An 11-year retrospective study of totally implanted central venous access ports: Complications and patient satisfaction

Abstract

Aims

We wanted to assess the factors that predict complications and patient satisfaction of totally implanted central venous access ports (TIAP).

Methods

We reviewed 550 patients with breast or gynaecological malignancies who had initial port placement for chemotherapy between 1995 and 2006. We retrospectively assessed all TIAP complications, port duration and follow-up care until the TIAPs were removed (or the last known recorded documentation) or until the death of the patient. TIAP-related patient satisfaction was also assessed via a questionnaire-based survey of 356 patients.

Results

561 TIAPs were placed in 550 cancer patients (11 patients received 2 TIAPs during the study period); the median time of port duration was 22.5 months. There were 104 complications in this group. Of these, 81 occurred during chemotherapy treatment that lasted a median time of 182 days. Removal secondary to complication was observed in 48 cases. TIAPs placed on the left chest side, through the subclavian vein or with the catheter tip localized in the peripheral part of superior vena cava demonstrated the highest incidence of complications. Patients with a BMI >28.75 had an increased risk for developing complications. Our follow-up questionnaire revealed a 93% patient satisfaction rate with the TIAP.

Conclusions

Patients with left-sided ports, catheter tips lying in the upper part of the superior vena cava and implantation via the subclavian vein are at a higher risk for TIAP-associated complications. Being excessively overweight was assessed as another risk factor for developing complications. TIAPs are highly accepted and further recommended by patients.

Introduction

The use of a totally implanted access port (TIAP) for administration of chemotherapy, parenteral nutrition, protracted drug infusion and taking blood samples is required for many patients with breast cancer and other malignancies. In chemotherapy patients, central venous administration is useful to avoid venous toxicity. Indwelling tunnelled Hickman or Broviac-type catheters and TIAPs have been used for reliable and convenient administration of various therapeutic agents in cancer patients.¹ Compared to externalized systems, advantages of the TIAP include only monthly maintenance (anticoagulation and flushing) and relatively low incidence of malfunction. However, as previous data noted the most common malfunctions included port-associated infection and thrombosis.² Venous devices can be introduced through different vessels such as the jugular veins, subclavian vein or the upper extremity veins however most TIAPs are inserted via the subclavian vein.³ It should be noted that some authors have suggested that there is a lower risk of thrombosis when the catheter tip is located in the lower part of the superior vena cava as opposed to the upper part of the vein.⁴

So far, the reported experience with central venous devices in the breast and gynaecological population has been limited to studies with a relatively small number of patients.² Until now, neither guidelines nor valid recommendations concerning port duration and long-term care have been elaborated. The aim of the present study was to evaluate the factors contributing to the long-term morbidity associated with TIAPs in a large group of women with breast or gynaecological malignancies as well as to ascertain patient satisfaction with the TIAP.