Implanted vascular access device options: a focused review on safety and outcomes

Abstract

Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports. Since the first report of a fully implantable vascular access device (IVAD) in 1982, 1 the use of these devices has grown exponentially. They consist of a reservoir cradled in the subcutaneous tissue that is connected to a catheter, with its tip terminating into a major vein. IVADs are frequently used in patients who have poor peripheral venous access and are in need of long-term administration of vesicant drugs, antimicrobials, blood products, or parenteral nutrition.2,3 They also are used as access for long-term therapeutic apheresis procedures. 4 Although nonimplanted, long-term catheters can be used for all of these purposes as well, the lack of an external component in IVAD ports provides multiple advantages; patients have improved perceptions of quality of life and body image and less limitation in their mobility. 5 These ports also minimize the need for maintenance care and risk of infectious complications when the IVAD is not in use. 6 These benefits of IVAD port use have also been demonstrated in pediatric cancer patients, with the added advantage of allowing the child to participate in normal activities and preserving body image. 7Despite the vast experience accrued over the years and the large volume of literature studying factors associated with IVAD port outcomes, early perioperative and late postoperative complications still occur (see Table 1). 8,9 Overall complication rates for IVAD ports reportedly occur in the range from 2% to 18% of all implanted devices. 10-12Port-related infections and venous thrombosis are particularly important, because they are associated with additional morbidity and costs and require removal of the IVAD as part of their treatment in as many as 6.5% of patients. 10 An additional complication specific to the use of IVAD ports during therapeutic apheresis is the occurrence of frequent pressure-related alarms, 13-15 which do not always result in a need to abort the procedure but can delay the duration of the treatments and require additional interventions. 13Here, we present a review focused on techniques, materials, and long-term management options of ports as IVAD options that have an impact on the relevant complications and overall safety profile of th...

Indwelling ports for prophylactic RBC exchanges in sickle cell patients: Comparison of bard and vortex ports

“…Our complication rate was also very low (0.8%) with only a single catheter associated thrombosis identified across our 9 patients and 124 RCE procedures and no associated infections. While we did not see any thromboses during the first year of our study while tPA usage was not standard protocol, its regular use over the last 2 years of our study may have played a role in our lower than expected complication rate (2‐18% reported from other studies) …”

“…While we did not see any thromboses during the first year of our study while tPA usage was not standard protocol, its regular use over the last 2 years of our study may have played a role in our lower than expected complication rate (2-18% reported from other studies). 10 Limitations of this study include its retrospective nature and small-moderate size. Because we only had 9 patients enrolled there is a possibility that differences in individual patients were enough to create differences present between the port types or mask possible benefit of tPA use.…”

“…Both single and dual lumen ports are available with dual lumen models allowing for no additional access sites, yet a peripheral line for blood return is required in the case of single lumen port utilization. Many models of implantable ports are now available and have been thoroughly reviewed elsewhere . Few studies have compared different port types or followed patients with implantable ports over an extended period.…”

“…Many models of implantable ports are now available and have been thoroughly reviewed elsewhere. 10 Few studies have compared different port types or followed patients with implantable ports over an extended period. We set out to compare two different models of dual lumen ports because manufacturing differences between the port and catheter design may lead to differences in function.…”

Implementation and 2‐year outcomes of the first FDA‐approved implantable apheresis vascular access device

“…Unfortunately, VADs are associated with increased risks, including bloodstream infections (BSIs), fibroblastic sleeves/thromboses, migration of catheter tip, and other mechanical failures . VADs are the most significant source of health care–associated BSIs, accounting for up to 500,000 BSIs each year in the United States .…”