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.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

A retrospective observational study on maintenance and complications of totally implantable venous access ports in 563 patients:Prolonged versus short flushing intervals

Objectives:To assess whether the extension of the flushing interval will increase risks of complications associated with totally implantable venous access port(TIVAP)in the off-treatment period.Methods:A retrospective single-center observational study was performed.Patients with a TIVAP in the off-treatment period that underwent regular flushing in our clinic were included.Data concerning patients and their TIVAPs were recorded.Patient baseline characteristics and TIVAP-related complications were analyzed.Continuous variables were analyzed by ANOVA or the Kruskal-Wallis H test.To compare the occurrence of TIVAP-related complications,the chi-square test was used;if needed,Fisher’s exact test was used.Results:Totally 607 patients were reviewed,and 563 patients were finally included.Thirteen complications were recorded,including 11 cases of catheter occlusion(1.95%),one case of port cannula rotation(0.18%),and one case of catheter tip malposition(0.18%).No device-related infection or venous thrombosis was recorded.Among these patients,the average flushing interval was 35.27±13.09 days.Patients were divided into three groups according to the flushing interval:every 28 days or less(Group 1,n=133);every 29-44 days(Group 2,n=350);and every 45 days or more(Group 3,n=80).No significant difference in catheter-related complications was found among the three groups(P>0.05).Conclusions:In the TIVAP off-treatment period,patients without any history of TIVAP-related complications during approximately one year can attempt to prolong the flushing interval to more than 4 weeks;we further suggest that 5-6 weeks may be an appropriate option for these patients.

Simpli?ed point-of-care ultrasound protocol to con?rm central venous catheter placement:A prospective study

BACKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(CVC) placement is with plain ? lm chest radiography(CXR). We hypothesized that a simple point-of-care ultrasound(POCUS) protocol could effectively con? rm placement and reduce time to con? rmation.METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8%(95%CI 77.1%–93.5%) and speci? city of 100%(95%CI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes(IQR 10–29) and 32 minutes(IQR 19–45), respectively.CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a con? rmatory CXR.