Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy
Tóm tắt
Since the first implant of totally implantable venous access device (TIVAD), performed by Niederhuber and colleague in 1982, the systems have increasingly been used in the field of oncology. We analyzed the clinical reviews and complications of TIVAD in an effort to achieve optimal management. We retrospectively studied 442 cases with TIVAD device at our hospital and we report the results. Four hundred and forty-two TIVAD were placed in the right subclavian vein in 345 cases, the left subclavian vein in 93 cases, the right jugular vein in 2 cases, the left jugular vein in 1 case, and the right femoral vein in 1 case. The immediate complications were 28 cases in malposition of the catheter, 10 cases of arterial puncture, and 2 cases of pneumothorax. The late complications were 3 cases of pocket infection, 2 cases of catheter related to sepsis, 3 cases of catheter obstruction, 2 cases of SVC thrombosis, and 1 case of catheter fracture (pinch-off syndrome: Hinke grade 3). There were no other early or late complications. The low rate of complications in the study confirms the safety and convenience of using TIVAD in patients undergoing prolonged chemotherapy. Yet because infection, thrombosis and catheter fracture are the most common long-term complications of TIVAD, early diagnosis and management of these problems can prevent severe complications.
Tài liệu tham khảo
Brothers TE, von Moll LK, Niederhuber JE, Roberts JA, Walker-Andrews S, Ensminger WD. Experience with subcutaneous infusion ports in three hundred patients. Surg Gynecol Obstet. 1988;166:295.
Broviac JW, Cole JJ, Scribner BH. A silicone rubber atrial catheter for proloned parenteral alimentation. Surg Gynecol Obstet. 1973;136(4):602–6.
Hickman RO, Buckner CD, Clife RA, Sandres JE, Stewart P, Thomas ED. A modified right atrial catheter for access to the venous system in marrow transplant receipients. Surg Gynecol Obstet. 1979;148(6):871–5.
Poorter RL, Lauw FN, Bemelman WA, Bakker PJ, Taat CW, Veenhof CH. Complications of an implantable venous access device (port-a-cath) during intermittent continuous infusion of chemotherapy. Eur J Cancer. 1996;32:2262–6.
Ballarini C, Intra M, Pisani Ceretti A, Codovana A, Pagani M, Farina G, et al. Complications of subcutaneous infusion port in the general oncology population. Oncology. 1999;56:97–102.
Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Cozzi RN. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982;92:706–11.
Hall P, Cedermark B, Swedenborg J. Implantable catheter system for long term intravenous chemotherapy. J Surg Oncol. 1989;41(1):39–41.
Lemmers NW, Gels ME, Sleijfer DT, Plukker JT, van der Graaf WT, de Langen ZJ, et al. Complications of venous access ports in 132 patients with disseminated testicular cancer treated with polychemotherapy. J Clin Oncol. 1996;14(11):2916–22.
Rahman A, Spencer D. Totally implantable vascular access devices for cystic fibrosis. Cochrane Database Syst Rev. 2003;(3):CD004111.
Sotir MJ, Lewis C, Bisher EW, Ray SM, Soucie JM, Blumberg HM. Epidemiology of device associated infections related to a long term implantable vascular access device. Infect Control Hosp Epidemiol. 1999;20(3):187–91.
Gould JR, Carloss HW, Skinner WI. Groshong catheter associated subclavian venous thrombosis. Am J Med. 1993;95(4):419–23.
Minassian VA, Sood AK, Lowe P, Sorosky JI, AI-Jurf AS, Buller RE. Long term central venous access in gynecologic cancer patients. J Am Coll Surg. 2000;191(4):403–9.
Hinke DM, Zandt-Stastny DA, Goodman LR, Quebbeman EJ, Krzywda EA, Andris DA. Pinch off syndrome: a complication of implantable subclavian venous access device. Radiology. 1990;177:353–6.