implantable venous infusion port, reduce the incidence of adverse events, relieve the tension and anxiety, and improve the satisfaction of patients with nursing.
... Based on the above results, it may be recommended to use the intracavitary ECG technique to locate the catheter tip as an alternative to the traditional surface measurement method. This is in line with the recommendations of other researchers (25,31). However, there are certain limitations to this study. ...
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Accurate positioning of the catheter tip is one of the most critical procedures in central venous catheter insertion. The traditional surface measurement method frequently has a large deviation and increases the X-ray exposure of doctors and patients. In the present retrospective study, cancer patients who received a totally implantable venous access port (TIVAP) in the upper arm using intracavitary electrocardiogram (ECG) guidance were compared with those where the traditional surface measurement method was used in terms of the rate of correct placement of the catheter tip, the rate of achieving the best position, the operation time and the complications. The results indicated that the correct placement rate and the best position rate of the catheter tip at the first attempt were higher in the ECG-guided group than in the traditional surface measurement method group (95.65 vs. 82.91% and 90.58 vs. 68.38%, respectively). The mean operation time was shorter in the ECG-guided group than in the surface measurement group (46.28 vs. 63.26 min). The incidence of complications in the ECG-guided group was 6.52%, while that in the surface measurement group was 10.26%. This indicated that the intracavitary ECG-guided tip positioning technique may improve the accuracy of tip catheter placement and shorten the operation time, thus reducing ionizing radiation caused by repeated positioning. Therefore, the intracavitary ECG-guided tip positioning technique is able to effectively place the tip of the TIVAD in the upper arm, holding great promise as a clinical application.
... With the increasing number of patients with cancer, physicians have shown interest in TIVAD insertion using a percutaneous approach (17). The selection of venous sites and approaches for TIVAD have already been discussed in literature (18)(19)(20)(21)(22). ...
Background/aim: To compare the outcomes of totally implantable central venous access device (TIVAD) insertions by surgical residents (SRs) with those by experienced surgeons (ESs) and establish the safety of percutaneous TIVAD insertion by SRs. Patients and methods: A total of 700 insertions were successfully performed between January 2015 and December 2019 in our Department. The puncture site conversion and complication rates were compared, and risk factors related to complications were analysed. Results: In total, 84 and 616 insertions were performed in the SR and ES groups, respectively. SRs mainly punctured the internal jugular vein (IJV), and ESs punctured the subclavian vein (SV). The conversion rate from the IJV to SV was similar, whereas that from the SV to IJV was higher by SRs than ESs. Overall, early, and delayed complications were similar between the two groups. Conclusion: Percutaneous TIVAD inserted into the IJV by an SR was demonstrated to be safe.
Background The peripherally inserted central catheter-port (PICC-port) technique is an innovation of the standard arm-totally implantable vascular access device. The design of surgical skin incision may have an important impact on the postoperative life of patients, the cosmetic result is important for patient satisfaction as well. Objectives To compare two different incision methods in the implantation of PICC-port. Design A before-after study. Settings and participants A total of 62 adult patients with malignant tumor requiring chemotherapy in Shanghai General Hospital were selected by convenience sampling, 31 in each group. All participants agreed to install PICC-port with signature from 1 Jan to 30 April, 2022. Methods 31 patients were given longitudinal incision, about 3 cm below the puncture point obliquely. Another 31 patients were given transverse incision, about 3 cm below the puncture point. T-test, chi-square test and rank sum test were used to compare the differences between the two groups in incision healing, scar score, and operation time. Results There was no statistically significant difference in incision healing between the two groups( p > 0.05). The scar scores of patients with transverse incision were higher than that of patients with longitudinal incision at 3 months ( p < 0.05). And the operation time of longitudinal incision group was longer than that of transverse incision group( p < 0.05). Conclusions Our study revealed that PICC-port implantation could be considered as safe as PICC insertion conducted by nurse. During our follow-up, all patients with PICC-port implantation had good wound healing, and there were no complications such as local infection happened. The transverse incision was more easier to be operated in bag making in PICC-port implantation.
Introduction: Bedside cutaneous vascular access is readily available for hospitalized patients with over five million non-tunneled central venous access devices and more than one million peripherally inserted central catheters (PICCs) placed annually in the United States. Tunneled and surgically implantable devices are almost exclusively available to patients in the Operating Room or Interventional Radiology suite and considered a last resort because of the perceived complexity of these procedures. The PICC-Port is placed in the same fashion as a traditional bedside PICC line using the modified Seldinger Technique with the simple addition of a subcutaneous pocket creation. The PICC-Port provides a subtle upper arm implantable vascular access device option for the patient to consider. While port placement is well known for patients receiving chemotherapy, there are many other patient populations with chronic conditions requiring long-term intermittent intravenous therapy such as sickle cell disease, cystic fibrosis, and lysosomal storage disorders who can benefit from PICC-ports.Case Report: The patient was a 37-year-old man who presented to the hospital in acute sickle cell crisis with severe chest and back pain. The patient attended an Urgent Care Center for fluid administration once per week, but the center was unable to access his veins. The result was infarction and a hemolytic crises from dehydration. The patient reported that every time he visits the Emergency Department, five to eight attempts are made to establish peripheral intravenous access. The patient has received multiple ultrasound-guided peripheral intravenous catheters, midlines, and peripherally inserted central catheters (PICC’s). As a result, he requested a PICC-Port before discharge to ensure fluid administration on an outpatient basis to control his sickle cell crises. The Vascular Access Service was consulted by the oncologist for a bedside PICC-Port placement.Conclusion: In patients requiring intermittent long-term intravenous therapy a safe bedside alternative option to the chest port-a-cath is a PICC-Port.KeywordsPort-a-cathPICC-PortBedside vascular access proceduresSickle cell diseaseSurgically implantable venous access deviceIntermittent intravenous therapy
Totally implanted venous access ports (TIVAPs) have been established as effective and safe devices for oncologic patients. In breast cancer setting, the implant of the reservoir at mid-arm allows the absence of additional scars on the chest and the easier access to the port with significant cosmetic and psychological advantages. In the last decades, breast surgery has made great progresses to ameliorate the cosmetic results even in mastectomy techniques. In fact, many studies have demonstrated that negative body image perception affects physical and psychological wellbeing of survivors. Despite this evidence, limited importance is still reserved to TIVAPs placement site, which is traditionally the chest. It is not unusual to see patients after a nipple-sparing mastectomy with excellent cosmetic result who show a disfiguring scar on their upper chest due to TIVAP placement. We report the case of a young woman with BRCA2-related breast cancer who underwent bilateral nipple sparing mastectomy with immediate reconstruction and adjuvant chemotherapy. Her TIVAP was located at the mid-arm, which is still an uncommon site compared to the upper chest. An optimal cosmetic result was obtained both in breast reconstruction and in the arm site of port, with high-rate patient satisfaction. This case presentation aims to raise awareness towards women’s body image preservation, particularly in the choice of TIVAP placement: in most cases neckline and upper chest should be avoided for a better patient related outcome.
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Abstract At present, there are few clinical studies on the application of high-concentration sodium chloride solutions in intracavitary ECG-guided catheter tip localization during the arm infusion port implantation. This study observed the effects of sodium chloride solutions with different concentrations on intracavitary ECG-guided arm infusion port implantation in the patients with cancer. The 657 patients receiving arm infusion port implantation in our hospital between January 2020 and August 2021 were randomly divided into 0.9% sodium chloride solution conduction group (group A), 5.45% sodium chloride solution conduction group (group B) and 10% sodium chloride solution conduction group (group C). The derived rate of stable intracavitary ECG, the occurrence rate of characteristic P wave, the time used for catheter tip localization and the optimal position rate of catheter tip were compared between the three groups. The derived rate of stable intracavitary ECG was significantly higher in the group B (97.78%) and group C (98.63%) than in the group A (93.90%) (all P
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Background: Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods: Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema. Results: Survey responses were received from 25 physicians and 57 oncology nurses. Administration of trastuzumab or an anthracycline was associated with a higher likelihood of a cvad being recommended. Other factors associated with recommendation of a cvad included prior difficult IV access and a recommendation from the chemotherapy nurse. Although the complication rates perceived to be associated with the use of piccs and ports remained high, respondents felt that cvads might improve patient quality of life. Risk factors perceived to be associated with the risk of lymphedema were axillary lymph node dissection, radiation to the axilla, and line-associated infection. Factors known to be unrelated to lymphedema risk (specifically, blood draws and blood pressure measurement) continue to be perceived as posing a higher risk. Conclusions: Despite widespread use of chemotherapy for patients with breast cancer, the type of venous access used for treatment varies significantly, as do perceptions about the risks of cvad use and the risk for lymphedema development. Further prospective studies are needed to identify best-practice strategies.
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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 as to determine the importance of previously reported risk factors predisposing to UEDVT in the setting of active cancer. We retrospectively reviewed the medical records of 297 women with breast cancer who had ports placed in our institution between the dates of December 1, 2010, and December 31, 2016. The primary outcome was the development of radiologically confirmed UEDVT ipsilateral to the implanted port. Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1 documented case of associated pulmonary embolism. Fourteen (9.5%) of 147 subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150 subjects with chest ports (P = .0056). Thus, implantation of arm ports as opposed to chest ports may be associated with a higher rate of UEDVT in patients with breast cancer.
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Background and objectives: The increasing use of peripherally inserted central venous catheters (PICCs) for chemotherapy has led to the observation of an elevated risk of complications and failures. This study investigates PICC failures in cancer patients. Methods: A prospective study was conducted at a single cancer institution on 291 PICC placement for chemotherapy. The primary study outcome was PICC failure. Results: Median follow-up was 119 days. PICC complications occurred in 72 patients (24.7%) and failures with removal in 44 (15.1%). Reasons for failures were upper extremity deep venous thrombosis (UEDVT) 12 (4.1%), central line associate bloodstream infection (CLABSI) 5 (1.7%) with an infection rate of 0.95 per 1,000 catheter days, exit site infection 9 (3.1%) with a rate of 1.46 per 1,000 catheter days, catheter dislodgment 11 (3.8%), and occlusion 7 (2.4%). Statistically significant risk factors were previous DVT (HR 2.95, 95%CI 1.33-6.53), reason for PICC implant (HR 3.65, 95%CI 1.12-10.34) and 5-fluorouracil, oxaliplatin and bevacizumab based chemotherapy (HR 3.11, 95%CI 1.17-8.26). Conclusions: PICC is a safe venous device for chemotherapy delivery. Nevertheless, a 15% rate of failure has to be taken in account when planning PICC insertion for chemotherapy purposes. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
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Background: We have employed upper arm central venous ports (UACVPs) since 2006 for long-term intravenous chemotherapy (CTx) or fluid supplementation. We evaluated the long-term availability of CVPs implanted in the upper arm to determine whether UACVPs could be one of the treatment options besides chest CVPs in terms of CVP-related complications. Methods: We reviewed the medical records of all patients who underwent subcutaneous implantation of UACVPs at Kyoto University Hospital from 1 April, 2006 to 30 June, 2009. We assessed the indwelling duration of the UACVPs and the incidences of early and late UACVP-related complications. Results: A total of 433 patients underwent subcutaneous implantation of UACVPs during this time period. The cumulative follow-up period was 251,538 catheter days, and the median duration of UACVP indwelling was 439.0 days (1-2, 24). There was no UACVP-related mortality throughout the study period. A total of 83 UACVP-related complications occurred (19.2 %), including 43 cases of infection (9.9 %, 0.17/1000 catheter days), ten cases of catheter-related thrombosis (2.3 %, 0.040/1000 catheter days), ten cases of occlusion (2.3 %, 0.040/1000 catheter days), nine cases of catheter dislocation (2.0 %, 0.036/1000 catheter days), five cases of port leakage (1.2 %, 0.019/1000 catheter days), four cases of skin dehiscence (0.9 %, 0.015/1000 catheter days) and two cases of port chamber twist (0.5 %, 0.008/1000 catheter days). The removal-free one-year port availability was estimated at 87.8 %. Conclusions: UACVPs were of long-term utility, with complication rates comparable to those of chest CVPs previously reported.
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Peripherally inserted central catheter (PICC) is a modern drug delivery system utilised in oncology practice. The purpose of this study was to determine the complications associated with PICCs within a one year study period. PICCs inserted in patients registered at Dharamshila Cancer Hospital and research centre from 1st July 2012 to 30th June 2013 were studied. Data was retrieved from the procedure room records, medical records department, department of radiology and department of microbiology. Data was collected by oncology residents and procedure team. A total of 246 PICCs were inserted during the one year period. Complete data was not available in 23 patients. 223 results were included in the final analysis. USG guidance was required in 14 patients (6.3%). Optimal PICC duration was achieved in 151 patients (67.7%). 28 patient developed culture positive infective complications (12.5%). 44 patients developed mechanical complications (19.7%). Our study shows a relatively higher rate of infective complications. PICC is an acceptable means of drug delivery system.
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Peripherally inserted central catheters (PICCs) are widely used in chemotherapy, but the reported PICC thrombosis incidence varies greatly, and risks of PICC thrombosis are not well defined. This study was to investigate the incidence and risk factors of PICC-related upper extremity vein thrombosis in cancer patients. This was a prospective study conducted in two tertiary referral hospitals from May 2010 to February 2013. Cancer patients who were subject to PICC placement were enrolled and checked by Doppler ultrasound weekly for at least 1 month. Univariable and multivariable logistic regression analyses were applied for identification of risk factors. Three hundred and eleven cancer patients were enrolled in the study. One hundred and sixty (51.4%) developed PICC thrombosis, of which 87 (54.4%) cases were symptomatic. The mean time interval from PICC insertion to thrombosis onset was 11.04±5.538 days. The univariable logistic regression analysis showed that complications (odds ratio [OR] 1.686, P=0.032), less activity (OR 1.476, P=0.006), obesity (OR 3.148, P=0.000), and chemotherapy history (OR 3.405, P=0.030) were associated with PICC thrombosis. Multivariate analysis showed that less activity (OR 9.583, P=0.000) and obesity (OR 3.466, P=0.014) were significantly associated with PICC thrombosis. The incidence of PICC thrombosis is relatively high, and nearly half are asymptomatic. Less activity and obesity are risk factors of PICC-related thrombosis.
Background: To evaluate the safety, technical feasibility, and complications of totally implanted central venous access ports (TIVAPs) in the upper arm, for comparison with trans-jugular chest ports in patients with breast cancer. Methods: In total, 223 consecutive female breast cancer patients who received a TIVAP in the upper arm or chest between July 2014 and February 2016 were included. All procedures were performed via a sonographic and fluoroscopic-guided approach using the Seldinger technique under local anesthesia. We reviewed the medical records to determine technical success, pain scale, early (≤30 days), and late (>30 days) complications. Results: In total, 231 devices were implanted in the upper arms (n=176, 76%) and chests (n=55, 24%) of the patients. The mean age was 51.6±10.7 years (range 23-78 years; upper arm, 52.1±11.0 years; chest, 50.1±9.7 years, P>0.05). The mean implantation time for TIVAPs was 181.7±109.2 days (range, 9-460 days; upper arm 175.2±102.7 days; chest, 202.4±126.6 days, P>0.05), with 41,974 catheter-days. The technical success rate was 100%. Fourteen complications (6.1%) occurred in 14 patients (0.33/1000 catheter-days). There was no significant difference in complication-free survival for patients with upper arm TIVAPs and those with trans-jugular chest TIVAPs. The mean amount of 2% lidocaine, used as local anesthesia, was 3.3±1.7 ml and 14.5±4.1 ml for upper arm and chest TIVAPs, respectively. (P<0.001). Conclusions: Implantation of TIVAPs in the upper arm is a safe procedure with a low rate of complications. Upper arm TIVAPs can be implanted with less pain compared with trans-jugular chest TIVAPs.
Objective: Totally implantable venous access devices (portacaths, or "ports"), are widely used for intermittent central venous access especially for cancer patients. Although ports have a superior safety margin compared with other long-term venous access devices, there are a number of complications associated with their use. Methods: This is a narrative review. We searched PubMed and Google Scholar for articles about complications related to the use of portacaths. "Similar articles" feature of PubMed and reference list of the existing literature were also reviewed for additional relevant studies. Results: In this review, we provide the latest evidence regarding the most common ones of these adverse events and how to diagnose and treat them. Immediate complications including pneumothorax, hemothorax, arterial puncture, and air embolism as well as late complications such as port infection, malfunction, and thrombosis are covered in detail. Conclusions: Physicians should be familiar with port complications and their diagnosis and management.
Background: We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. Methods: Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. Results: We received 374 responses (11,693 procedures) from 153 centers (38.5 %). The overall complication rates were 7.4 % for the chest (598/8,097 cases); 6.8 % for the neck (157/2325); 5.2 % for the upper arm (54/1,033); 7.3 % for the forearm (9/124); and 6.1 % for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications (P = 0.010), and multivariate logistic regression (odds ratio 0.69; 95 % confidence interval 0.51-0.91; P = 0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8 %), followed by the neck (69.8 %), forearm (53.2 %), chest (41.8 %), and other groups (34.2 %). Conclusion: Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.
Background: Although many catheter-related bloodstream infections (CR-BSIs) are preventable, measures to reduce these infections are not uniformly implemented. Objective: To update an existing evidenced-based guideline that promotes strategies to prevent CR-BSIs. Data Sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Studies Included: Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiological investigations. Outcome Measures: Reduction in CR-BSI, catheter colonization, or catheter-related infection. Synthesis: The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e. education and training, maximal sterile barrier precautions and 2% chlorhexidine for skin antisepsis). Conclusion: Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection. (Am J Infect Control 2002;30:476-89.)