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Chest ports placed in oncologic patients with a history of prior port removal: is there any increased risk for complications?
JVIR
’
Scientific Session
Wednesday
and gram negative organisms, and each patient received optimized antibiotic therapy based upon cultures and sensitivities. Of the patients with proven bacteremia who underwent an over-the-wire exchange, 6% (n ¼ 5) developed recurrent bacteremia with the same culture-proven organism within 3 months of the exchange compared to 11% (n ¼ 11) of patients who underwent catheter removal with or without replacement after line holiday (P ¼ 0.28). Conclusions: Reinfection rates after over-the-wire tunneled catheter exchanges were lower than in those patients who underwent catheter removal and line holidays despite similar causative organisms and appropriate antibiotic therapy. In the setting of suspected line infection, catheter exchange is as effective as removal for a line holiday.
’
S197
PICC-associated VT was the highest with DL catheter because it was the most used catheter. We should be more conservative when choosing the right number of lumens for the PICC that the patient will have for their long term IV therapy and avoid the consequences of PICC-associated VT. References 1. Evans RS, Sharp JH, Linford LH, Lloyd JF, Woller SC, et al. Reduction of peripherally inserted central catheter-associated DVT. Chest 2013; 143 (3):627–633. PubMed PMID: 22878346. 2. Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 2010 Oct; 138(4):803–810. PubMed PMID: 20923799. 3. O’Brien J, Paquet F, Lindsay R, Valenti D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol 2013; 10(11):864–868. PubMed PMID: 24075218.
Reference 1. Tanriover, Bekir, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney International 2000; 57(5): 2151–2155.
8:27 AM
Abstract No. 439
Size matters, reducing peripherally inserted central venous access associated thrombosis F. Kang, K. Wheeler, R. Ryu, D. Johnson; University of Colorado Denver, Aurora, CO.
Abstract No. 440
Chest ports placed in oncologic patients with a history of prior port removal: is there any increased risk for complications? G. Stewart1, K. Kobayashi1, P. Skummer1, J. Patel1, M. Faridnia2, M. Jawed1, D. Zhang3, C. Mendenhall4, M. Karmel5; 1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University, Baldwinsville, NY; 3SUNY Upstate Medical University, Indianapolis, IN; 4SUNY Upstate Medical University, Manlius, NY; 5Upstate Medical University, Syracuse, NY. Purpose: Patients with cancer (oncologic patients) with a history of prior chest port (port) removal may need another port for various reasons including continuation of chemotherapy after port-related complications, recurrent disease, or new cancer. We retrospectively investigated the incidences of port-related complications in oncologic patients with a history of prior port removal and to compare those without the history. Materials: Between January 1, 2012 and May 30, 2014, 832 ports were placed in 809 oncologic patients (M/F: 420/389, mean age: 57). 60 ports had a history of prior port removal (port removal group) and 772 ports were placed for the first time (primary port group). The reasons of prior port removal were completion of prior treatment (n¼17, non-complication group) and complications (n¼43, complication group). The medical records and imaging studies were reviewed to identify port-related complications requiring treatment or port removal. Complications were classified as 1) (local or blood stream) infection, 2) mechanical (such as catheter malpositioning), 3) thrombotic, and 4) port site skin issues (such as erosion). SPSS was used for statistical analyses. Results: 17 ports (27.4%) in port removal group and 95 ports (11.6%) in primary port group were associated with complications (Po0.05). Incidence of infection (10/60 vs 59/772, P o0.05) and that of mechanical complications (4/60 vs 15/772, Po0.05) were significantly higher in port removal group. Incidence of thrombotic complications (3/60 vs 18/772, P¼0.24) and that of port site skin issues (2/60 vs 8/772, P¼0.12) were not significantly different between the two groups. Among port removal group, incidence of complications in complication group were not statistically different from that in non-complication group (5/17 vs 12/43, P¼0.572).
WEDNESDAY: Scientific Sessions
Purpose: Peripherally inserted central catheter (PICC) has become the main modality for the long term intravenous (IV) therapy, and as its popularity increased, so has the PICCassociated venous thrombosis (VT). Often double lumen (DL) or triple lumen (TL) catheters are requested for the ease of IV access despite single lumen (SL) catheter may be sufficient for the patients’ long term IV therapy. During the review of our institutional rate of PICC-associated VT, we noticed an unusually high number of PICC –associated VT in DL catheters. As the number of lumens for PICC may pose as the most modifiable risk for PICC-associated VT, this study was aimed at the difference in the rate of PICC-associated VT among SL, DL, and TL catheters. Materials: We conducted a 2-year retrospective cohort study of all PICC insertion by a certified designated PICC team using highly replicable approach at our institution, which is a 593bed, level I trauma and tertiary referral hospital from 2013 to 2014. During this period, PICC insertions were done with either SL, DL, or TL catheters based on the request from the primary healthcare team, and any patients with PICC insertion who were symptomatic for upper extremity VT were evaluated with Doppler ultrasound for the presence of PICC-associated VT. Results: We identified a total of 5818 UE PICC insertions during the 24-month period. PICC-associated VTs were detected in 41 of 1346 (3.0%) SL catheters, 169 of 3114 (5.4%) DL catheters and 112 of 1358 (8.2%) TL catheters (X2 P o 0.00001). When the rate of PICC-associated VT for TL catheter was compared directly against DL and SL catheters, the rate was significantly higher (P o 0.001, P o 0.00000001), and the rate for DL catheter compared directly to the rate for SL catheter was significantly higher (P o 0.001) as well. Conclusions: TL catheter had the highest rate of PICCassociated VT followed by DL catheter. The number of
8:36 AM
S198
’
Wednesday
Scientific Session
Conclusions: Chest ports placed in oncologic patients with a history of prior port removal, regardless of the reason of the prior removal, were at a statistically higher risk of complications, especially infection and mechanical ones.
8:45 AM
Abstract No. 441
Are routine labs necessary prior to tunneled dialysis catheter placement?
WEDNESDAY: Scientific Sessions
J. Konrad1, G. Dubel2, S. Ahn3; 1Brown University, Providence, RI; 2Barrington, RI; 3Rumford, RI. Purpose: To examine the utility of pre-procedural labs in patients undergoing tunneled hemodialysis catheter placement. Materials: In this HIPAA compliant IRB approved study, a retrospective review of tunneled 15F hemodialysis catheter placement during a two-year period at a tertiary academic medical center was performed. Electronic medical record (EMR) review included platelet count, international normalized ratio (INR), past medical history, anticoagulation status, transfusion requirement, and post-procedural hemorrhagic complications. Results: A total of 541 tunneled dialysis catheters placements were available for review. Average patient age was 67 years (range 12-92). Ninety percent of catheter placements were placed via the right jugular vein and 10% via the left internal jugular vein. 419/541 and 444/541 had coagulation profile and platelet count, respectively within 30 days prior to the procedure. Overall, 96% (402/419) of patients had an INR less than or equal to 1.8 and 99% (440/444) had a platelet count 450K. Of the 17 patients with INR 41.8, 15/17 (88%) and of the 4 patients with platelet count o50K, 3/4 (75%) had history of multi-organ failure, pre-existing hematological dysfunction, or Coumadin therapy. In the absence of above risk factors, the INR was o¼ 1.8 in 99.5% (417/419) and platelet counts was 450K in 99.8% (443/444). Overall, there was a 0.4% (2/541) hemorrhagic complications rate requiring either blood products or additional management. Conclusions: Overall hemorrhagic complications are rare in neck tunneled catheter placement. Routine INR and platelet count is not necessary in the absence of multi-organ failure, known hematological disorder, or Coumadin therapy.
’
JVIR
due to the bulk of the implanted port, the incision may be subjected to higher levels of skin tension in the upper chest and thus higher risk of dehiscence, infection, and worse scarring. Therefore, the purpose of this study was to compare outcomes of skin closure with octylcyanoacrylate versus the gold standard method of subcuticular suture closure. Materials: Patients scheduled to undergo single-lumen implantable venous port insertion for chemotherapy were evaluated for study enrollment. Following port implantation, if there was reasonable incision apposition after suture of the deep fascia, patients were randomized to skin closure with either octylcyanoacrylate or absorbable subcuticular suture. Subjects were followed for episodes of infection or dehiscence for 3 months. At 3 months, a photograph of the healed incision was obtained and reviewed by a blinded plastic surgeon who rated the scar appearance based on a validated 10-point cosmesis score. Results: Of 109 subjects (28 males, 81 females, mean age 58.6) undergoing venous port implantation, 54 were randomized to skin adhesive and 55 to subcuticular suture. There were no significant differences in demographics between groups. No patients had incision dehiscence. Infection rates were similar between groups (5.6% vs 1.8%, p¼0.36). The mean cosmesis scores were 4.40 for skin adhesive and 4.46 for subcuticular suture, p¼0.898. The procedural time was 8.6 minutes for suture versus 1.4 minutes for skin adhesive, p o 0.001). Skin adhesive was purchased at $25.92 per unit, whereas the suture material was purchased at $2.54 per unit. Conclusions: Patient outcomes and scar cosmesis results did not significantly vary between skin adhesive versus subcuticular suture. When factoring in cost of material, operator time, and IR suite time, skin adhesive may be more cost effective.
9:03 AM
Abstract No. 443
Outcomes of a percutaneous technique for shortening of totally implanted chest port catheters C. Duncan1, S. Trerotola2; 1Hospital of the University of Pennsylvania, Penn Image-Guided Interventions Lab, Philadelphia, PA; 2University of Pennsylvania Medical Center, Philadelphia, PA.
Reference 1. Patel I, Davidson J. et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. JVIR 2012.
8:54 AM
Abstract No. 442
Randomized controlled trial of skin adhesive versus subcuticular suture for skin closure after implantable venous port placement J. Martin1, S. Hollenbeck1, R. Makar2, W. Pabon-Ramos3, P. Suhocki3, M. Miller3, D. Sopko3, T. Smith3, C. Kim4; 1 Duke University, Durham, NC; 2United States; 3Duke University Medical Center, Durham, NC; 4Raleigh, NC. Purpose: Cancer patients undergoing implantable venous port placement may be predisposed to impaired wound healing due to chemotherapy and tumor-related cachexia. Furthermore,
Purpose: Chest ports are commonly used in the setting of malignancy. Port catheters that are too long either due to initial misplacement or by virtue of weight loss and subsequent inward migration may threaten the patient’s safety by causing arrhythmia or other complications. Too-long port catheters are typically removed or revised; the subcutaneous position of port reservoirs precludes standard over the wire exchange techniques. The outcomes of a percutaneous port catheter shortening technique which obviates incision were reviewed. Materials: Retrospective review was performed of 36 patients (25F:11M) who underwent percutaneous port catheter shortening between 8/1/2005 and 8/1/2015. The technique involves jugular puncture, snaring and delivery of the catheter through a sheath, catheter shortening and replacement back through the sheath. 38 procedures were performed on 37 different ports. Mean patient age was 50 years (range 26-77). Median follow-up was 19 months (range 2–107).
’
Scientific Session
Wednesday
and gram negative organisms, and each patient received optimized antibiotic therapy based upon cultures and sensitivities. Of the patients with proven bacteremia who underwent an over-the-wire exchange, 6% (n ¼ 5) developed recurrent bacteremia with the same culture-proven organism within 3 months of the exchange compared to 11% (n ¼ 11) of patients who underwent catheter removal with or without replacement after line holiday (P ¼ 0.28). Conclusions: Reinfection rates after over-the-wire tunneled catheter exchanges were lower than in those patients who underwent catheter removal and line holidays despite similar causative organisms and appropriate antibiotic therapy. In the setting of suspected line infection, catheter exchange is as effective as removal for a line holiday.
’
S197
PICC-associated VT was the highest with DL catheter because it was the most used catheter. We should be more conservative when choosing the right number of lumens for the PICC that the patient will have for their long term IV therapy and avoid the consequences of PICC-associated VT. References 1. Evans RS, Sharp JH, Linford LH, Lloyd JF, Woller SC, et al. Reduction of peripherally inserted central catheter-associated DVT. Chest 2013; 143 (3):627–633. PubMed PMID: 22878346. 2. Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 2010 Oct; 138(4):803–810. PubMed PMID: 20923799. 3. O’Brien J, Paquet F, Lindsay R, Valenti D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol 2013; 10(11):864–868. PubMed PMID: 24075218.
Reference 1. Tanriover, Bekir, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney International 2000; 57(5): 2151–2155.
8:27 AM
Abstract No. 439
Size matters, reducing peripherally inserted central venous access associated thrombosis F. Kang, K. Wheeler, R. Ryu, D. Johnson; University of Colorado Denver, Aurora, CO.
Abstract No. 440
Chest ports placed in oncologic patients with a history of prior port removal: is there any increased risk for complications? G. Stewart1, K. Kobayashi1, P. Skummer1, J. Patel1, M. Faridnia2, M. Jawed1, D. Zhang3, C. Mendenhall4, M. Karmel5; 1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University, Baldwinsville, NY; 3SUNY Upstate Medical University, Indianapolis, IN; 4SUNY Upstate Medical University, Manlius, NY; 5Upstate Medical University, Syracuse, NY. Purpose: Patients with cancer (oncologic patients) with a history of prior chest port (port) removal may need another port for various reasons including continuation of chemotherapy after port-related complications, recurrent disease, or new cancer. We retrospectively investigated the incidences of port-related complications in oncologic patients with a history of prior port removal and to compare those without the history. Materials: Between January 1, 2012 and May 30, 2014, 832 ports were placed in 809 oncologic patients (M/F: 420/389, mean age: 57). 60 ports had a history of prior port removal (port removal group) and 772 ports were placed for the first time (primary port group). The reasons of prior port removal were completion of prior treatment (n¼17, non-complication group) and complications (n¼43, complication group). The medical records and imaging studies were reviewed to identify port-related complications requiring treatment or port removal. Complications were classified as 1) (local or blood stream) infection, 2) mechanical (such as catheter malpositioning), 3) thrombotic, and 4) port site skin issues (such as erosion). SPSS was used for statistical analyses. Results: 17 ports (27.4%) in port removal group and 95 ports (11.6%) in primary port group were associated with complications (Po0.05). Incidence of infection (10/60 vs 59/772, P o0.05) and that of mechanical complications (4/60 vs 15/772, Po0.05) were significantly higher in port removal group. Incidence of thrombotic complications (3/60 vs 18/772, P¼0.24) and that of port site skin issues (2/60 vs 8/772, P¼0.12) were not significantly different between the two groups. Among port removal group, incidence of complications in complication group were not statistically different from that in non-complication group (5/17 vs 12/43, P¼0.572).
WEDNESDAY: Scientific Sessions
Purpose: Peripherally inserted central catheter (PICC) has become the main modality for the long term intravenous (IV) therapy, and as its popularity increased, so has the PICCassociated venous thrombosis (VT). Often double lumen (DL) or triple lumen (TL) catheters are requested for the ease of IV access despite single lumen (SL) catheter may be sufficient for the patients’ long term IV therapy. During the review of our institutional rate of PICC-associated VT, we noticed an unusually high number of PICC –associated VT in DL catheters. As the number of lumens for PICC may pose as the most modifiable risk for PICC-associated VT, this study was aimed at the difference in the rate of PICC-associated VT among SL, DL, and TL catheters. Materials: We conducted a 2-year retrospective cohort study of all PICC insertion by a certified designated PICC team using highly replicable approach at our institution, which is a 593bed, level I trauma and tertiary referral hospital from 2013 to 2014. During this period, PICC insertions were done with either SL, DL, or TL catheters based on the request from the primary healthcare team, and any patients with PICC insertion who were symptomatic for upper extremity VT were evaluated with Doppler ultrasound for the presence of PICC-associated VT. Results: We identified a total of 5818 UE PICC insertions during the 24-month period. PICC-associated VTs were detected in 41 of 1346 (3.0%) SL catheters, 169 of 3114 (5.4%) DL catheters and 112 of 1358 (8.2%) TL catheters (X2 P o 0.00001). When the rate of PICC-associated VT for TL catheter was compared directly against DL and SL catheters, the rate was significantly higher (P o 0.001, P o 0.00000001), and the rate for DL catheter compared directly to the rate for SL catheter was significantly higher (P o 0.001) as well. Conclusions: TL catheter had the highest rate of PICCassociated VT followed by DL catheter. The number of
8:36 AM
S198
’
Wednesday
Scientific Session
Conclusions: Chest ports placed in oncologic patients with a history of prior port removal, regardless of the reason of the prior removal, were at a statistically higher risk of complications, especially infection and mechanical ones.
8:45 AM
Abstract No. 441
Are routine labs necessary prior to tunneled dialysis catheter placement?
WEDNESDAY: Scientific Sessions
J. Konrad1, G. Dubel2, S. Ahn3; 1Brown University, Providence, RI; 2Barrington, RI; 3Rumford, RI. Purpose: To examine the utility of pre-procedural labs in patients undergoing tunneled hemodialysis catheter placement. Materials: In this HIPAA compliant IRB approved study, a retrospective review of tunneled 15F hemodialysis catheter placement during a two-year period at a tertiary academic medical center was performed. Electronic medical record (EMR) review included platelet count, international normalized ratio (INR), past medical history, anticoagulation status, transfusion requirement, and post-procedural hemorrhagic complications. Results: A total of 541 tunneled dialysis catheters placements were available for review. Average patient age was 67 years (range 12-92). Ninety percent of catheter placements were placed via the right jugular vein and 10% via the left internal jugular vein. 419/541 and 444/541 had coagulation profile and platelet count, respectively within 30 days prior to the procedure. Overall, 96% (402/419) of patients had an INR less than or equal to 1.8 and 99% (440/444) had a platelet count 450K. Of the 17 patients with INR 41.8, 15/17 (88%) and of the 4 patients with platelet count o50K, 3/4 (75%) had history of multi-organ failure, pre-existing hematological dysfunction, or Coumadin therapy. In the absence of above risk factors, the INR was o¼ 1.8 in 99.5% (417/419) and platelet counts was 450K in 99.8% (443/444). Overall, there was a 0.4% (2/541) hemorrhagic complications rate requiring either blood products or additional management. Conclusions: Overall hemorrhagic complications are rare in neck tunneled catheter placement. Routine INR and platelet count is not necessary in the absence of multi-organ failure, known hematological disorder, or Coumadin therapy.
’
JVIR
due to the bulk of the implanted port, the incision may be subjected to higher levels of skin tension in the upper chest and thus higher risk of dehiscence, infection, and worse scarring. Therefore, the purpose of this study was to compare outcomes of skin closure with octylcyanoacrylate versus the gold standard method of subcuticular suture closure. Materials: Patients scheduled to undergo single-lumen implantable venous port insertion for chemotherapy were evaluated for study enrollment. Following port implantation, if there was reasonable incision apposition after suture of the deep fascia, patients were randomized to skin closure with either octylcyanoacrylate or absorbable subcuticular suture. Subjects were followed for episodes of infection or dehiscence for 3 months. At 3 months, a photograph of the healed incision was obtained and reviewed by a blinded plastic surgeon who rated the scar appearance based on a validated 10-point cosmesis score. Results: Of 109 subjects (28 males, 81 females, mean age 58.6) undergoing venous port implantation, 54 were randomized to skin adhesive and 55 to subcuticular suture. There were no significant differences in demographics between groups. No patients had incision dehiscence. Infection rates were similar between groups (5.6% vs 1.8%, p¼0.36). The mean cosmesis scores were 4.40 for skin adhesive and 4.46 for subcuticular suture, p¼0.898. The procedural time was 8.6 minutes for suture versus 1.4 minutes for skin adhesive, p o 0.001). Skin adhesive was purchased at $25.92 per unit, whereas the suture material was purchased at $2.54 per unit. Conclusions: Patient outcomes and scar cosmesis results did not significantly vary between skin adhesive versus subcuticular suture. When factoring in cost of material, operator time, and IR suite time, skin adhesive may be more cost effective.
9:03 AM
Abstract No. 443
Outcomes of a percutaneous technique for shortening of totally implanted chest port catheters C. Duncan1, S. Trerotola2; 1Hospital of the University of Pennsylvania, Penn Image-Guided Interventions Lab, Philadelphia, PA; 2University of Pennsylvania Medical Center, Philadelphia, PA.
Reference 1. Patel I, Davidson J. et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. JVIR 2012.
8:54 AM
Abstract No. 442
Randomized controlled trial of skin adhesive versus subcuticular suture for skin closure after implantable venous port placement J. Martin1, S. Hollenbeck1, R. Makar2, W. Pabon-Ramos3, P. Suhocki3, M. Miller3, D. Sopko3, T. Smith3, C. Kim4; 1 Duke University, Durham, NC; 2United States; 3Duke University Medical Center, Durham, NC; 4Raleigh, NC. Purpose: Cancer patients undergoing implantable venous port placement may be predisposed to impaired wound healing due to chemotherapy and tumor-related cachexia. Furthermore,
Purpose: Chest ports are commonly used in the setting of malignancy. Port catheters that are too long either due to initial misplacement or by virtue of weight loss and subsequent inward migration may threaten the patient’s safety by causing arrhythmia or other complications. Too-long port catheters are typically removed or revised; the subcutaneous position of port reservoirs precludes standard over the wire exchange techniques. The outcomes of a percutaneous port catheter shortening technique which obviates incision were reviewed. Materials: Retrospective review was performed of 36 patients (25F:11M) who underwent percutaneous port catheter shortening between 8/1/2005 and 8/1/2015. The technique involves jugular puncture, snaring and delivery of the catheter through a sheath, catheter shortening and replacement back through the sheath. 38 procedures were performed on 37 different ports. Mean patient age was 50 years (range 26-77). Median follow-up was 19 months (range 2–107).