Görüntüleme eşliğinde takılan port kateterlerinin komplikasyonları ve komplikasyonlara etki eden faktörler

Yıl 2024, Cilt: 17 Sayı: 2, 303 - 312, 01.04.2024

Muhammed Tekinhatun Muhammet Arslan Halil Serdar Aslan Hüseyin Gökhan Yavaş Mahmut Demirci Başak Ünver Koluman Kadirhan Alver

https://doi.org/10.31362/patd.1368908

Öz

Amaç: Bu araştırma, Görüntüleme Destekli Port Kateterler (IAPC'ler) ile ilişkili komplikasyonları araştırarak, bunların kullanımında yer alan sağlık çalışanlarına öngörü sağlamaktadır. Çalışma, hasta güvenliğini optimize etmeyi, önleyici stratejiler uygulamayı ve IAPC'lerin klinik kullanımında kanıta dayalı karar verme sürecine rehberlik etmeyi amaçlamaktadır.
Gereç ve yöntem: Girişimsel Radyoloji Ünitesinde 01.09.2012-01.09.2020 tarihleri arasında IAPC yerleştirilen 1247 hastayı içeren retrospektif bir çalışma yapıldı. Port yerleştirme endikasyonları, komplikasyonlar, portun kalış süresi ve eksplantasyon nedenleri dahil olmak üzere veriler elektronik tıbbi kayıtlardan elde edildi. Cerrahi olarak implante edilen portlarla karşılaştırmalı analiz yapıldı ve görüntüleme kılavuzluğunda port implantasyonunun etkinliği ve güvenliği değerlendirildi.
Bulgular: Çalışmada ağırlıklı olarak sağ internal juguler ven yerleştirildi (%93,8). Portun 7 ila 1330 günlük kullanımı sırasında majör komplikasyon görülmedi. Ortalama kullanım süresi 243 gün ve toplam 310.503 kateter günü idi. En sık enfeksiyöz komplikasyonlar (%4,8) görülmüş olup hematolojik malignitelerde anlamlı derecede yüksektir (%13,9). Çok değişkenli analiz hematolojik malignite hastalarında komplikasyon oranının önemli ölçüde arttığını ortaya koymuştur (p<0,001).
Sonuç: Araştırma, IAPC kullanımında genel komplikasyon insidansının %8,6 olduğunu ve hematolojik malignitenin önemli bir bağımsız risk faktörü olarak tanımlandığını ortaya koymaktadır. Her 1000 kateter günü başına düşen düşük komplikasyon oranı (0,36), görüntü rehberliği ve prosedürel uzmanlığın faydalarını vurgulayan son çalışmalarla uyumludur. Özellikle hematolojik malignite hastalarında görülen enfeksiyöz komplikasyonlar, uzun süreli intravenöz erişim için IAPC yönetimini iyileştirmeye yönelik daha fazla araştırma yapılması gerektiğinin altını çizmektedir. Bu çalışma, hastaların yararına IAPC yönetimini ilerletmek için devam eden çabaları vurgulayarak, bu alanda çalışan sağlık profesyonelleri için önemli bilgiler sunmaktadır.

Anahtar Kelimeler

Kanser tedavisi, kateterizasyon, komplikasyon, tamamen implante edilebilir port kateter, ultrason rehberliği

Complications of imaging-assisted port catheters and factors affecting complications

Öz

Purpose: This research investigates complications associated with Imaging-Assisted Port Catheters (IAPCs) to provide insights for healthcare professionals involved in their usage. The study aims to optimize patient safety, implement preventive strategies, and guide evidence-based decision-making in the clinical use of IAPCs.
Materials and methods: A retrospective study comprising 1247 patients who underwent IAPC placement in the Interventional Radiology Unit between 01.09.2012-01.09.2020 was conducted. Data, including indications for port placement, complications, duration of port stay, and reasons for explantation, were extracted from electronic medical records. Comparative analysis with surgically implanted ports was performed, and the efficacy and safety of imaging-guided port implantation were assessed.
Results: The study predominantly involved right internal jugular vein placement (93.8%). Major complications did not occur during the 7 to 1330 days of port usage. The average usage period was 243 days, totaling 310,503 catheter-days. Infectious complications were the most common (4.8%), significantly higher (13.9%) in hematological malignancies. Multivariate analysis revealed a significantly increased complication rate in hematological malignancy patients (p<0.001).
Conclusion: The research reveals an 8.6% overall incidence of complications in IAPC usage, with hematologic malignancy identified as a significant independent risk factor. The low complication rate per 1000 catheter days (0.36) aligns with recent studies, emphasizing the benefits of image guidance and procedural expertise. Notably, infectious complications, especially in hematologic malignancy patients, underscore the need for further research to refine IAPC management for long-term intravenous access. The study contributes essential insights for healthcare professionals involved in the field, emphasizing ongoing efforts in advancing IAPC management for the benefit of patients.

Anahtar Kelimeler

Cancer treatment, catheterization, complication, totally implantable access port, ultrasound guidance

Etik Beyan

Ethics committee approval: Ethics Committee approval from Pamukkale University Medical Ethics Committee (10.12.2020/60116787-020/73335)) were obtained.

Destekleyen Kurum

none

Teşekkür

none

Kaynakça

• 1. Krupski G, Fröschle GW, Weh FJ, Schlosser GA. Central venous access devices in treatment of patients with malignant tumors: venous port, central venous catheter and Hickman catheter. Cost-benefit analysis based on a critical review of the literature, personal experiences with 135 port implantations and patient attitude. Chirurg 1995;66:202-207.
• 2. Gonda SJ, Li R. Principles of subcutaneous port placement. Tech Vasc Interv Radiol 2011;14:198-203. https://doi.org/10.1053/j.tvir.2011.05.007
• 3. Morris SL, Jaques PF, Mauro MA. Radiology-assisted placement of implantable subcutaneous infusion ports for long-term venous access. Radiology 1992;184:149-151. https://doi.org/10.1148/radiology.184.1.1609072
• 4. Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol 2011;14:217-224. https://doi.org/10.1053/j.tvir.2011.05.003
• 5. Wang TY, Lee KD, Chen PT, et al. Incidence and risk factors for central venous access port-related infection in Chinese cancer patients. J Formos Med Assoc 2015;114:1055-1060. https://doi.org/10.1016/j.jfma.2015.06.013
• 6. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998;22:12-16. https://doi.org/10.1007/s002689900342
• 7. Lyon RD, Griggs KA, Johnson AM, Olsen JR. Long-term follow-up of upper extremity implanted venous access devices in oncology patients. J Vasc Interv Radiol 1999;10:463-471. https://doi.org/10.1016/s1051-0443(99)70066-7
• 8. Wolosker N, Yazbek G, Nishinari K, et al. Totally implantable venous catheters for chemotherapy: experience in 500 patients. Sao Paulo Med J 2004;122:147-151. https://doi.org/10.1590/s1516-31802004000400003
• 9. Samaras P, Dold S, Braun J, et al. Infectious port complications are more frequent in younger patients with hematologic malignancies than in solid tumor patients. Oncology 2008;74:237-244. https://doi.org/10.1159/000151393
• 10. Shim J, Seo TS, Song MG, et al. Incidence and risk factors of infectious complications related to implantable venous-access ports. Korean J Radiol 2014;15:494-500. https://doi.org/10.3348/kjr.2014.15.4.494
• 11. Nezami N, Xing M, Groenwald M, Silin D, Kokabi N, Latich I. Risk factors of infection and role of antibiotic prophylaxis in totally implantable venous access port placement: propensity score matching. Cardiovasc Intervent Radiol 2019;42:1302-1310. https://doi.org/10.1007/s00270-019-02255-0
• 12. Pandey N, Chittams JL, Trerotola SO. Outpatient placement of subcutaneous venous access ports reduces the rate of infection and dehiscence compared with inpatient placement. J Vasc Interv Radiol 2013;24:849-854. https://doi.org/10.1016/j.jvir.2013.02.012
• 13. Bos A, Ahmed O, Jilani D, Giger M, Funaki BS, Zangan SM. Dual-lumen chest port infection rates in patients with head and neck cancer. Cardiovasc Intervent Radiol 2015;38:651-656. https://doi.org/10.1007/s00270-014-0973-3
• 14. Bademler S, Üçüncü M, Yıldırım İ, Karanlık H. Risk factors for complications in cancer patients with totally implantable access ports: a retrospective study and review of the literature. J Int Med Res 2019;47:702-709. https://doi.org/10.1177/0300060518808167
• 15. Ji L, Yang J, Miao J, Shao Q, Cao Y, Li H. Infections related to totally implantable venous-access ports: long-term experience in one center. Cell Biochem Biophys 2015;72:235-240. https://doi.org/10.1007/s12013-014-0443-1
• 16. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-1171. https://doi.org/10.4065/81.9.1159
• 17. Seok JP, Kim YJ, Cho HM, Ryu HY, Hwang WJ, Sung TY. A retrospective clinical study: complications of totally implanted central venous access ports. Korean J Thorac Cardiovasc Surg 2014;47:26-31. https://doi.org/10.5090/kjtcs.2014.47.1.26
• 18. Nagasawa Y, Shimizu T, Sonoda H, et al. A comparison of outcomes and complications of totally implantable access port through the internal jugular vein versus the subclavian vein. Int Surg 2014;99:182-188. https://doi.org/10.9738/INTSURG-D-13-00185.1
• 19. Hourmozdi JJ, Markin A, Johnson B, Fleming PR, Miller JB. Routine chest radiography is not necessary after ultrasound-guided right internal jugular vein catheterization. Crit Care Med 2016;44:804-808. https://doi.org/10.1097/CCM.0000000000001737
• 20. Machat S, Eisenhuber E, Pfarl G, et al. Complications of central venous port systems: a pictorial review. Insights imaging 2019;10:86. https://doi.org/10.1186/s13244-019-0770-2
• 21. Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011;21:1224-1232. https://doi.org/10.1007/s00330-010-2045-7
• 22. Guan X, Yan H, Zhang J, Li Y, Zhou Y. Risk factors of infection of totally implantable venous access port: a retrospective study. J Vasc Access 2023;24:1340-1348. https://doi.org/10.1177/11297298221085230
• 23. Chang TC, Yen MH, Kiu KT. Incidence and risk factor for infection of totally implantable venous access port. Langenbeck's Arch Surg 2022;407:343-351. https://doi.org/10.1007/s00423-021-02328-0
• 24. Chen H, Yamane T, Haruyama T, et al. Predictors of central line-associated bloodstream infections in cancer patients undergoing chemotherapy through implanted venous access ports: a retrospective, observational study. Transl Cancer Res 2023;12:3538-3546. https://doi.org/10.21037/tcr-23-1217