SUBCUTANEOUSLY IMPLANTED CENTRAL VENOUS ACCESS DEVICES IN CANCER-PATIENTS - A PROSPECTIVE ANALYSIS

BACKGROUND. Long term intravenous access is a common requirement for c ancer patients. This analysis was designed to determine device-related morbidity and factors predictive of poor long term outcome for patien ts with subcutaneous single lumen intravenous access ports. METHODS. S ix hundred eighty patients who underwent subcutaneous intravenous port placement between lune 1987 and May 1989 at Memorial Sloan-Kettering Cancer Center were followed prospectively until port removal, death, o r a maximum of 1960 days. Indications for and circumstances of placeme nt, patient diagnoses, patient demographics, and subsequent courses of treatment were recorded, as well as technical and microbiologic devic e-related complications. Total, device specific, and complication free device durations were calculated. RESULTS. The median patient age was 52.4 years (range, 1.6-83.9 years). The female-to-male ratio was 1.5 to 1. Cancer diagnoses included solid organ tumors (84%), leukemia (4% ), lymphoma (11%), and others (1%). Indications included access for sy stemic chemotherapy (98%), total parenteral nutrition (0.5%), and othe rs (1.5%). One insertion complication and six insertion failures occur red, without mortality. The estimated mean overall actuarial device sp ecific duration was 1191 days (range, 2-1960 days). Actuarial mean com plication free, device specific duration was 952 days. Complications i ncluded sepsis (n = 31; 4.4%), site infection (n = 31; 4.4%), and acce ssibility failures such as thrombosis and leakage (n = 40, 5.7%). Reas ons for end of port duration were patient death (72.4%), end of treatm ent (13.5%), functional failure or intractable infection (11.2%), and others (2.9%). Independent factors correlating with decreased port spe cific, complication free duration included placement site, age, tumor type, and catheter tip position. CONCLUSIONS. Subcutaneous intravenous access ports in cancer patients are safe and well tolerated. Long ter m device duration is primarily influenced by patient survival. In this study, 90% of patients alive at 1 year and 70% of patients alive at y ears had a functional port. (C) 1997 American Cancer Society.