MC  Vol.2 No.2 , April 2013
Extending the interval for port-a-cath maintenance
ABSTRACT
Objective: The objective of this study is to assess the outcome of port-a-cath (PAC) maintenance every three months in patients with gynecologic malignancies with the goal of standardizing a safe and appropriate interval that would maintain patency and minimize side effects. Methods: We performed a retrospective medical record review and evaluation of all patients with a Bard? PAC who were noted to have no evidence of disease (NED) during the years 2003 to 2010. The interval between accessions and any complications related to the presence of the PAC were recorded. Relevant complications included skin infections, bacteremia, thrombosis, and occlusions. Statistical analysis was done using the Fisher’s exact test. Results: A total of 201 patients had PAC placed and 43 patients underwent PAC accessions to maintain patency. The total number of accessions was 150 with a median number per patient of 2.0 (range 1 - 10). The mean time between flushes was 112 days (SD = 57). When comparing women in maintenance who had flushes within 90 days versus those who had flushes over 90 days apart, there was no difference in infection or occlusion rates between these groups (p = 0.515). In the <90-day group, one patient was noted to have resistance during the flush. In the ≥90-day group, one patient had an occlusion that did not resolve with Alteplase. Another patient had skin erythema with spontaneous resolution. Conclusion: Infections and occlusions are rare in women with gynecologic malignancies undergoing maintenance of their PAC. Longer intervals between PAC flushes do not appear to affect the outcome in our patients. Our ongoing data and follow-up confirm that extending the interval of PAC accession to every 3 months, rather than monthly, is safe, effective and convenient in the patient population with gynecologic malignancies.

Cite this paper
Girda, E. , Phaeton, R. , Goldberg, G. and Kuo, D. (2013) Extending the interval for port-a-cath maintenance. Modern Chemotherapy, 2, 15-18. doi: 10.4236/mc.2013.22003.
References
[1]   Ng, F., Mastoroudes, H., Paul, E., Davies, N., Tibballs, J., Hochhauser, D., Mayer, A., Begent, R. and Meyer, T. (2007) A comparison of Hickman line-and port-a-cath-associated complications in patients with solid tumours undergoing chemotherapy. Clinical Oncology, 7, 551-556. doi:10.1016/j.clon.2007.04.003

[2]   Sanchez, Y.L., Caravajal, J.M., Fuster, D. and Eiras, M.E. (2006) Protocol for the implantation of a venous access device (port-a-cath system). The complications and solutions found in 560 cases. Clinical and Translational Oncology, 10, 735-741. doi:10.1007/s12094-006-0120-y

[3]   Coccaro, M., Bochicchio, A.M., Capobianco, A.M., Di Leo, P., Mancino, G. and Cammarota, A. (2001) Long- term infusional systems: Complications in cancer patients. Tumori, 87, 308-311.

[4]   Vandoni, R.E., Guerra, A., Sanna, P., Bogen, M., Cavalli, F. and Gertsch, P. (2009) Randomized comparison of complications from three different permanent central venous access systems. Swiss Medical Weekly, 139, 313- 316.

[5]   Kock, H.J., Pietsch, M., Krause, U., Wilke, H. and Eigler, F.W. (1998) Implantable vascular access systems: Experience in 1500 patients with totally implanted central venous port systems. World Journal of Surgery, 22, 12- 16. doi:10.1007/s002689900342

[6]   Kuo, Y.S., Schwartz, B., Santiago, J. and Anderson, P.S. (2005) How often should a port-a-cath be flushed? Cancer Investigation, 23, 582-585. doi:10.1080/07357900500276923

 
 
Top