Outcomes, cost comparison, and patient satisfaction during long-term central venous access in cancer patients: Experience from a Tertiary Care Cancer Institute in South India

Abstract

Introduction:Prolonged treatment, frequent administration of chemotherapy, antibiotics and blood products in cancer patients requires long term venous access. Central venous catheters (CVC) inserted into the subclavian vein or internal jugular vein, peripherally inserted central venous catheters (PICC) and chemoport (CP) are the commonly used central venous access devices (CVAD).Aim:This study was envisaged to review our experience of CVADs over a one year period and analyze the outcome with regard to catheter life, reasons for removal, complications, patient satisfaction and cost comparison between the CVAD types in the Indian setting.Settings and Design:This was a prospective, observational study carried out in a tertiary care cancer institute.Materials and Methods:180 CVADs placed in patients with hematological malignancies and solid tumors from January 2014 to December 2014 were included.Statistical Analysis Used:Data was analyzed using descriptive statistics, Mann Whitney U test. P <0.05 was taken as statistically significant.Results:180 CVADs were placed in 160 patients. The median catheter indwelling period was 76 days (16 days to 313 days) for CVC, 59 days (20days – 313 days) for PICC and 137 days (70 days – 258 days) for CP. 66 out of 160 patients developed complications (41.2%). 108 complication events were noted in 66 patients. There were 40 episodes of CRBSI. Out of the 68 mechanical complications, 37 were encountered during insertion of the CVAD and 31 were during the catheter indwelling period. Out of 160 patients, 138 (86.25%) were satisfied with the CVAD. The cost incurred for CVC/PICC (INR 4,480) was lower than that for CP (INR 24,150) and it was statistically significant (P < 0.0001). Our patients were highly satisfied with the CVAD.Conclusion:Use of CVC and PICC is a safe, reliable and cost saving way of administration of chemotherapy in developing countries. The incidence of complications and catheter loss was acceptable. Our patients were highly satisfied with the CVAD.

Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

“…Many of the patients in this study preferred PICC or NTC instead of port because of the cost. Thus, the economic factor was an important reason that led to fewer catheterizations of port in our study, which was similar to the previous study 8. As far as expenses were concerned, our recommendation was that PICC was a good choice for the patients.…”

“…Usually, NTCs had shorter duration time when they were used in intensive care units or emergency departments. It was reported to have longer duration time when NTCs were used in chemotherapy 8. Many patients in our study were positive to express their own preference to retain the catheter to use when there was no complication.…”

“…In China, the NTCs in the internal jugular vein or subclavian vein cost less than other CVCs and are used when the chemotherapy process is short. Complications of NTCs were reported more than PICCs and ports 6–8. But in Leon’s study, no significant differences were found when complication rates in PICC and non-tunneled devices were compared 9.…”

“…Complications of NTCs were reported more than PICCs and ports. 6 – 8 But in Leon’s study, no significant differences were found when complication rates in PICC and non-tunneled devices were compared. 9 According to the Centers for Disease Control and Prevention (CDC) guideline, PICCs had lower rate of infection than NTCs, and totally implantable catheter had the lowest risk for catheter-related bloodstream infection (CRBSI).…”

Evaluation of complications of totally implantable central venous port system insertion

“…In terms of the complication rate, the present results are superior to those reported in other studies (5–19%). A comparison of complications reported in various studies is presented in Table III (12,17,20,22). All patients of the present study underwent the insertion procedure performed according to good clinical practice, as mentioned above.…”