Totally implantable central venous catheters are widely used in the management of patients (pts) with malignant diseases in order to facilitate drug delivery for the new therapeutic protocols. These are based on continuous administration and higher doses of chemotherapeutic agents with relative phlebitis problems and supportive treatment. Staff of our department, specially trained on the routinely implant of central venous accesses were in charge of the procedure. The technique was carried out under local anesthesia in a special suite of day hospital, under strict aseptic measures without fluoroscopic control.
From Sep 94 to January 2017, 1665 devices (port-a-cath systems [PS]) were implanted in 1627 pts, with a median age of 50.5 yr (range 14-81), and median K.I. 70% (50-100), female 982/male 683. Venous access: right interior jugular 983, left subclavian 316, right subclavian 333, left interior jugular 33. A thorax X-ray was performed after each procedure and in 216 pts prophylactic antibiotics were given.
The venous access remained implanted a median of 438 days (1- +2210). Complications occurred in 266 placements (16%): Infections 116 (7%); deep venous thrombosis 66 (4%) obstruction 10 (0.6%); malpositioned 16 (2%); fractures/migration 28 (1.7%); pneumothorax 6 (0.32%); local skin necrosis 7 (0.6%). Five hundred and twenty devices were removed, three hundred and forty-seven (66%) after completing planned therapy and 173 (34%) due to complications [Infections (92), migration (22), malposition (12), venous thrombosis (26), obstruction (11) and skin necrosis (10)]. Cost-effectiveness of venous catheters in a non-surgical scenery compared to devices implanted by interventional vascular radiologists in operating room turned out to be 1000 euro cheaper for each device.
Our experience suggests that implant of vascular access devices by medical oncologist in a non-surgical scenery has similar or even less complications and is more cost effective with regard to radiology suite and operating room placement procedures.
Clinical trial identification
Legal entity responsible for the study
Emilio Esteban, Oncología Médica, Hospital Universitario Central de Asturias.
All authors have declared no conflicts of interest.