A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients.

Mueller, Brigitta U.; Skelton, Jane; Callender, Diana; Marshall, Dorie; Gress, Janet; Longo, David J.; Norton, John A.; Rubin, Marc; Venzon, David; Pizzo, Phillip A.

doi:10.1200/jco.1992.10.12.1943

Cited by 166 publications

(88 citation statements)

References 12 publications

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“…Previous reports have suggested the operator's experience, 28 CVL insertion time, 15 and complications 8 to be associated with VTE, though a recent well-designed study did not observe any of these associations. 14 No association was reported between CVL type 12,15,29 or number of CVL lumen 8,14,16 and the incidence of VTE. In addition, the time of CVL insertion was not recorded, which restricted the ability to assess whether the duration of CVL placement was associated with VTE.…”

Section: Discussionmentioning

confidence: 97%

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

Male

Chait

Andrew

et al. 2003

Blood

220

164

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Venous thromboembolic events (VTEs) in children are associated with central venous lines (CVLs). The study objective was to assess whether CVL location and insertion technique are associated with the incidence of VTE in children. We hypothesized that VTE would be more frequent with (1) CVL location on the left body side, (2) CVL location in the subclavian vein rather than the jugular vein, and (3) CVL insertion by percutaneous technique rather than venous cut-down. This was a prospective, multicenter cohort study in children with acute lymphoblastic leukemia who had a CVL placed in the upper venous system during induction chemotherapy. Characteristics of CVL were documented prospectively. All children had outcome assessment for VTE by objective radiographic tests, including bilateral venography, ultrasound, echocardiography, and cranial magnetic resonance imaging. Among 85 children, 29 (34%) had VTE; 28 VTEs appeared in the upper venous system, and 1 was sinovenous thrombosis. Left-sided CVL (odds ratio [OR], 2.5; 95% confidence interval, 1.0-6.4; P ‫؍‬ .048), subclavian CVL (OR, 3.1; 95% CI, 1.2-8.5; P ‫؍‬ .025), and percutaneous CVL insertion (OR, 3.5; 95% CI, 1.3-9.2; P ‫؍‬ .011) were associated with an increased incidence of VTE. Interaction occurred between CVL vein location and insertion technique. Subclavian vein CVL inserted percutaneously had an increased incidence (54%) of VTE compared with any other combination (P ‫؍‬ .07). For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk for CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cutdown appears preferable over percutaneous insertion.

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Section: Discussionmentioning

confidence: 97%

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

Male

Chait

Andrew

et al. 2003

Blood

220

164

View full text Add to dashboard Cite

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“…Thus, the method of insertion may affect the outcome. A number of the studies attempted to compare CVAPD with either Groshong catheters or Hickman catheters and consistently found a higher rate of complications in the central external catheters (Mueller et al, 1992;Gleeson et al, 1993;Groeger et al, 1993;Eastridge and Lefor, 1995) (Table 2).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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Central venous access port devices (CVAPD) are necessary for delivery of prolonged infusional chemotherapy or in patients with poor peripheral venous access. Previous studies of Hickman catheters report complication rates in about 45% of patients. Our aim was to assess the early and late complication rate, and duration that the CVAPD remained functional, following insertion by interventional radiologists in patients with solid tumours. A prospective study was undertaken in 110 consecutive patients who had insertion of 111 subclavian CVAPD. The median age of patients was 57 years (range 17 -83), 64 were females; 68 patients (61%) had gastrointestinal tumours and 25 (23%) had breast cancer. CVAPD were successfully implanted in all but one patient. There were four (4%) immediate major complications: thrombosis 2 and pneumothorax 2. Nine patients (8%) had bruising or pain. Four devices (4%) became infected. In total, 100 CVAPD (90%) were either removed as planned at the end of treatment (n ¼ 23) after a median 203 days, or remained in situ for a median of 237 days (7 -1133). Premature removal occurred in eight patients due to infection (n ¼ 4), thrombosis (n ¼ 3) or faulty device (n ¼ 1). Four patients were lost to follow-up. Radiological insertion of CVAPD is safe and convenient with low rates of complications.

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“…Catheter-related infection rates of 11-45% 17,22-24 have been reported in Hickman catheters and of 0-22% 17,22,25,26 in patients with implantable port access. Given the high risk of prolonged neutropenia and the sustained immunosuppression in our patients, the infection rate was moderate and comparable to that observed in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Nevertheless port systems have been shown to provide stable venous access beyond day 100 15 with a rate of infection and thrombosis comparable to external vascular access devices even in patients with leukemia. 2,[16][17][18][19] Ports were shown to provide longer failurefree function than Hickman and Broviac catheters. 15 The feasibility of prolonged and durable central venous access in a dog model of myeloablative BMT has been shown by Dennis et al 20 While there are reports on single lumen ports in patients with leukemia, 21 no data on the prospective use of port devices in patients receiving allogeneic blood stem cell transplantation have been published.…”

Section: Discussionmentioning

confidence: 99%

Double lumen port access in patients receiving allogeneic blood stem cell transplantation

Platzbecker

Illmer

Schaich

et al. 2001

Bone Marrow Transplant

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Summary:We performed a prospective trial investigating the feasibility of a double lumen port access in 26 patients with hematological malignancies or solid tumors receiving either standard conditioning (n ‫؍‬ 9, median age 49 years (range 19-65)) or dose-reduced conditioning (n ‫؍‬ 17, median age 56 years (range 35-66)) followed by allogeneic blood stem cell transplantation. The port system was implanted within 3 months (n ‫؍‬ 20, range 7-91 days) before transplantation or as indicated at different time points after transplantation (n ‫؍‬ 6, range 28-680 days). Most infusions, including the graft itself and all blood drawings, were performed via the port. Over a cumulative duration of 5622 days (1310 days after standard conditioning (range 56-349) and 4431 days after dose-reduced conditioning (range 49-489)) two port systems of patients receiving standard conditioning were removed due to early postimplantation pocket infection on day 6 and 8 after insertion, respectively. In the dose-reduced conditioning group only one late removal (day 287) of a port was required. Most of the patients in both groups reported less pain and a higher degree of comfort compared to peripheral or central venipuncture. The use of double lumen port access during conditioning and in an outpatient setting after allogeneic hemopoietic stem cell transplantation is feasible and advantageous for both patient and medical staff. Implantation several weeks before the start of conditioning might help in avoiding early infectious complications after conventional myeloablative conditioning. Bone Marrow Transplantation (2001) 28, 1067-1072. Keywords: double lumen port; allogeneic; dose-reduced conditioning Dose-reduced conditioning (DRC) followed by allogeneic stem cell transplantation (SCT) is increasingly performed

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A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients.

Abstract: There were no differences between the two study groups regarding incidence of documented infections or mechanical or thrombotic complications.

Cited by 166 publications

References 12 publications

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

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

Double lumen port access in patients receiving allogeneic blood stem cell transplantation

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