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,an...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.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 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
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
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 rate...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.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
Objective To assess the efficacy and safety of dual ultrasound-guided(DUG)totally implantable venous access port(TIVAP)implantation(namely,using ultrasoundguided percutaneous puncture with transesophageal echocardiogr...Objective To assess the efficacy and safety of dual ultrasound-guided(DUG)totally implantable venous access port(TIVAP)implantation(namely,using ultrasoundguided percutaneous puncture with transesophageal echocardiography-guided catheterization)via the right internal jugular vein(IJV)in pediatric patients with cancer.Methods Fifty-five children with cancer requiring chemotherapy underwent DUG-TIVAP implantation via the right IJV.Clinical data were recorded,including the procedure success rate,first attempt success rate,and perioperative and postoperative complications.Results All 55 cases were successfully operated on.The first puncture success rate was 100%.The operation time was 22–41min,with a mean time of 30.8±5.5min.The mean TIVAP implantation time was 253±145 days(range 42–520 days).There were no perioperative complications.The postoperative complication rate was 5.4%(3/55),including skin infections around the port in one case,catheter-related infection in one case,and fibrin sheath formation in one case.The ports were all preserved after anti-infection or thrombolytic therapy.No unplanned port withdrawal was recorded in this study.Conclusions DUG-TIVAP implantation is a technique with a high success rate and a low complication rate;therefore,it provides an alternative for children with cancer.Further randomized controlled studies are needed to confirm the efficacy and safety of DUG-TIVAP via the right IJV in children.展开更多
文摘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.
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.
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.
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.
文摘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.
基金Chongqing Medical Scientific Research Project(Joint project of Chongqing Health Commission and Science and Technology Bureau)(2021MSXM073).
文摘Objective To assess the efficacy and safety of dual ultrasound-guided(DUG)totally implantable venous access port(TIVAP)implantation(namely,using ultrasoundguided percutaneous puncture with transesophageal echocardiography-guided catheterization)via the right internal jugular vein(IJV)in pediatric patients with cancer.Methods Fifty-five children with cancer requiring chemotherapy underwent DUG-TIVAP implantation via the right IJV.Clinical data were recorded,including the procedure success rate,first attempt success rate,and perioperative and postoperative complications.Results All 55 cases were successfully operated on.The first puncture success rate was 100%.The operation time was 22–41min,with a mean time of 30.8±5.5min.The mean TIVAP implantation time was 253±145 days(range 42–520 days).There were no perioperative complications.The postoperative complication rate was 5.4%(3/55),including skin infections around the port in one case,catheter-related infection in one case,and fibrin sheath formation in one case.The ports were all preserved after anti-infection or thrombolytic therapy.No unplanned port withdrawal was recorded in this study.Conclusions DUG-TIVAP implantation is a technique with a high success rate and a low complication rate;therefore,it provides an alternative for children with cancer.Further randomized controlled studies are needed to confirm the efficacy and safety of DUG-TIVAP via the right IJV in children.
