Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are g...Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are generally placed in position by the percutaneous subclavian vein puncture approach (SVPA). However, this approach causes infrequent intraoperative or postoperative complications. Using the internal jugular vein puncture approach (IJVPA), TIVADs could be placed more easily and safely. Materials and Methods: Fifty-six patients who received TIVADs for chemotherapy of colorectal carcinomas were enrolled in this study. The choice of approach (IJVPA or SVPA) was adopted at the discretion of each doctor in charge of the patient. The operation time, success rate and complications of the two approaches were compared and evaluated. Results: TIVAD placement was successful in all patients. Thirty patients received the device via IJV puncture, but 1 patient required conversion to SVPA. Twenty-six patients underwent SVPA for device placement, but 3 of these patients required conversion to IJVPA. Mean operation time was 34.3 min in IJVPA and 35.2 min in SVPA. The success rate was 96.6% in IJVPA and 88.5% in SVPA. No severe perioperative complications were observed. However, long-term complications were observed in five cases, 3 by IJVPA and 2 by SVPA, but no significant difference in the rate of complications was observed between these two approaches. A catheter-related thrombosis was found by CT scan in 3 patients, two of whom underwent IJVPA (6.7%) and one case underwent SVPA (3.8%). Two patients received simultaneous administration of bevacizumab. Catheter infections occurred in 1 patient who underwent IJVPA (3.3%) and 1 patient who underwent SVPA (3.8%). Conclusions: The IJVPA is a safe and feasible method for TIVAD placement.展开更多
With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an incr...With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.展开更多
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 inse...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.展开更多
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 infecti...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.展开更多
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 ...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.展开更多
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 b...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.展开更多
目的:探讨结直肠癌病人完全植入式静脉输液港护理维护学习曲线,为即将开展此项护理维护的同行提供参考和借鉴。方法:采用累积和分析法(cumulative sum analysis, CUSUM)对福建医科大学附属漳州市医院结直肠病区2023年2月1日-4月20日连...目的:探讨结直肠癌病人完全植入式静脉输液港护理维护学习曲线,为即将开展此项护理维护的同行提供参考和借鉴。方法:采用累积和分析法(cumulative sum analysis, CUSUM)对福建医科大学附属漳州市医院结直肠病区2023年2月1日-4月20日连续维护结直肠癌化疗病人输液港(PORT)的护理维护学习曲线进行分析,由同一名护士独立完成输液港护理维护全部操作,该护士参与研究前未曾独立完成该操作。结果:84例接受连续维护的结直肠癌病人被纳入分析。护士操作时间为15.0~25.0 min,平均17.8 min,操作时间随操作例数的积累呈整体下降趋势。学习曲线最佳拟合为三次方曲线,即CUSUM(n)=0.000 47n3-0.081n2+3.372n+10.656(n为操作例数),R2=0.956。拟合曲线在操作例数累积至第27例时达到顶点,以此为分界将学习曲线划分为学习提高阶段和熟练掌握阶段。过渡到熟练掌握阶段后,护士操作时间明显缩短[由(19.8±2.6)min缩短至(16.8±1.1)min,P<0.001]。两阶段均顺利完成维护操作,均无发生输液港堵管,无红肿热痛局部感染症状,无重度疼痛等症状。熟练掌握阶段操作过程违反无菌原则例数、病人满意度明显优于学习提高阶段(均P<0.05)。学习提高阶段出现1例渗血、渗液,发生在学习提高阶段第2例,熟练掌握阶段未发生该类事件。结论:通过CUSUM分析法明确了积累27例输液港护理维护经验后可熟练掌握该项操作,为即将开展此项操作的同行提供参考和借鉴。展开更多
文摘Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are generally placed in position by the percutaneous subclavian vein puncture approach (SVPA). However, this approach causes infrequent intraoperative or postoperative complications. Using the internal jugular vein puncture approach (IJVPA), TIVADs could be placed more easily and safely. Materials and Methods: Fifty-six patients who received TIVADs for chemotherapy of colorectal carcinomas were enrolled in this study. The choice of approach (IJVPA or SVPA) was adopted at the discretion of each doctor in charge of the patient. The operation time, success rate and complications of the two approaches were compared and evaluated. Results: TIVAD placement was successful in all patients. Thirty patients received the device via IJV puncture, but 1 patient required conversion to SVPA. Twenty-six patients underwent SVPA for device placement, but 3 of these patients required conversion to IJVPA. Mean operation time was 34.3 min in IJVPA and 35.2 min in SVPA. The success rate was 96.6% in IJVPA and 88.5% in SVPA. No severe perioperative complications were observed. However, long-term complications were observed in five cases, 3 by IJVPA and 2 by SVPA, but no significant difference in the rate of complications was observed between these two approaches. A catheter-related thrombosis was found by CT scan in 3 patients, two of whom underwent IJVPA (6.7%) and one case underwent SVPA (3.8%). Two patients received simultaneous administration of bevacizumab. Catheter infections occurred in 1 patient who underwent IJVPA (3.3%) and 1 patient who underwent SVPA (3.8%). Conclusions: The IJVPA is a safe and feasible method for TIVAD placement.
文摘With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.
基金the National Natural Science Foundation of China,No.815729311.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC18034。
文摘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.
基金Supported by Program of B.Braun Medical,No.CN-0486-AECVSE2019169Program of Military Medicine for Youth,No.QNF19055.
文摘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.
文摘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.
文摘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.
