Predictors of hospital discharge in cancer patients with pericardial effusion undergoing surgical pericardial drainage.

INTRODUCTION: Pericardial effusion (PE) is a complication of late-stage cancer and some patients never leave the hospital despite drainage. The main objective of this study was to identify predictors of hospital discharge in cancer patients with (PE) who underwent pericardial drainage. We also report the occurrence of paradoxical hemodynamic instability (PHI). METHODS AND MATERIALS: A retrospective study was carried out in a cancer center. Patients included had malignancy, PE, and underwent surgical drainage. An institutional database was reviewed for preoperative variables, analyzed for hospital discharge. RESULTS: One-hundred and thirteen patients were included, with a mean age of 54 years old (SD 14.3). Sixty-three patients were discharged from hospital (55.7%). Age (odds ratio [OR], 1.04; P = 0.004), higher ECOG status (OR, 0.63; P = 0.019), recent chemotherapy (OR, 3.40; P = 0.007), and renal failure (OR, 0.14; P = 0.002) were associated with hospital discharge. Median survival was 43 days (IQ 25%-75%; 15-162). Patients with pulmonary embolism or neutropenia were at greater risk of developing PHI (OR, 10.11; P = 0.009 and OR, 12.13; P = 0.015, respectively). CONCLUSION: Almost half of the patients never left the hospital. Patients with no chemotherapy within 45 days of procedure, patients with renal failure and higher ECOG status are at greater risk of not getting discharged. PHI remains a serious condition with high mortality.

Totally implantable venous catheters: insertion via internal jugular vein with pocket implantation in the arm is an alternative for diseased thoracic walls.

PURPOSE: Insertion of totally implantable catheters via deep vessels that drain into the superior vena cava results in a lower incidence of venous thrombosis and infection as compared to catheters inserted into femoral and arm veins. Superior vena cava obstruction and inadequacy of the thoracic wall are conditions that prevent reservoir implantation in the chest wall. In this article, we describe a technical innovation that enables the pocket to be fixed in the arm while still allowing access to be achieved via the internal jugular vein. METHOD: The procedure reported maintains the use of the internal jugular vein for access even when the patient's chest is not suited for reservoir implantation, which is localized in the arm. RESULTS: The procedure was successful and no complications occurred. The position of the catheter tip did not alter with arm movement. CONCLUSION: The implantation of a port reservoir in the arm following venous access via the internal jugular vein is both safe and convenient.