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A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital
Ryhov County Hospital, Sweden .
Linköpings universitet, Institutionen för medicin och hälsa, Thoraxkirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
Ryhov County Hospital, Sweden .
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Infektionsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Infektionskliniken i Östergötland.
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2013 (Engelska)Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, nr 5, s. 893-901Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background. Reliable central vein access is a fundamental issue in modern advanced oncological care. The aim of this study was to determine the incidence of complications and patient perception regarding central vein access ports. Methods. We prospectively studied 249 single lumen access ports implanted between 1 July 2008 and 15 March 2010 in a mixed patient population at a 500-bed secondary level hospital in Sweden. We determined the number of catheter days, infection rate and mechanical complications, as well as patient satisfaction regarding the access port, over a six-month follow-up period. Results. Two hundred and forty-four different patients received 249 ports yielding a total of 37 763 catheter days. Ultrasound and fluoroscopic guidance was used in 98% of procedures. Vein access was obtained percutanously by an anaesthesiologist in all cases. There was no case of pneumo- or haemothorax. The incidence of catheter-related bloodstream infection, was 0.05/1000 catheter days and the incidence of pocket/tunnel infection was 0.39/1000 catheter days. Clinically apparent deep vein thrombosis occurred in four patients (1.6%). Patient satisfaction was overall high. Conclusion. These results confirm that our team-based approach with written easily accessible evidence-based guidelines and a structured education programme leads to a very low complication rate and a high degree of patient satisfaction.

Ort, förlag, år, upplaga, sidor
Informa Healthcare , 2013. Vol. 52, nr 5, s. 893-901
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-93959DOI: 10.3109/0284186X.2013.770601ISI: 000318655300003OAI: oai:DiVA.org:liu-93959DiVA, id: diva2:628291
Anmärkning

Funding Agencies|Futurum - the Academy for Healthcare, Jonkoping County Council, Jonkoping, Sweden||

Tillgänglig från: 2013-06-13 Skapad: 2013-06-13 Senast uppdaterad: 2019-07-23
Ingår i avhandling
1. Vascular access in cancer patients – clinical implications
Öppna denna publikation i ny flik eller fönster >>Vascular access in cancer patients – clinical implications
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Central venous catheters (CVC) are vital for patients receiving chemotherapy not compatible with peripheral infusion. Thousands of centrally and peripherally inserted central venous catheters are inserted into patients with cancer each year. All types of intravascular catheters are associated with complications. These complications may be divided into infectious, thrombotic, mechanical and occlusive events. All of these events have the potential to harm patients and cause additional expense for the health-care system. Furthermore, the above-mentioned complications are largely avoidable through proper patient selection, insertion technique, hygiene precautions and catheter maintenance.

Catheter-related infections and deep venous thrombosis are the two most common and feared CVC related complications. Infection in a catheter can cause lifethreatening bacteraemia, and thrombosis can lead to pulmonary embolisation, post-thrombotic syndrome and stenosis of the vessel affected. Many studies describing methods to minimise infectious complications associated with central venous catheters have been carried out. These methods appear to have been implemented in most modern advanced healthcare facilities resulting in a continual decrease in catheter-related infections over the last two decades. New implantation techniques, fewer infections and better catheter materials are likely to have contributed to the reduction in the incidence of catheter-related deep venous thrombosis (CR-DVT). Peripherally inserted central venous catheters (PICC) and subcutaneously implanted vascular access ports (PORT) are two very commonly used catheter devices for delivery of chemotherapy. International guidelines are unclear as to which device to choose due to the paucity of controlled trials.

The aim of this thesis was to study complications related to central venous access devices used over long periods of time, usually for the delivery of chemotherapy. Vascular access in cancer patients – clinical implications We prospectively studied PORT complications (Study 1) over a six-month follow- up period. In Study 2, we assessed the number of common CVC-related micro- organisms that are transferred across PORT membrane contaminated by a controlled suspension of micro-organisms when a non-coring access needle is inserted using two different techniques. In the largest randomised controlled trial published on this topic (Study 3), we compared PICC with PORT regarding CRDVT and other catheter-related complications. The economic implications of using PICC or PORT were assessed from health-care system´s perspective (Study 4), using data on adverse events and clinical factors (implantation, treatments and dwell-time) from Study 3.

Chemotherapy against various forms of cancer is very common. Implantation of PORT is one of the ten most common surgical procedures in Sweden according to the Swedish Perioperative Register. Hence, the topic in this thesis may be clinically relevant to many patients and their health care providers.

We found that the incidence of catheter-related blood stream infection was very low in the cohorts studied. In general, PICCs are associated with significantly more CR-DVTs and adverse events than PORTs. The cost to the health-care system when using PICC is higher than for PORT when complications are included. Given the choice, patients about to commence chemotherapy appear to prefer PORT to PICC. PORT implantation is more painful than PICC insertion, but PICC appears to influence activities of daily life more than PORT.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2019. s. 99
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1693
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:liu:diva-159085 (URN)10.3384/diss.diva-159085 (DOI)9789176850220 (ISBN)
Disputation
2019-09-06, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-07-23 Skapad: 2019-07-23 Senast uppdaterad: 2019-08-01Bibliografiskt granskad

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