63 - Freie Mitteilung
16. Mai 2019, 13:45 - 15:15, Sopra Grande, 4. OG
Risk factors and indications for removal of totally implantable venous-access ports in oncological and non-oncological patients
R. Fahrner, F. Schenker, F. Rauchfuss, U. Settmacher, Presenter: R. Fahrner (Jena/DE)
Totally implantable venous-access ports (TIVP) play an important role in the treatment of oncological but also in non-oncological patients. Although these devices are considered as the safest way of long-term central venous access, complications and adverse events are often seen and the removal of the TIVP is necessary. The aim of this investigation was to analyse the patient cohort undergoing TIVP removal in our surgical department.
Patients undergoing TIVP removal between January 2004 and December 2016 were retrospectively analysed regarding patients characteristics, underlying disease, indications, and TIVP related factors.
During the investigated time period in total 3166 TIVP and 609 TIVP removals (19%) were performed. 53% of patients undergoing TIVP removal were initially treated in our department, the others were treated in external hospitals or other institutions (other surgical specialties, radiology). There was an increase of TIVP removals during the investigated time period. Organ-related malignancy (n=348, 57%) was more frequently seen than hematologic malignant diseases (n=122, 20%) or non-oncological diseases. The mean time span between implantation and removal was 19.2 months, interestingly 14.5% of removals were performed during the first month after TIVP insertion. The majority of TIVP were inserted on the right side (74%), and 314 TIVPs were inserted by open cut-down approach (52%) with cephalic vein as predominant vessel (52%). A high proportion of patients (62%) were still under running chemotherapy. The majority of removals were performed due to TIVP related infections (58.3%), followed by TIVP related complications in 21% (dislocation, dysfunction, thrombosis) or end of treatment (15.9%). Patients with running chemotherapy were more likely to get a TIVP infection than patients without chemotherapy (p<0.001). In the majority of infectious complications staphylococcus species were isolated either from the blood stream or surgical swabs (62.3%), followed by gram-negative bacilli (12.3%) or fungi (9.7%).
Infectious complications after TIVP implantations are frequent. An important risk factor for mainly staphylococcus associated infections seems to be running chemotherapy. Therefore, strict adherence to a sterile technique during implantation and during manipulation of TIVP devices are important issues to prevent infectious complications.