A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital

Figures & data

Figure 1. Study outline.

Table I. Patient and insertion characteristics.

	n	%
Gender
Female	150	60.2
Male	99	39.8
Indication for implantation
Cytotoxic drugs	238	95.6
Parenteral nutrition	5	2
Difficult iv access	6	2.4
Disease
Haematological malignancy	29	11.6
Colorectal cancer	55	22.1
Upper GI cancer	12	4.8
Breast cancer	67	26.9
ENT cancer	3	1.2
Urogenital cancer	18	7.2
Lung cancer	11	4.4
Sarcoma	2	0.8
Pancreatic cancer	20	8
Hepatocellular cancer	1	0.4
Malignant melanoma	5	2
Gynaecological cancer	11	4.4
Unknown tumour	3	1.2
Other	12	4.8
Competence level of inserting doctor
Specialist	238	95.6
Resident	11	4.4
Vein choice
Right internal jugular	214	85.9
Left internal jugular	24	9.6
Right subclavian	4	1.6
Left subclavian	6	2.4
Femoral	1	0.4
Use of ultrasound
Yes	244	98
No	5	2
Tip position
Superior vena cava	170	69.4
Right atrium	71	29
Brachiocephalic vein	3	1.2
Inferior vena cava	1	0.4
Antibiotics
Not administered	234	94
Prophylaxis	10	4
Ongoing	4	1.6
Ongoing and prophylaxis	1	0.4
Anaesthetic
Local infiltration	170	68.2
Local infiltration and sedation	78	31.3
General anaesthesia	1	0.4

Table II. Patients’ perceptions.

	n	%
Grade of procedural discomfort
No discomfort	68	27.4%
Light discomfort	116	46.8%
Moderate discomfort	58	23.4%
Severe discomfort	6	2.4%
Moderate to severe discomfort and...
Local anaesthetic only	42	25.7%
Local anaesthetic and sedation	20	25.6%
Does port influence everyday life^1
Much influence	24	9.6%
Little to no influence	182	73.1%
No data^2	43	17.3%
Does port facilitate during treatment^1
Yes	202	81.1%
No	2	0.8%
No data^2	45	18.1%
Are you satisfied with your port^1
Yes	199	79.8%
No	7	2.8%
No data^2	43	17.3%

¹Median values during follow-up; ²Patient dead or unable to answer at first follow-up.

Table III. Port-related adverse events in recent studies.

Author (year)	Method	No. of catheters	Catheter-days	Arterial puncture N (%)	Pneumothorax N (%)	Haemothorax N (%)	Local haemorrage N (%)	Local infection N per 1000 catheter-days (%)	Catheter-related bloodstream infection N per 1000 catheter-days (%)	Catheter-related deep vein thrombosis N per 1000 catheter-days (%)
Teichgräber (2011) [10]	Retrospective	3160	922 599	5 (0.16)	0 (0)	NA	3 (0.11)	0.016 (0.57)	0.15 (5.1)	0.11 (3.7)
Barbetakis (2011) [13]	Retrospective	700	156 800	3 (1.6)	16 (2.2)	NA	19 (2.6)	0.19 (4.4)	NA	0.21 (4.7)
Peris (2010) [16]	Prospective*	3951	1 642 402	176 (4.4)	109 (2.8)	NA	205 (5.2)	0.186 (7.3)¤	0.186 (7.3)¤	0.261 (10.2)
Heibl (2010) [11]	Prospective	140	29 107	NA	3 (2.1)	NA	1 (0.7)	0.17 (3.8)	0.27 (5.6)	0.03 (0.7)
Biffi (1997) [12]	Prospective	178	32 089	3 (1.6)	6 (3.37)	0	0	0.031 (0.56)	0.124 (2.24)	0.062 (1.12)
Present series (2013)	Prospective	249	37 763	7 (2.8)	0 (0)	0 (0)	1 (0.4)	0.39 (6)	0.05 (0.8)	0.1 (1.6)

*Both ports and tunneled catheters included. ¤ No differentiation between local and systemic infection.

Table IV. Infected ports.

Infected access port	Clinical signs	On day	Wound/pocket swab	Cultures Tip	Blood	Interpretation	Misc.
1	Local infectious	30	S. aureus*	–	–	PI	Treated in situ
2	Blister, thin skin covering reservoir	86	CoNS*	–	–	PI	CVC-DVT
3	Small skin wound over reservoir	35	CoNS^§	–	–	PI
4	Rubor and some pus	25	E. coli*	–	–	PI
5	Discoloration of skin over reservoir	142	Proprionibacterium*	–	–	PI	CVC-DVT
6	Wound over reservoir	136	Peptostreptococci^§ CoNS*	–	–	PI
7	Local infectious	21	Klebsiella^§ Entcoccus fecalis*	–	–	PI	Treated in situ
8	Wound over reservoir	119	S. aureus*	S. aureus* (1–14 CFU)	–	PI	No systemic symptoms, catheter tip contaminated during explantation
9	Rubor over reservoir	26	S. aureus*	S. aureus* (1–14 CFU)	–	PI	No systemic symptoms, catheter tip contaminated during explantation
10	Local infectious	35	CoNS^§	CoNS ^§ (1–14 CFU)	–	PI	No systemic symptoms, catheter tip contaminated during explantation
11	Reservoir covered by thin epithelial layer	82	–	CoNS* ^§ (1–14 CFU)	–	–	Tip colonisation Two different strains with different resistance patterns
12	Wound gap, pus over reservoir	34	CoNS*	CoNS* (15–50 CFU)	–	PI	No systemic symptoms, catheter tip contaminated during explantation
13	Wound rupture	89	CoNS*	CoNS* (> 50 CFU)	–	PI	No systemic symptoms, catheter tip contaminated during explantation
14	Local infectious	154	CoNS*	CoNS* (> 50 CFU)		PI	No systemic symptoms, catheter tip contaminated during explantation
15	Small wound	63	CoNS^§	CoNS^§ (1–14 CFU)	–	PI	Fever as only systemic symptom, tip contamination
16	Sepsis	15	S. aureus*	–	S. aureus*	PI	Complex interpretation, multiple skin ulcerations, not CRBSI according to definition
17	Sepsis and local infectious	7	S. aureus*	S. aureus*	S. aureus*	CRBSI
18	Sepsis and local infectious	37	S. aureus^§	S. aureus^§	S. aureus^§	CRBSI
19	High fever, light rubor around reservoir	68	–	CoNS^§ (1–14 CFU)	Lactobacillus^§	–	Tip colonisation

CFU, colony forming units; CoNS, coagulase negative Staphylococci; CRBSI, catheter-related blood stream infection; CVC-DVT, central venous catheter-related deep venous thrombosis; PI, pocket/local infection,

*Sensitive to all tested antibiotics; ^§Antibiotic resistance to some degree, no methicillin resistant S. aureus (MRSA) recorded.

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