Complications of Subcutaneous Infusion Port in the General Oncology Population

Abstract

Subcutaneous infusion ports (SIPs) represent a valid method for long-term chemotherapy. The SIPs have several advantages over other methods of venous access: they are easy to implant under local anaesthesia, have less discomfort for the patients, allow low costs, can be implanted in day hospital, and can be managed ambulatorily. However, SIPs have delayed complications, frequently related to clinical conditions of the neoplastic patients, and immediate complications, often due to the placement technique. From March 1992 to March 1997 we placed, under local anaesthesia and under fluoroscopic control, 102 SIPs in 99 general oncology patients for long-term chemotherapy (88% solid, 12% haematological tumours). The percutaneous venous access devices were in the subclavian vein in 96% of the cases and in the internal jugular vein in 4% of them. Immediate complications were: 1 haemopneumothorax, which required thoracic aspirations and two blood transfusions, 1 loop of the tunneled part of the catheter without alterations in SIP function, and 1 left jugular thrombosis in a patient with subclavian veins already thrombosed. The venous access was in the subclavian vein in the first 2 cases, and it was not necessary to suspend the therapeutic program. In the third instance, implanted in jugular vein, it was necessary to remove the SIP. Delayed complications were: 1 necrosis of the skin over the port, 1 infection of subcutaneous pocket, 2 infections of the system, 1 catheter deconnection, and 3 catheter ruptures with embolization of the catheter tip. The SIPs were removed in all cases but 1 in whom infection was successfully treated by appropriate antibiotic therapy. Embolization of the catheter required removal from the pulmonary artery under fluoroscopic guidance in the cardiac catheterization laboratory. In conclusion, infection and thrombosis are the two major complications of SIP in general oncology patients. In these cases it is not necessary to remove systematically the system, but a cor rect therapy (antibiotic, fibrinolytic agents) can be utilized with good results. The catheter rupture is often due to the wear over the costoclavicular angle. The interventional radiology is the method of choice in the treatment of the catheter embolization by rupture or dislocation. The experience of the surgical and nursing staff is probably the most important factor in decreasing the total rate of complications.

Totally implantable venous catheters for chemotherapy: experience in 500 patients

“…However, recent series in the literature show significant complication rates, with up to 2% incidence of pneumothorax, 14% cardiac arrhythmia, 3% arterial puncture, 3% bending of the guide wire, 3% kinking of the introductory sheath and 1% serious bleeding. 6,10,15 In our series, because we preferentially utilized dissection of the jugular veins (81.5% of the total), we did not observe such complications. Even in the cases in which puncturing was performed (18.4% of the total), the incidence of pneumothorax and serious bleeding was null.…”

“…Late complications are of fundamental importance, since these are the main causes of catheter removal, 15 and they occurred in 68 of our implanted catheters. Despite the care, infection continues to be the main late complication, with bacteremia related to the catheter being the most frequent type.…”

Interventional radiological retrieval of embolized vascular access device fragments

“…If the patients had received chest radiographies before the operation, the catheter embolism would have been diagnosed beforehand, and they would have been directly referred to the interventional radiology unit for both port chamber and catheter removal. Separation or disconnection, which is another mechanism of catheter embolism, is estimated to occur in 0.2% to 2% of cases (6,14,15). Traction on the extravascular portion of the catheter by the soft tissues of the chest wall or incorrect locking of the port catheter connection has been suggested as a root cause (16).…”

Vats Assisted Repositioning of a Central Venous Access Device Catheter Causing Inadvertent SVC Puncture: A Rare Case Report and Literature Review.

“…The delayed complications include skin necrosis, infection, catheter fracture, occlusion or thrombosis. 5 Why do left-implanted catheters with high-lying tips represent such a risk? The first hypothesis concerns anatomy: venographies show that in most patients and especially in the stocky ones (i.e., those with a short, wide thorax), the left innominate vein forms a more marked angle with the vena cava.…”