Subcutaneously implanted central venous access devices in cancer patients: a prospective analysis

Abstract

Background: Long term intravenous access is a common requirement for cancer patients. This analysis was designed to determine device-related morbidity and factors predictive of poor long term outcome for patients with subcutaneous single lumen intravenous access ports.

Methods: Six hundred eighty patients who underwent subcutaneous intravenous port placement between June 1987 and May 1989 at Memorial Sloan-Kettering Cancer Center were followed prospectively until port removal, death, or a maximum of 1960 days. Indications for and circumstances of placement, patient diagnoses, patient demographics, and subsequent courses of treatment were recorded, as well as technical and microbiologic device-related complications. Total, device specific, and complication free device durations were calculated.

Results: The median patient age was 52.4 years (range, 1.6-83.9 years). The female-to-male ratio was 1.5 to 1. Cancer diagnoses included solid organ tumors (84%), leukemia (4%), lymphoma (11%), and others (1%). Indications included access for systemic chemotherapy (98%), total parenteral nutrition (0.5%), and others (1.5%). One insertion complication and six insertion failures occurred, without mortality. The estimated mean overall actuarial device specific duration was 1191 days (range, 2-1960 days). Actuarial mean complication free, device specific duration was 952 days. Complications included sepsis (n = 31; 4.4%), site infection (n = 31; 4.4%), and accessibility failures such as thrombosis and leakage (n = 40, 5.7%). Reasons for end of port duration were patient death (72.4%), end of treatment (13.5%), functional failure or intractable infection (11.2%), and others (2.9%). Independent factors correlating with decreased port specific, complication free duration included placement site, age, tumor type, and catheter tip position.

Conclusions: Subcutaneous intravenous access ports in cancer patients are safe and well tolerated. Long term device duration is primarily influenced by patient survival. In this study, 90% of patients alive at 1 year and 70% of patients alive at 4 years had a functional port.