Risk factors for infectious and noninfectious complications of totally implantable venous catheters in cancer patients.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the risk factors for complications of totally implantable catheters in a referral cancer center. METHODS: This was a retrospective study of prospectively collected data of all consecutive cancer patients undergoing port placement, with a primary outcome of interest of major complication and subanalysis of the types of complications. RESULTS: We studied 1255 nonvalved implanted port catheters inserted in 1230 patients, for a combined total of 469,882 catheter-days of use. Venous puncture was ultrasound (US)-guided in 1049 cases (84%). Inadvertent arterial puncture occurred in 14 cases (1.1%) and was more frequent in procedures not guided by US (P = .045). Among the outpatients, 90 (9%) developed infection, and 75 (29%) of the hospitalized patients (P < .001) developed infections. Infection was diagnosed in 131 catheters (13%) implanted through the internal jugular vein (IJV), 23 catheters (14%) implanted in the subclavian vein (SCV), 1 catheter (5%) implanted in the external jugular vein, and 10 catheters (31%) implanted in the femoral vein (P = .044). In the multivariate analysis, only the hospitalization regimen maintained statistical significance, with hospitalization presenting as a risk factor for infection (P < .001). Regarding the introduction site, ambulatory patients in whom the femoral vein was the site of access had more infections than the others (28.6% vs 9.4% of the IJV, 4.8% of the SCV, and 4.8% of the external jugular vein; P = .019), which did not occur among the hospitalized patients (33.3% vs 26.5% of IJV and 39.5% of the SCV; P = .218). CONCLUSIONS: Not using US is a risk factor for iatrogenic arterial puncture. Port implantation in hospitalized patients and the use of femoral access are risk factors for infection.