Clinical benefit of power-injectable port systems: A prospective observational study
Introduction
Until recently, no totally implantable port catheter system used in clinical routine was approved for high-pressure injections, as they are required during contrast enhanced computed tomography scans (CECTs). Over the past years, the number of computed tomography scans (CTs) has increased steadily [1]. Patients with malignant or chronic diseases frequently undergo diagnostic imaging for staging purposes. This patient population could especially profit from a port catheter system allowing for contrast media (CM) injection during CECTs. Such a system may also simplify everyday clinical practice, as additional peripheral venous accesses would no longer be necessary for CM injections.
Previous studies on CM administration via standard central venous lines showed that injections can also be performed at flow rates as low as 0.3–2.5 ml/s [2]. However, common CT studies such as angiographies to diagnose pulmonary embolisms, aortic dissections or aneurysms, as well as coronary angiography or CT brain perfusion studies require flow rates of up to 4–5 ml/s [3].
In vitro assessment of power injections through non-approved catheters merely illustrated a failure of the external tubing [4]. Nevertheless, policy at many institutions prohibits high-pressure injections via central venous lines due to concerns about complications resulting from inappropriate use and legal issues. In this context, the United States Food and Drug Administration (FDA) published a warning on the use of non-approved vascular access devices for power injection, after having received reports on over 250 adverse events with ruptured catheters [5].
The objective of this study was to prospectively evaluate the clinical benefit of a central venous port system approved for CM injection during CECTs. The complication rate, utilization of the port for high-pressure CM injection and migration of the port capsule were considered.
Section snippets
Patient characteristics
At a university teaching hospital 98 patients (59 female, 39 male; median age 61.7 years; range 23–83) had a power-injectable central venous port catheter system implanted between January 2008 and July 2009. After the intervention, patients were observed for a follow-up period of at least 180 days.
Indications for port catheter implantation were planned chemotherapy (n = 93), parenteral nutrition (n = 3) and a required long-term venous access (n = 2). Table 1 provides an overview on the patient
Results
Of initially 98 patients who received a power-injectable port system, only 55 completed the intended follow-up period of 180 days. 23 patients were deceased before the intended follow-up period was completed. 3 patients explicitly refused follow-up and 2 could not be contacted. One port system was removed within the 180-day period after the intravenous treatment via the port system had been completed. The remaining 14 patients did not return the questionnaire. Venous access was established via
Discussion
Totally implantable port catheter systems are commonly used for long-term intermittent venous access in patients with malignant or chronic diseases. The port system used in this study meets the requirements for high-pressure injections, which makes additional peripheral venous accesses for CM injection unnecessary [10]. Especially patients with malignant or chronic diseases frequently undergo diagnostic imaging for staging purposes. These may benefit from this venous access device, as the
Acknowledgements
The study was not financed by third-party funds. None of the authors is associated with Bard Access Systems.
References (18)
- et al.
Cavoatrial junction and central venous anatomy: implications for central venous access tip position
J Vasc Interv Radiol
(2008) - et al.
Outcomes of surgical and radiologic placed implantable central venous access ports
Am J Surg
(2009) - et al.
Use of totally implantable central venous access ports for high-dose chemotherapy and peripheral blood stem cell transplantation: results of a monocentre series of 376 patients
Ann Oncol
(2004) - et al.
To clot or not to clot? That is the question in central venous catheters
Clin Radiol
(2004) - et al.
Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations
Radiology
(2005) - et al.
Power injection of contrast media using central venous catheters: feasibility, safety, and efficacy
AJR Am J Roentgenol
(2001) - et al.
Emergency cardiac CT for suspected acute coronary syndrome: qualitative and quantitative assessment of coronary, pulmonary, and aortic image quality
AJR Am J Roentgenol
(2008) - et al.
Central venous catheter integrity during mechanical power injection of iodinated contrast medium
Radiology
(2009) - FDA, Reminders from FDA Regarding Ruptured Vascular Access Devices from Power Injection....
Cited by (14)
Endovascular management of the peripherally inserted central venous catheter iatrogenic pinch-off syndrome: A case report
2019, Radiology Case ReportsCitation Excerpt :A safe venous access is required for the majority of cancer treatment regimens and the benefits and potential risks of PICCs or port-systems implantation have to be accurately considered. PICCs are safe and reliable tool to deliver chemotherapeutic drugs, particularly during the first 3 months after implantation [1,2]. In the large study assessing the overall risk of PICC failure in patients under active chemotherapy, Bertoglio et al. report 15% of PICCs removal rate due to various complications before finishing the treatment [3].
Randomized Clinical Trial Evaluating Complications and Complication-Related Removal of Arm-Situated Power-Injectable and Non-Power–Injectable Totally Implanted Venous Access Devices among Cancer Patients
2018, Journal of Vascular and Interventional RadiologyComplications after implantation of subcutaneous central venous ports (PowerPort<sup>Ⓡ</sup>)
2017, Annals of Medicine and SurgeryCitation Excerpt :PowerPort devices were not associated with any adverse events at the time of contrast-enhanced imaging, and the incidences of adverse events such as catheter obstruction and infection were similar to those of other types of ports. PowerPort ports can thus be used safely [17–19]. Although PowerPort devices have many advantages, the features of PowerPort ports should be differentiated from those of the many other types of ports that have been used in our hospital.
Systematic review of the safety and efficacy of contrast injection via venous catheters for contrast-enhanced computed tomography
2017, European Journal of Radiology OpenCitation Excerpt :Twenty-three articles were considered eligible for answering the research question after selection based on title and abstract. Seventeen articles were excluded during full text screening because of the following reasons: incorrect domain (n = 1) [9], outcome not focusing on safety, efficacy, and complications (n = 1) [10], CVC use in pediatrics (n = 7) [11–17], in vitro studies (n = 4) [18–21], no original article (n = 3) [1,22,23], and not meeting language requirements (n = 1) [24]. During cross referencing, one study was included missed by the initial search [25].
- 1
DRK Kliniken Berlin Köpenick, Salvador-Allende-Straße 2-8, 12559 Berlin, Germany.