Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devices approved for high-pressure injections

Abstract

Objectives: To evaluate the technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) approved for high-pressure injections, and to analyse their value for arterial phase CT scans. Methods: Retrospectively, we identified 204 patients who underwent TIVPP implantation in the forearm (n5152) or chest (n552) between November 2009 and May 2011. Implantation via an upper arm (forearm port, FP) or subclavian vein (chest port, CP) was performed under sonographic and fluoroscopic guidance. Complications were evaluated following the standards of the Society of Interventional Radiology. Power injections via TIVPPs were analysed, focusing on adequate functioning and catheter's tip location after injection. Feasibility of automatic bolus triggering, peak injection pressure and arterial phase aortic enhancement were evaluated and compared with 50 patients who had had power injections via classic peripheral cannulas. Results: Technical success was 100%. Procedure-related complications were not observed. Catheter-related thrombosis was diagnosed in 15 of 152 FPs (9.9%, 0.02/100 catheter days) and in 1 of 52 CPs (1.9%, 0.002/100 catheter days) (p,0.05). Infectious complications were diagnosed in 9 of 152 FPs (5.9%, 0.014/100 catheter days) and in 2 of 52 CPs (3.8%, 0.003/100 catheter days) (p.0.05). Arterial bolus triggering succeeded in all attempts; the mean injection pressure was 213.8 psi. Aortic enhancement did not significantly differ between injections via cannulas and TIVPPs (p.0.05). Conclusions: TIVPPs can be implanted with high technical success rates, and are associated with low rates of complications if implanted with sonographic and fluoroscopic guidance. Power injections via TIVPPs are safe and result in satisfying arterial contrast. Conventional ports should be replaced by TIVPPs.

Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan

“…The forearm group showed a significantly higher incidence of catheter occlusion than the chest group, corresponding to findings reported previously [3,34]. The forearm is located the most peripherally compared to the remaining sites considered in this study and has the longest catheter, which passes the elbow joint, and these factors may affect the occurrence of catheter occlusion at this site.…”

“…Central venous port implantation (CVPI) is used in different phases of cancer therapy as it is a secure venous route for treatment (chemotherapy), supportive therapy (e.g., prophylactic agents for chemotherapy-related adverse events and intravenous hyperalimentation), palliative care (e.g., symptom-relieving agents), and other procedures (e.g., blood collection and rapid injection of contrast media for imaging examination [with verified devices]) [1][2][3][4]. Since it enables easy transition of these interventions from the inpatient department to the outpatient department or home, CVPI shortens the length of hospitalization and may consequently reduce the overall cost of healthcare [5][6][7][8].…”

Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience

“…A central venous access is mandatory for hyperosmolar, basic (pH ≤4.0), alkaline (pH ≥9.0) and local irritant medication, such as chemotherapy, antibiotics and parenteral nutrition. Moreover, high pressure infusions such as those required for computed tomographic examinations of up to 5 ml/s, as well as blood tests, which can be performed through such selected systems, streamlining workflow and increasing patient quality of life (1)(2)(3).…”

Ultrasound-Guided Arm Ports: Indications, Techniques, and Management

“…In retrospective studies, venous thrombosis (VT) rate has been found to be statistically higher in patients with arm ports compared with patients with chest ports (11.4% vs 4.8%; n ¼ 440 patients), (9.9% vs 1.9%; n ¼ 204 patients). 23,24 According to a retrospective study by Akahane et al, 25 combined phlebitis and mechanical rates were higher in patients with arm ports (n ¼ 162 patients). In a prospective study 26 (n ¼ 215), VT rates were found to be similar in both patient groups.…”