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- Title
Beyond Thrombolytics: Malposition and Venous Thrombosis Related Occlusions in Implanted PORTs.
- Authors
McDiarmid, Sheryl
- Abstract
Introduction Totally implanted venous access devices (PORTs) have been widely recognized as safe and convenient devices for use in patients on long term chemotherapy. However, the true incidence of symptomatic PORT related thromboembolism (VTE) in cancer patients is unclear, and there are very limited data on its associated risk factors. Materials and Methods We performed a retrospective cohort study of 400 cancer patients with a newly inserted implanted PORT for deliverance of chemotherapy. Thirty-four patients (8.5% [95% CI, 6.0%-11.7%]) had symptomatic VTE (16 DVTs, 16 PEs, and 2 with both). We further described these 34 patients with symptomatic VTE to determine if there were any clinical indicators that were unique to this group of patients that could have provided an early warning that these patients were at risk and could have possibly avoided a VTE. Results Of the 34 patients with VTE, the PORT tip was no longer in the distal superior vena cava in nine (26%) of the patients at the time the VTE was detected. Of those patients, seven had recurrent issues with blood withdrawal from the PORT requiring administration of thrombolytics that temporarily resolved the occlusion. Three patients developed VTE after their initial PORT was removed and a second one immediately re-implanted on the same side. Conclusion Persistent occlusions in PORTs should be thoroughly investigated. We have developed an algorithm that requires all occlusions to be reported to the vascular access team. On the second occurrence, the patient is referred to the team where a progressive evaluation including radiography, flow studies, thrombolytic infusion, and where indicated, device removal and reinsertion is done. This approach ensures early detection and correction of complications such as malposition and fibrin sheath formation that may predispose patients to VTE. This study also suggests that when PORTs require replacement, the risk for VTE may increase.
- Subjects
BLOOD vessels; CANCER chemotherapy; CATHETERIZATION; CATHETERIZATION complications; LONGITUDINAL method; MEDICAL equipment; THROMBOEMBOLISM; THROMBOLYTIC therapy; VEINS; RETROSPECTIVE studies
- Publication
Vascular Access, 2014, Vol 8, Issue 1, p23
- ISSN
1913-6692
- Publication type
Article