Totally implantable port management: impact of positive pressure during needle withdrawal on catheter tip occlusion (an experimental study).

BACKGROUND: Totally implanted ports (TIP) have become a standard part of patient care, providing long-term central venous access for treatment administration and other procedures. Despite overall the safety and effectiveness of TIP, complications still occur. Negative pressure created during needle withdrawal induces blood reflux and subsequent catheter occlusion. Application of positive pressure during needle withdrawal is thought to largely prevent such reflux, but supporting data are limited. PURPOSE OF RESEARCH: To quantify the role of positive pressure, using a test model designed to simulate physiological conditions. METHODS: Reflux associated with needle withdrawal with and without applied positive pressure was tested using various TIP models from different manufacturers mounted on a specially designed test bench. In addition to the presence or absence of positive pressure during needle withdrawal, study variables comprised of needle type (safety and standard), needle gauge and port septum diameter. RESULTS: Application of positive pressure during needle withdrawal reduced the incidence of reflux during needle withdrawal by nearly 80% (22% vs. 99%, p<0.001). When reflux did occur, the mean residual volume was half that observed without positive pressure. In the absence of positive pressure, mean reflux increased with septum diameter and needle gauge to a statistically significant extent. None of these variables significantly affected reflux in the context of needle withdrawal under positive pressure. CONCLUSION: The results of this study support the use of positive pressure during needle withdrawal to prevent blood reflux potentially leading to catheter tip occlusion.

[2008 Standards, Options: Recommendations for venous thromboembolic events(VTE)treatment and central venous catheter thrombosis(CVCT) management in cancer patients]. / Standards, Options : Recommandations 2008. Traitement curatif de la maladie thromboembolique veineuse, prevention et traitement des thromboses veineuses sur catheter chez les patients atteints de cancer.

The Standards, Options: Recommendations (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. In order to answer questions related to venous thromboembolic events(VTE) treatment and to central venous catheter thrombosis (CVCT) management in cancer patients, the SOR elaborated national guidelines, here presented in a short report. It results of a collaborative work with members from three learned societies("société nationale française de médicine interne": SNFMI, "société française de médicine vasculaire": SFMV and "société française dEanesthésie-réanimation:SFAR).

[Complications of central venous and indwelling catheterization]. / Complications des dispositifs intraveineux de longue durée.

Complications on Hickman central venous catheter and venous access ports Hickman central venous catheter and venous access ports are widely used in patients with hematology or oncology disorders. However, these long-term venous access devices can be the source of several kinds of complications that may compromise the functional and/or vital patient's prognosis. All these complications must be known, diagnosed, treated and prevented. If there is no consensus concerning the prevention of catheter-related thrombosis, various methods are now available to diagnose, treat and prevent device-related bloodstream infections. Extravasation of corrosive drugs represents a very serious complication of long-term venous access devices. The surgical technique that uses early subcutaneous wash-out in acute extravasation injuries is simple and safe; it helps to reduce the severe sequelae of highly toxic drug extravasation for the patient.

[Recommendations for venous thromboembolic events treatment and central venous catheter thrombosis management in cancer patients]. / Traitement curatif de la maladie thromboembolique veineuse et prise en charge des thromboses veineuses sur cathéter chez les patients atteints de cancer Méthode SOR.

The "Standards, Options: Recommendations" (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) and is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. In order to answer questions related to venous thromboembolic events (VTE) treatment and to central venous catheter thrombosis (CVCT) management in cancer patients, the SOR elaborated national guidelines, here presented in a short report. It results of a collaborative work with members from three learned societies (<< Société nationale française de médecine interne >> : SNFMI, << Société française de médecine vasculaire >> : SFMV and << Société française d'anesthésie-réanimation >> : SFAR).

[2008 Standards, Options: recommendations for venous thromboembolic events (VTE) treatment and central venous catheter thrombosis (CVCT) management in cancer patients]. / Standards, Options : Recommandations 2008. Traitement curatif de la maladie thromboembolique veineuse, prévention et traitement des thromboses veineuses sur cathéter chez les patients atteints de cancer.

The <> (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. In order to answer questions related to venous thromboembolic events (VTE) treatment and to central venous catheter thrombosis (CVCT) management in cancer patients, the SOR elaborated national guidelines, here presented in a short report. It results of a collaborative work with members from three learned societies ("société nationale française de médicine interne": SNFMI, "société française de médicine vasculaire": SFMV and "société française d'anesthésie-réanimation": SFAR).

Prospective, double-blind, randomized trial of equimolar mixture of nitrous oxide/oxygen to prevent pain induced by insertion of venous access ports in cancer patients.

BACKGROUND: To assess the efficacy of equimolar mixture of nitrous oxide/oxygen (EMNO) to prevent pain induced by venous access ports (VAPs) implantation in cancer patients. PATIENTS AND METHODS: In a randomized, double-blind study on an adult population not knowing the effects of EMNO, cancer patients were randomly assigned to breath via a facial mask, EMNO or a placebo mixture comprising 50% oxygen and 50% nitrogen. The primary end-point was the patients' assessment of the severity of pain evaluated using a visual analog scale (VAS, 0 to 100) and the proportion of patients suffering pain in each group. The secondary criteria were side effects, tolerability of EMNO, and the level of satisfaction of both the patients and the medical team. RESULTS: Eighty-three adults (42 in the EMNO group and 41 in the placebo group) were included. VAPs were implanted in the jugular vein in 95% of patients. In the placebo group, 78% of the patients declared that they found VAP implantation painful vs. 34% in the EMNO group (p=0.001). The severity of the pain was reduced by 50% in the EMNO group in comparison with placebo (p=0.0125). Although the median time to perform implantation was strictly identical in both groups (20 min), the estimated duration of surgery seemed longer to patients in the control group. Patient and investigator satisfaction indexes were >90% in both groups. CONCLUSION: EMNO provides an effective solution for the prevention of pain during placement of VAPs.