Four-Year Study on Subcutaneous Port Catheters in Oncology Patients: Patency, Complications, and Outcomes

Year 2024, Volume: 8 Issue: 3, 228 - 235, 30.12.2024

Asiye Aslı Gözüaçık Rüzgar , Hakan Öntaş

https://doi.org/10.30565/medalanya.1548606

Abstract

Aim: Our primary focus was port patency, postoperative complications, mortality rates, and demographic factors.

Methods: In this extensive four-year study, we examined subcutaneous port catheter placement in 172 oncology patients (111 men, 61 women) between March 2018 and December 2021. We excluded one 10-month-old infant who received a pediatric port catheter.

Results: Patients predominantly underwent jugular intervention via the right internal jugular vein (97%) and occasionally via the left internal jugular vein (3%). On average, the port patency lasted for 375 days, with an overall duration of 432 days. Males had a mean patency of 13.58 months, while females averaged 11.97 months. Notably, bladder cancer patients had the longest port patency (44 months), followed by uterine cancer (35 months) and breast cancer (22.5 months). Among the 171 patients, nine had mild to moderate infections, six had mild ecchymosis-hematoma, and two required early catheter removal due to severe infections. Only one patient had mild pneumothorax that did not necessitate surgery. No major complications, such as hemothorax, nerve injury, neck compression, massive hematoma, blood transfusion, substantial bleeding, port detachment, rupture, or fragment embolism were recorded.

Conclusion: Subcutaneous port catheter placement proved to be safe and effective for patients undergoing chemotherapy, particularly with skilled surgical teams. Procedures via the right internal jugular vein consistently yielded favorable outcomes, with low infection rates, minimal occlusion, stenosis, thrombosis, and complication rates, while maintaining extended port patency. This study underscores the substantial improvement in oncology patients' quality of life by eliminating the challenges associated with frequent peripheral vessel access.

Keywords

Port catheter, Complications, Intravenous Chemotherapy, Malignancy, Internal Jugular Vein

Onkoloji Hastalarında Subkutan Port Kateterler Üzerine Dört Yıllık Çalışma: Açıklık, Komplikasyonlar ve Sonuçlar

Abstract

Amaç: Öncelikli odak noktamız port açıklığı, postoperatif komplikasyonlar, mortalite oranları ve demografik faktörlerdi.

Yöntem: Bu dört yıllık kapsamlı çalışmada, Mart 2018 ve Aralık 2021 tarihleri arasında 172 onkoloji hastasında (111 erkek, 61 kadın) subkutan port kateter yerleştirilmesini inceledik. Pediatrik port kateteri takılan 10 aylık bir bebek hariç tutulmuştur.

Bulgular: Hastalara ağırlıklı olarak sağ internal juguler venden (%97) ve nadiren soldan (%3) juguler girişim uygulandı. Ortalama olarak, port açıklığı 375 gün sürmüş ve toplam süre 432 gün olmuştur. Erkeklerde ortalama açık kalma süresi 13,58 ay iken, kadınlarda ortalama 11,97 aydır. Özellikle, mesane kanseri hastaları en uzun port açıklığına (44 ay) sahipken, bunu rahim kanseri (35 ay) ve meme kanseri (22,5 ay) takip etmiştir. 171 hastanın dokuzunda hafif ila orta derecede enfeksiyon, altısında hafif ekimoz-hematom ve ikisinde ciddi enfeksiyon nedeniyle kateterin erken çıkarılması gerekmiştir. Sadece bir hastada ameliyat gerektirmeyen hafif bir pnömotoraks görülmüştür. Hemotoraks, sinir yaralanması, boyun sıkışması, masif hematom, kan transfüzyonu, ciddi kanama, port ayrılması, rüptür veya fragman embolisi gibi majör komplikasyonlar kaydedilmedi.

Sonuç: Subkütan port kateter yerleştirme işleminin kemoterapi hastaları için, özellikle de deneyimli cerrahi ekiplerle, güvenli ve etkili olduğu kanıtlanmıştır. Sağ internal juguler ven yoluyla yapılan prosedürler, düşük enfeksiyon oranları, minimal oklüzyon, stenoz, tromboz ve komplikasyon oranları ile sürekli olarak olumlu sonuçlar verirken, uzun süreli port açıklığını da korumuştur. Bu araştırma, sık periferik damar erişimiyle ilişkili zorlukları ortadan kaldırarak onkoloji hastalarının yaşam kalitesindeki önemli iyileşmenin altını çizmektedir.

Keywords

Port Katater, Komplikasyonlar, İntravenöz Kemoterapi, Malignite, Internal Juguler Ven

References

• 1. Kelseka E, Güldoğuş F. Retrospective Evaluation of Our Vascular Port Implantations. UHOD, 2005;15(4):195-8.
• 2. Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982;92(4):706-12. PMID: 7123491.
• 3. Schwarz RE, Groeger JS, Coit DG. Subcutaneously implanted central venous access devices in cancer patients: a prospective analysis. Cancer. 1997;79(8):1635-40. PMID: 9118051.
• 4. Wang K, Zhou Y, Huang N, Lu Z, Zhang X. Peripherally inserted central catheter versus totally implanted venous port for delivering medium- to long-term chemotherapy: A cost-effectiveness analysis based on propensity score matching. J Vasc Access. 2022;23(3):365-74. doi: 10.1177/1129729821991360.
• 5. Ballarini C, Intra M, Pisani Ceretti A, Cordovana A, Pagani M, Farina G, et al. Complications of subcutaneous infusion port in the general oncology population. Oncology. 1999;56(2):97-102. doi: 10.1159/000011947.
• 6. Samancı T, Mandel NM, Bozkurt AK, Kutlu F, Uras C. Evaluation of port complications in 115 cancer patients. Cerrahpaşa J Med. 2004;35(2):71-7.
• 7. Bayrak S, Gunes T, Ozcem B, Gokalp O, Yurekli I, Yazman S, et al. Port catheter implantation under scopy in hybrid operation rooms. Turk Gogus Kalp Dama 2012;20:275-80. doi: 10.5606/tgkdc.dergisi.2012.052.
• 8. Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med. 2005;33(1):13-20; discussion 234-5. doi: 10.1097/01.ccm.0000149838.47048.60.
• 9. Ignatov A, Hoffman O, Smith B, Fahlke J, Peters B, Bischoff J, et al. An 11-year retrospective study of totally implanted central venous access ports: complications and patient satisfaction. Eur J Surg Oncol. 2009;35(3):241-6. doi: 10.1016/j.ejso.2008.01.020.
• 10. Madabhavi I, Patel A, Sarkar M, Anand A, Panchal H, Parikh S. A Study of Use of "PORT" Catheter in Patients with Cancer: A Single-Center Experience. Clin Med Insights Oncol. 2017;11:1179554917691031. doi: 10.1177/1179554917691031.
• 11. Bertoglio S, Annetta MG, Brescia F, Emoli A, Fabiani F, Fino M, et al. A multicenter retrospective study on 4480 implanted PICC-ports: A GAVeCeLT project. J Vasc Access. 2022:11297298211067683. doi: 10.1177/11297298211067683.
• 12. Schaal NK, Brückner J, Wolf OT, Ruckhäberle E, Fehm T, Hepp P. The effects of a music intervention during port catheter placement on anxiety and stress. Sci Rep. 2021;11(1):5807. doi: 10.1038/s41598-021-85139-z.
• 13. Zengin S, Kabul S, Al B, Sarcan E, Doğan M, Yildirim C. Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure. Complement Ther Med. 2013;21(6):689-96. doi: 10.1016/j.ctim.2013.08.017.
• 14. Ignatov A, Ignatov T, Taran A, Smith B, Costa SD, Bischoff J. Interval between port catheter flushing can be extended to four months. Gynecol Obstet Invest. 2010;70(2):91-4. doi: 10.1159/000294919.
• 15. Goyal N, Kamal M, Paliwal B, Kumar R. Migration of chemoport catheter to the right ventricle: A catastrophic rare complication. Saudi J Anaesth. 2022;16(1):124-5. doi: 10.4103/sja.sja_460_21.
• 16. Krupski G, Fröschle GW, Weh FJ, Schlosser GA. Zentralvenöse Zugangsysteme in der Behandlung von Malignompatienten: Venöser Port, ZVK und Hickman-Katheter. Kosten-Nutzen-Analyse anhand einer kritischen Literaturübersicht, eigener Erfahrungen aus 135 Port-Implantationen und aus Patientensicht [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(3):202-7. German. PMID: 7750390.
• 17. Beypınar İ, Demir H, Araz M, Beypınar D, Uysal M. The Comparison of Central Venous Port Catheters in Gastrointestinal Cancer Treatment. J Oncol Sci. 2020;6(1):10-4. doi:10.37047/jos.2019-73122.