Difficulty removing a totally implantable venous access port:A case report

BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.

Correlation between psychological,family social support,and home nursing quality for an implanted venous access port

BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication instructions.Home care ensures continued support after discharge.However,due to factors such as age,gender,culture,psychological status,and family support,the quality of home care varies significantly.Understanding these factors can help provide targeted guidance to improve the care of cancer patients.AIM To explore IVAP chemotherapy on home care quality and its association with mental health and family support for cancer patients.METHODS This investigative study was based on a medical records system.It investigated the relationship between psychological status,family support,and home care quality in 180 patients with cancer undergoing IVAP chemotherapy.Psychological status was assessed using the State Anxiety Inventory(S-AI);family support was assessed using the Perceived Social Support Scale(PSSS),and home care quality was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30).Pearson’s correlation and Structural Equation Modeling were used to analyze the interplay between these factors.RESULTS The average S-AI score was 47.52±14.47,PSSS was 52.48±12.64,and EORTC QLQ-C30 was 70.09±17.32.A substantial inverse relationship was observed between the EORTC QLQ-C30 and S-AI scores(r=-0.712).A significant positive correlation was found between the EORTC QLQ-C30 and the PSSS,with a correlation coefficient of(r=0.744).The multiple linear regression analysis indicated that family social support,psychological status,and average monthly family income were the main factors influencing the variation in the quality of home care,explaining 71.9%of the variation.The Structural Equation Modeling results indicated that psychological status acted as a partial mediator in the association between family social support and home care quality of life,explaining 32.78%of the mediation effect.CONCLUSION Psychological status and family social support positively impacted cancer patients’home care quality,with psychology partially mediating this effect.

Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas

Totally implantable access port is a fully implantable drug delivery system that is implanted subcutaneously and can be retained for a long time.Advantages of ports include a simple nursing process,low risk of infection and embolism,and high patient comfort.In order to promote the standardized application of ports in the treatment of digestive tract tumors and reduce port-related complications,the Chinese Research Hospital Association Digestive Tumor Committee,the Chinese Association of Upper Gastrointestinal Surgeons,the Chinese Gastric Cancer Association,and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association have organized multidisciplinary expert discussions at the General Hospital of the People’s Liberation Army and nationwide expert letter reviews and on-site seminars,and formulated an expert consensus of the operation guidelines.

Gastrointestinal stromal tumor metastasis at the site of a totally implantable venous access port insertion:A rare case report

BACKGROUND The totally implantable venous access port(TIVAP)is an important device in patients for injecting blood products,parenteral nutrition or antineoplastic chemotherapy.Metastatic spread at the site of the insertion of a TIVAP is extremely rare.CASE SUMMARY We report the case of 33-year-old male with advanced gastrointestinal stromal tumor(GIST)who underwent radical tumor resection after neoadjuvant imatinib therapy.However,a solitary GIST metastasis at the site of a TIVAP insertion developed during adjuvant imatinib treatment.Mutational analysis showed secondary mutation in KIT exon 13(V564 A),which is resistant to imatinib treatment.To our knowledge,this is the first case report of a patient with advanced GIST developing GIST metastasis at the site of a TIVAP insertion.CONCLUSION This case highlights that when a patient with advanced,high metastatic GIST requires TIVAP insertion,we should realize that there is a risk of developing tumor metastasis at the site of a TIVAP insertion.

Shanghai expert consensus on totally implantable access ports 2019

Totally implantable access ports(TIAPs)are used for patients with poor peripheral vascular support requiring central venous access.In recent years,TIAPs have been gradually accepted and promoted by patients,doctors,and nurses owing to their advantages of convenient carrying,a long maintenance period,low complications,and a high quality of life for patients.Currently,medical personnel that handle TIAP implantation and management in China are from different areas of healthcare,including surgery,internal medicine,radiology,nurse anesthesia,vascular access,etc.,and many only handle TIAP as a part of their duties.Therefore,the operating procedures and steps for the diagnosis and treatment of complications of TIAP vary from person to person,resulting in different incidence and treatment methods for complications in the implantation and use of TIAP in different medical units.Based on this,we have updated the Shanghai expert consensus on TIAPs from 2015 and explored the diagnosis and treatment procedures of related complications while continuing to emphasize standardized implantation and maintenance.

Continuously Injection with Diluted Heparin Solution via Catheter for Implantation of Totally Implantable Access Ports (TIAP)

Background: Totally implantable access ports (TIAP) could be done in two methods: puncture of subclavian vein and cephalic vein cutdown. Cephalic vein cutdown method has fewer complications but has higher failure rates. We present a method to decrease the failure rates. Methods: We use the continuously injection with diluted heparin solution via catheter while introducing the TIAP catheter into the cephalic vein. Results: From January 2005 to January 2009, 20 patients were performed. This method was successfully applied in 11 patients with no complications. The other 9 patients was unsuccessfully and further underwent guidewire assisted. Conclusions: Continuously injection with diluted heparin solution via catheter while inserting TIAP catheter into the cephalic vein is safe and simple. It could be used for difficulties of insertion of TIAP and increased the successful rates of cephalic vein cut-down method.

Implantable Venous Access Ports for Chemotherapy in Lung Cancer Patients: Comparison of the Femoral and Subclavian Vein Approaches without Guidance

Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous access ports without guidance in lung cancer patients. Methods: We conducted a retrospective review of total 163 lung cancer patients who underwent implantations of a central venous access port for chemotherapy. 95 patients received the ports by the femoral vein blind-puncture technique and 68patients had the port implanted via the subclavian vein blind-puncture technique. The initial success rate of port implantation and the frequency of occurrence of complications were calculated. Results: The primary success rate of venous port implantation was 93.7% for femoral approach and 88.2% for the subclavian approach respectively (p < 0.05). Intraoperative complications developed in two patients (2.1%) in the femoral approach group and in five patients (7.4%) in the subclavian approach group. Although a higher intraoperative complication ratio for the subclavian approach was encountered compared to that for the femoral vein approach, there was no statistically significant difference (p = 0.103). Nor was there any statistically significant difference in terms of the occurrence of late complications. Conclusions: Venous access port implantation via the femoral vein approach is safe, and its success rate is very high, with the equal complication rates comparable to the subclavian approach. This approach avoids many of the intraoperative complications. Thus, the femoral vein approach for implanting a venous access port in lung cancer patients should be considered a valid, and safe technique.

应用Port-Access系统行微创冠状动脉旁路移植术21例体会

目的 介绍应用Port-Access系统进行微创冠状动脉旁路移植术的体会。 方法 采用左胸小切口 (6～ 7)cm ,经股静脉插静脉管 ,经升主动脉或股动脉插动脉管 ,主动脉内球囊阻断的方法 ,行微创冠状动脉旁路移植术。 结果 本组 2 1例无手术死亡 ,无重大并发症。 结论 应用Port-Access系统进行微创冠脉搭桥手术是一种安全可靠的手术方法 ,可以避免胸骨切开 ,减轻疼痛 ,利于患者后恢复。

Basilic vein variation encountered during surgery for arm vein port:A case report

BACKGROUND Venous variations are uncommon and usually hard to identify,and basilic vein variation is particularly rare.Basilic vein variation usually presents without any clinical symptoms and is often regarded as a benign alteration.This case was a patient with congenital basilic vein variation encountered during surgery for an infusion port.CASE SUMMARY We documented and analyzed an uncommon anatomical variation in the basilic vein encountered during arm port insertion.This peculiarity has hitherto remained undescribed in the literature.We offer remedial strategies for addressing this anomaly in the future and precautionary measures to circumvent its occurrence.We conducted a comprehensive review of analogous cases in the literature,offering pertinent therapeutic recommendations and solutions,with the aim of enhancing the efficacy and safety of future arm port implantations.CONCLUSION Venous variation is rare and requires detailed intraoperative and postoperative examination to ensure accuracy,so as not to affect subsequent treatment.

孔式入路体外循环的概念及辨析（二）——Port—access的不同插管方式及在微创心血管外科手术中的应用

微创心脏外科从进入心脏外科领域到全世界范围的推广和应用，已经显示出强大的生命力。多学科的交叉、融合、发展，心脏外科工作者理念的更新，以及人们不断提高的物质和文化需求，都给微创心脏血管外科提供了坚实的基础和新的要求。近年体外循环的新观点、新材料、新设备的出现，

Clinical Course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcutaneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235 - 627) and 563 (95% confidence interval, 368 - 728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.

A Technique of Bilateral Inguinal Hernia Repair Using 10 mm Single Port Access and Bioresorbable Composite Mesh Fixed with Endoclose Sutures: Three Cases Reported

Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.

PICC和PORT静脉输液技术综合输液效果比较

目的对PICC和PORT的综合效果指数进行测算,以评价两种中心静脉输液技术的综合输液效果。方法抽取上海市某三级甲等医院采用PICC或PORT行中长期静脉输液的肿瘤患者为研究对象,通过回顾性队列研究和横断面调查收集两种静脉输液技术的安全性、有效性及患者体验相关指标,测算并比较两种中心静脉输液技术在总留置时间、留置3~个月、6~个月及9~12个月的综合效果指数。结果PICC和PORT置管患者分别纳入377例、293例,PICC留置时间显著短于PORT,置管及维护过程中次要并发症发生率显著高于PORT,生活质量得分显著低于PORT(均P<0.05)。PICC在总留置时间、留置3~个月、6~个月及9~12个月的综合效果指数值均小于PORT。结论PORT的综合输液效果优于PICC,从输液效果角度,建议优先选择PORT作为中长期静脉输液的血管管路。

肿瘤患者上臂植入式静脉给药装置全程管理中国专家共识解读

上臂植入式静脉给药装置(implantable venous access ports,IVAP)是经上臂全部植入体内并可以长期使用的闭合静脉输液系统,在国内相关领域得到充分应用。为此,国家肿瘤质控中心乳腺癌专家委员会和西安交通大学第一附属医院牵头组织国内相关领域专家撰写《肿瘤患者上臂植入式静脉给药装置全程管理中国专家共识(2023版)的专家共识》(简称《共识》)。该文对《共识》中的重点内容进行解读,旨在加深医护人员对《共识》的认识,促进上臂IVAP规范应用于肿瘤患者的综合治疗。

Accidental venous port placement via the persistent left superior vena cava:Two case reports

BACKGROUND Breast cancer poses a great threat to females worldwide.There are various therapies available to cure this common disease,such as surgery,chemotherapy,radiotherapy,and immunotherapy.Implantable venous access ports(IVAP,referred to as PORT)have been widely used for breast cancer chemotherapy.Venous malformations are possible conditions encountered during PORT implantation.Persistent left superior vena cava(PLSVC)is a common superior vena cava malformation.Most patients have normal right superior vena cava without affecting hemodynamics,so patients often have no obvious symptoms.CASE SUMMARY We incidentally found that two patients had PLSVC while a PORT was implanted via the internal jugular vein.Due to chemotherapy for breast cancer,PORT was successfully implanted under the guidance of ultrasound into these 2 patients.Positive chest X-ray examination after the operation showed that the catheter ran beside the left mediastinum and the end was located in the seventh thoracic vertebra.The patients had no catheter-related complications and successfully completed the course of chemotherapy.Ultrasonography found that the ratio of PORT outer diameter to PLSVC inner diameter was less than 0.45,which was in line with the recommendations of relevant literature and operating guidelines.The purpose of this article is to introduce two rare cases and review the relevant literature.CONCLUSION Correct assessment of PLSVC status and ultrasound-guided PORT placement generally does not affect breast cancer patients chemotherapy.

Single access laparoscopic surgery:Complementary or alternative to NOTES?

In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.

湖南省56家医院完全植入式静脉输液港应用及管理现况调查

目的:调查完全植入式静脉输液港(Totally Implantable Vennous Access Ports,TIVAP)应用现况及管理过程存在的问题,并提出干预策略,为实现TIVAP的科学安全管理提供参考依据。方法:通过问卷调查,于2022年10月—11月采用便利抽样法调查湖南省14个地区的56家医院TIVAP应用及管理现况。结果:20家(35.7%)医院开展了TIVAP植入技术,47家(83.9%)医院开展了TIVAP维护技术。在TIVAP管理方面,47家已开展TIVAP业务的医院中,有39家(83.0%)医院成立了静脉治疗管理小组,14家(29.8%)医院开展了TIVAP植入数据监测,二级医院与三级医院比较差异具有统计学意义(P<0.05);40家(85.1%)医院定期对专科护士进行TIVAP培训,只有17家(36.2%)医院定期对TIVAP使用情况进行质量督查。结论:湖南省各级医院的TIVAP管理制度有待完善,需要进一步完善不同等级医院的TIVAP管理规范、维护流程等,需要加强信息化管理和专科人员培训,以提高TIVAP的管理质量。

4例儿童植入式静脉输液港导管断裂原因分析及处理

目的探讨4例儿童植入式静脉输液港导管发生断裂的原因,并总结护理经验。方法2011年3月—2023年1月本科室共植入应用输液港319例,其中4例患儿发生导管断裂,发生率1.3%,4例患儿断裂的输液港均经手术完整取出;对导管发生断裂的原因、识别方法进行分析总结。结果病例1导管断裂位置距离港座6cm,断裂的导管未发生移位;病例2在距离港座7cm处发现导管呈线状裂纹,外观完整无断裂,推注液体时可见裂纹处有液体溢出;病例3导管断裂位置距离港座11cm,断裂的导管未发生移位;病例4导管断裂位置距离港座1cm处,且断裂后导管沿右心房-右肺动脉-右下肺动脉发生移位。输液港导管断裂原因:病例1、3、4有频繁且长时间的颈部、上肢肢体活动;病例2输液港维护不当。输液港拔除术后,病例1、2、4患儿因原发病需继续住院治疗,病例3术后第2天出院。结论导管断裂是输液港临床维护及使用过程中的严重并发症之一,医护人员应重视输液港规范化操作与维护、加强患儿及家长的健康宣教,及时发现异常并处理,其是保障患儿输液港安全使用的重要措施。

超声联合DSA引导下经上臂静脉输液港植入术在恶性肿瘤化疗患者中的临床应用研究

目的 探讨超声联合DSA引导下经上臂静脉植入式输液港(TIVAP)作为恶性肿瘤患者化疗通路的安全性和有效性。方法 回顾性分析2020年1月至2022年1月上海交通大学医学院附属仁济医院1 546例接受经上臂TIVAP的恶性肿瘤患者临床资料,分析比较PICC置管室和DSA手术室实施该手术的植入成功率、一次置管成功率、手术时间和并发症率。结果 1 546例患者植入成功率100%,一次置管成功率99.48%;手术时间(22.7±3.1) min;总并发症率7.37%(114/1 546);置管室操作766例,DSA下操作780例,与置管室组比较,DSA组手术时间更短[(20.1±1.3) min vs (25.4±1.9) min],原发导管异位发生率更低(0%vs 0.78%),差异有统计学意义(P<0.05)。感染、血栓形成、上肢运动障碍、导管堵塞、港体外露、港体翻转等并发症两组间比较无统计学差异(P>0.05)。结论 超声引导下经上臂TIVAP对肿瘤化疗患者是一种安全有效的输液通路,联合术中DSA引导可减少手术时间,降低手术相关并发症率。

植入式静脉输液港肩关节受限患者的康复训练

目的 探讨康复训练方案在植入式静脉输液港肩关节受限患者中的应用效果。方法 选取植入式静脉输液港肩部活动受限患者,按入院时间先后将69例设为对照组,采用常规握力球进行训练;72例设为干预组,采用康复训练方案进行干预。3个月后,比较两组患者肩关节活动度、日常生活活动能力及并发症发生情况。结果 两组干预后肩关节活动度前屈、外展、外旋、内旋、后伸活动度及日常生活活动能力评分显著优于本组干预前,干预后干预组关节活动度及日常生活活动能力评分显著优于对照组,血栓发生率显著低于对照组(均P<0.05);两组导管堵塞、异位发生率比较,差异无统计学意义(均P>0.05)。结论 康复训练方案简单易学,容易掌握,不受场地与时间限制,能改善静脉输液港肩关节受限患者肩关节活动度、日常生活活动能力,降低患者血栓发生率。