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Supportive Care in Cancer

, Volume 17, Issue 2, pp 137–143 | Cite as

Patients’ perceptions of having a central venous catheter or a totally implantable subcutaneous port system–results from a randomised study in acute leukaemia

  • Eva JohanssonEmail author
  • Per Engervall
  • Hjördis Björvell
  • Robert Hast
  • Magnus Björkholm
Original Article

Abstract

Goals of work

The selection process of type of central venous access device (CVAD) in patients with acute leukaemia (AL) is generally based on appropriate catheter capacity/function and risk of complications in relation to the planned length of therapy. Advantages and disadvantages of the CVAD from the patient’s perspective should also be important parts in the selection of type of device. Perceptions on having a CVAD were thus analysed in a series of adult patients with AL included in a prospective randomised study evaluating the use of a double lumen totally implantable subcutaneous port system (PORT) or a double lumen central venous catheter (CVC) regarding survival time and complication rate.

Materials and methods

Perceptions were registered in 32 patients (median age 68 years, range 24–83 years) on three occasions (T1; the day after placement, T2; 3 weeks after placement and T3 after 12 weeks and/or when the CVAD was removed) with the use of two study specific questionnaires.

Main results

Overall, many patients reported minor catheter related discomfort, feelings of anxiety and restrictions. Half of the patients (6/11) who experienced a local bleeding after CVAD insertion described the placement procedure as unpleasant. More patients in the CVC group compared with the PORT group stated that they thought of having a CVAD (T3; p = 0.02) and that the CVAD interfered when dressing themselves (T2; p = 0.02 and T3; 0.04) or taking a shower (T3; p = 0.009).

Conclusion

Our findings support the view that the PORT is less restrictive in daily life than the CVC.

Keywords

Central venous catheter Implantable subcutaneous port system Acute leukaemia Randomised Patient satisfaction 

Notes

Acknowledgements

This study was supported by grants from the Swedish Cancer Society, and the Stockholm County Council. The authors wish to thank Jan Jacobson, Peter Löthman, Rabbe Takolander, Per Olofsson, Lars Backman, Eddie Weitzberg, anaesthesiologists and surgeons, inserting CVADs in this study.

References

  1. 1.
    Biffi R, Corrado F, de Braud F et al (1997) Long-term, totally implantable central venous access ports connected to a Groshong catheter for chemotherapy of solid tumours: experience from 178 cases using a single type of device. Eur J Cancer 33:1190–1194PubMedCrossRefGoogle Scholar
  2. 2.
    Biffi R, Martinelli G, Pozzi S et al (1999) Totally implantable central venous access ports for high-dose chemotherapy administration and autologous stem cell transplantation: analysis of overall and septic complications in 68 cases using a single type of device. Bone Marrow Transplant 24:89–93PubMedCrossRefGoogle Scholar
  3. 3.
    Björkholm M, Liliemark J, Gahrton G et al (1995) Mitoxantrone, etoposide and ara-C vs doxorubicin-DNA, ara-C, thioguanine, vincristine and prednisolone in the treatment of patients with acute myelocytic leukaemiaA randomized comparison. Eur J Haematol 55:19–23PubMedCrossRefGoogle Scholar
  4. 4.
    Borst C, de Kruif A, van Dam F, de Graaf P (1992) Totally implantable venous access ports—the patients’ point of viewA quality control study. Cancer Nursing 15:378–381PubMedCrossRefGoogle Scholar
  5. 5.
    Carde P, Cosset-Delaigue M, Laplanche A, Chareau I (1989) Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumours. Eur J Cancer Clin Oncol 25:939–944PubMedCrossRefGoogle Scholar
  6. 6.
    Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE (1968) Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 64:134–142PubMedGoogle Scholar
  7. 7.
    Engervall P, Ringertz S, Hagman E et al (1995) Change of central venous catheter dressings twice a week is superior to once a week in patients with haematological malignancies. J Hosp Infect 29:275–286PubMedCrossRefGoogle Scholar
  8. 8.
    Goossens G, Vrebos M, Stas M et al (2005) Central vascular access devices in oncology and hematology considered from a different point of view: how do patients experience their vascular access ports? J Infus Nurs 28:61–67PubMedCrossRefGoogle Scholar
  9. 9.
    Groeger J, Lucas A, Thaler H et al (1993) Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med 119:1168–1174PubMedGoogle Scholar
  10. 10.
    Johansson E, Bjorkholm M, Bjorvell H et al (2004) Totally implantable subcutaneous port system versus central venous catheter placed before induction chemotherapy in patients with acute leukaemia—a randomized study. Support Care Cancer 12:99–105PubMedCrossRefGoogle Scholar
  11. 11.
    Kappers-Klunne M, Degener J, Stijnen T, Abels J (1989) Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection. Cancer 64:1747–1752PubMedCrossRefGoogle Scholar
  12. 12.
    Karthaus M, Doellmann T, Klimasch T et al (2002) Central venous catheter infections in patients with acute leukemia. Chemotherapy 48:154–157PubMedCrossRefGoogle Scholar
  13. 13.
    Keung Y-K, Watkins K, Chen S-C et al (1995) Increased incidence of central venous catheter-related infections in bone marrow transplant patients. Am J Clin Oncol 18:469–474PubMedCrossRefGoogle Scholar
  14. 14.
    Lilienberg A, Bengtsson M, Starkhammar H (1994) Implantable devices for venous access: nurses’and patients’ evaluation of three different port systems. J Adv Nurs 19:21–28PubMedCrossRefGoogle Scholar
  15. 15.
    Löfgren C, Paul C, Aström M et al (2004) Granulocyte-macrophage colony-stimulation factor to increase efficacy of mitoxantrone, etoposide and cytarabine in previously untreated elderly patients with acute myeloid leukaemia: a Swedish multicentre randomized trial. Br J Haematol 124:474–480PubMedCrossRefGoogle Scholar
  16. 16.
    Mermel L (2000) Prevention of Intravascular Catheter-Related Infections. Ann Intern Med 132:391–402PubMedGoogle Scholar
  17. 17.
    Moinpour CM, Sawyers Triplett J, McKnight B et al (2000) Challenges posed by non-random missing quality of life data in an advanced-stage colorectal cancer clinical trial. Psychooncology 9:340–354PubMedCrossRefGoogle Scholar
  18. 18.
    Mueller B, Skelton J, Callender D et al (1992) A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients. J Clin Oncol 10:1943–1948PubMedGoogle Scholar
  19. 19.
    O’Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infectionsCenters for Disease Control and Prevention. Morb Mort Wkly Rep Recomm Rep 51(RR-10):1–29Google Scholar
  20. 20.
    Platzbecker U, Illmer T, Schaich M et al (2001) Double lumen port access in patients receiving allogeneic blood stem cell transplantation. Bone Marrow Transplant 28:1067–1072PubMedCrossRefGoogle Scholar
  21. 21.
    Puntillo K, White C, Morris A et al (2001) Patients’ perceptions and responses to procedural pain: Results from thunder project II. Am J Crit Care 10:238–251PubMedGoogle Scholar
  22. 22.
    Raad II, Hohn DC, Gilbreath BJ et al (1994) Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 15(4 Pt 1):231–238PubMedCrossRefGoogle Scholar
  23. 23.
    Rodgers H, Liddle K, Nixon S et al (1998) Totally implantable venous access devices in cystic fibrosis: complications and patients’ opinions. Eur Respir J 12:217–220PubMedCrossRefGoogle Scholar
  24. 24.
    Sharpe PC, Morris TC (1994) Complications associated with central venous catheters in a haematology unit. Ulster Med J 63:144–150PubMedGoogle Scholar
  25. 25.
    Thompson A, Kidd E, McKenzie M et al (1989) Long term central venous access: the patient’s view. Intensive Ther Clin Monit 5:142–144Google Scholar
  26. 26.
    Wilson J, Grow J, Demong C et al (1962) Central venous pressure in optimal blood volume maintenance. Arch Surg 85:563–578PubMedGoogle Scholar
  27. 27.
    Wincent A, Liden Y, Arner S (2003) Pain questionnaires in the analysis of long lasting (chronic) pain conditions. Eur J Pain 7:311–321PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Eva Johansson
    • 1
    Email author
  • Per Engervall
    • 1
  • Hjördis Björvell
    • 2
  • Robert Hast
    • 1
  • Magnus Björkholm
    • 1
  1. 1.Department of Medicine, Division of Hematology, Karolinska University Hospital SolnaKarolinska InstitutetStockholmSweden
  2. 2.Karolinska InstitutetStockholmSweden

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