Clinical experiences of using ports and non-coring needles

Abstract

The following case studies describe the use of the Smith Medical implanted ports and Gripper huber needles. Smiths Medical produces a range of implanted ports that include the Port-A-Cath and P.A.S. Port Power P.A.C. systems. The ports are easy to implant, maintain and remove. They are lightweight and have features that are designed to reduce complication rates, including a highly compressed septum to increase needle retention, a titanium chamber with a gouge-resistant floor, a bevelled chamber for optimal rinsing, a round shape to avoid overturning and the Ultralock connection. They are available in various configurations, with single and dual lumens. There is also a needle for power-injection of contrast media for certain types of diagnostic imaging scans (Smith Medical 18). The Gripper Plus needle is designed with an emphasis on safety, effectiveness and patient comfort. These non-coring needles have a bevelled tip that sits flush with the back of the port without impeding the flow of fluid; this also prevents holes forming in the septum ( Barton et al, 2018 ). The needle is available in different gauges and lengths, which can be tailored to reflect individual patient needs and the amount of adipose tissue present. It is essential to select the correct size, which will reduce the risk of dislodgement. The Gripper needles are compatible with paclitaxel and lipid solutions, and are recommended by the National Institute for Occupational Safety and Health (NIOSH) (1999) . They are compatible with both the Port-a-Cath and P.A.S. Port Power P.A.C. systems, and can be ordered from the same manufacturer, which has the potential to make ordering, training and support more efficient.

A scoping review of Clinical Studies, Hospital Group Reports and National Strategic Documents on vascular access devices in cancer patients

“…Our review on sample sizes found that two sample sizes were not specified, 28,30 six sample sizes were not applicable, 11,24–27,29 four sample sizes had under 50 patients, 14,17,21,31 three had sample sizes between 50 and 100 patients, 15,19,23 one was between 100 and 500 patients, 16 two were between 500 and 1000 patients 18,20 and two were over 1000 patients. 22,32…”

“…The most common research questions examined by the reports were infection of VADs with 30% ( n = 6) of them being related to this topic, 15,17,20,23,24,28 25% ( n = 5) reported on the care and maintenance of VADs for Health Care Practitioners (HCPs), 14,21,25,26,27 20% ( n = 4) reported on complications associated with VADs, 11,22,29,32 10% ( n = 2) reported on complications of a peripherally inserted central catheter (PICC) in haematology patients, 16,19 10% ( n = 2) reported on education for parents of paediatric patients 18,30 and 5% ( n = 1) reported on VAD choice by the patient. 31…”

“…Study design varied with the most common type using a retrospective design. We included nine retrospective study designs, [15][16][17][18][19][20][21][22][23] four guidelines, [24][25][26][27] two prospective design studies, 14,28 two literature reviews, 11,29 one survey, 30 one case study 31 and one cross sectional analysis. 32 Among the reports included, no randomised control trials (RCTs), no systematic reviews, no meta-analysis or meta-synthesis and no scoping reviews were identified.…”

“…To also monitor rates of peripheral intravenous cannula adverse events and blood culture contamination rates before and after the changeover of doctors Practitioners (HCPs), 14,21,25,26,27 20% (n = 4) reported on complications associated with VADs, 11,22,29,32 10% (n = 2) reported on complications of a peripherally inserted central catheter (PICC) in haematology patients, 16,19 10% (n = 2) reported on education for parents of paediatric patients 18,30 and 5% (n = 1) reported on VAD choice by the patient. 31 Our review on sample sizes found that two sample sizes were not specified, 28,30 six sample sizes were not applicable, 11,[24][25][26][27]29 four sample sizes had under 50 patients, 14,17,21,31 three had sample sizes between 50 and 100 patients, 15,19,23 one was between 100 and 500 patients, 16 two were between 500 and 1000 patients 18,20 and two were over 1000 patients. 22,32 We found no evidence of study protocol publication and no study was registered as a clinical trial.…”

“…• • CVC infection rates were 10.9 per 1000 line days before the non-consultant hospital doctors (NCHD) changeover and 1.5 per 1000 line days afterwards Implications for future research. Eight of the studies did not mention recommendations for future research, 14,16,[18][19][20]23,30,31 as displayed in Table 2. Two of the included guidelines did not give a schedule for review and update.…”