Is radiologic placement of an arm port mandatory in oncology patients?

Abstract

The aim of this study was to evaluate the potential of carboxymethyl chitosan (CM‐chitosan) nanoparticles as carriers for the anticancer drug, doxorubicin (DOX). Different kinds of CM‐chitosan with various molecular weight (MW) and degree of substitution (DS) were employed to prepare nanoparticles through ionical gelification with calcium ions. Factors affecting nanoparticles formation in relation to MW and DS of CM‐chitosan were discussed. By the way of dynamic light scattering (DLS), TEM, and atomic force microscopy (AFM), nanoparticles were shown to be around 200–300 nm and in a narrow distribution. FTIR revealed strong electrostatic interactions between carboxyl groups of CM‐chitosan and calcium ions. DOX delivery was affected by the molecular structure of CM‐chitosan. Increasing MWs of CM‐chitosan from 4.50 to 38.9 kDa, DOX entrapment efficiency was enhanced from 10 to 40% and higher DS slightly improved the load of DOX. In vitro release studies showed an initial burst followed by an extended slow release. The DOX release rate was hindered by CM‐chitosan with high MW and DS. These preliminary studies showed the feasibility of CM‐chitosan nanoparticles to entrap DOX and the potential to deliver it as controlled release nanoparticles. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 4689–4696, 2006

Central venous access: techniques and indications in oncology

“…3a,b,c) compared to the landmark-guided technique improves the overall success rate and the success rate of first attempt, decreases the average access time and decreases the complication rate [2][3][4]. Venography is helpful in upper extremity and subclavian vein (SCV) access [5][6][7] to monitor venous puncture and network patency. Real-time US guidance offers several benefits over venographic guidance: internal jugular vein (IJV) access, identification of both vein and artery, no risk of allergic medium reactions and/or renal impairment, and no need of a small-bore intravenous line.…”

“…This procedure is still efficient even on patients in an upright position (morbid obesity, severe kyphosis) and/or who are contraindicated for chest-port insertion. Techniques include insertion in the arm or forearm using US guidance (patient with seemingly no veins) or venography [5,24,25]. Three possibilities of venous access include the basilic, brachial or cephalic veins during a single session [26].…”

“…Reported risks of iatrogenic subclavian artery injury are virtually zero with procedures performed under real-time US [22], 0.3% under venography [34] and 7.8% in case of a blind attempt [19]. Also, life-treatening SVC thrombosis and pulmonary embolism have been reported in less than 0.4% of the literature's largest series [5,20,31].…”

“…Catheter rupture and distal embolisation have been described in 0.8 to 1.1% in percutaneous SCV access [23,45] and in 0.5% in percutaneous brachial access [5], due to pinch-off syndrome and other microtraumatic events at brusque change of the catheter course (Fig. 9a,b).…”

Letter to the Editor re “Outcome analysis in 3160 implantations of radiologically guided placements of totally implantable central venous port systems”: observations about right internal jugular access.

“…This monocentre retrospective study almost only concerns percutaneous internal jugular vein access procedures (83.5%) that were attempted using the Seldinger technique under ultrasound and X-ray guidance by seventeen senior radiologists. The other three largest series included respectively 1500 surgical procedures [2], 1000 upper extremity venography-guided procedures (performed by radiologists) [3] and up to 3951 percutaneous procedures comparing anatomic landmarks to ultrasoundguidance (performed by anaesthethists) [4] According to Teichgraber's study, the technical success rate using combined ultrasound (US)-and X-ray-guidance was 99.8%. This is the highest success rate ever reported among all insertion procedures whatever the technique (venous cutdown, percutaneous) and the inherent anatomical variants [5,6].…”