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Long-term outcomes of totally implantable venous access devices

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Abstract

Purpose

Identifying risk factors for premature totally implantable venous access device (TIVAD) catheter removal is crucial; however, because of the diversity of study methodologies, there is no consensus on such factors. The objective of the present study was to identify such risk factors by applying a cohort design study with a long-term follow-up period.

Methods

For this cohort study, we selected cancer patients who had newly implanted TIVADs between July 2008 and December 2008. The follow-up period lasted until September 2012. Univariate analysis was performed for age, gender, cancer type, TIVAD brand, puncture site, sidedness of puncture, and catheter tip position. The hazard ratio (HR) of potential risk factors was calculated using the Cox proportional hazards regression model, and Kaplan–Meier curves were applied for catheter survival analysis.

Results

Our study consisted of 240 people, with 5 people lost to follow-up. The cumulative premature catheter removal rate of all TIVADs was 9.8%, with the most common reason for premature removal being port-associated blood stream infection (PABSI), which proved to be highest in patients with hematology cancer (27.8%) and upper gastrointestinal cancer (19.4%). Suboptimal tip position (HR 5.13, 95% confidence interval 1.73–15.21) was also a risk factor for premature removal, and it was correlated with symptomatic TIVAD occlusion (p = 0.0004).

Conclusions

PABSI was the most common reason for premature catheter removal, with a varied incidence rate between different cancer types. Suboptimal tip position was also a risk factor. Confirming the final tip position after implantation is crucial. Infection control is important for TIVAD care, especially in high-risk cancer patients.

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Acknowledgments

The authors acknowledge the statistical assistance provided by the Taiwan Clinical Trial Statistical Center, Training Center, and Pharmacogenomics Laboratory (founded by the National Research Program for Biopharmaceuticals (NRPB) at the Ministry of Science and Technology in Taiwan; MOST 104-2325-B-002-032), as well as the Department of Medical Research at National Taiwan University Hospital.

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Authors and Affiliations

  1. Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002

    Yi-Chia Wang, Pei-Lin Lin, Wei-Han Chou, Chih-Peng Lin & Chi-Hsiang Huang

  2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan

    Chih-Peng Lin

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  1. Yi-Chia Wang
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  2. Pei-Lin Lin
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Correspondence to Chi-Hsiang Huang.

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Wang, YC., Lin, PL., Chou, WH. et al. Long-term outcomes of totally implantable venous access devices. Support Care Cancer 25, 2049–2054 (2017). https://doi.org/10.1007/s00520-017-3592-0

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