A VENOUS ACCESS MINI-PORT IMPLANTED ON THE PROXIMAL FOREARM, ON THE DISTAL UPPER ARM OR ON THE CHEST-WALL

Background: The main objective of this study was to compare 3 implanta tion sites for a new mini-port-system (Pharmacia Deltec, Erlangen, FRG ) on the proximal forearm, on the distal upper arm and on the chest wa ll in a prospective, nonrandomized fashion with respect to feasibility , complications and acceptance. Patients and Methods: The mini-port wa s used for central venous access in 61 patients. Fifteen patients (8 w ith solid tumors, 4 lymphomas, 3 acute leukemias) had the port positio ned on their proximal forearm, 24 (with solid tumors) on the distal up per arm, and 22 (13 with solid tumors, 7 lymphomas, 1 acute leukemia, 1 CML) on the chest wall. Results: Observed life-span of mini-ports wa s 201 days (range 28-549) for the proximal forearm port, 130 days (ran ge 29-261) for the distal upper arm port, and 87 days (range 0 - 480) for the chest wall port with cumulative observation periods of 3,778, 3,120 and 3,358 patient-days, respectively. Mini-ports were used for c hemotherapy, supportive treatment including parenteral nutrition and t ransfusion of blood products and for taking blood samples. No complica tions were observed in 8 of 15 patients with the proximal forearm port , 23 of 24 patients with the distal upper arm port, and 18 of 22 patie nts with the chest wall-positioned port. There were 6 patients with pe ripheral vein thrombosis, 3 with reversible port occlusion, and 3 with port infections for the proximal forearm port. One port infection occ urred in the group with the distal upper arm port. For the chest wall position we have found 1 patient with port infection, 1 with dislocati on of the catheter tip, 1 with unsuccessful implantation, 2 patients w ith paravasations, and 1 patient with port occlusion. However, loss of function and/or explantation were the consequences for only 6 mini-po rts (proximal forearm port, n = 2, distal upper arm port, n = 1, chest wall port, n = 3). A new electromagnetic catheter tracking system (Ca th-Finder, Pharmacia) was used in 32 patients for implantation of peri pheral access port. When compared with X-ray detection the system pred icted the catheter tip accurately in 29 patients and changed surgical procedure by predicting wrong positioning in 4 patients. Conclusions: The new mini-port can be used like the older and larger systems with l ess cosmetic damage. Positioning of the port on the distal upper arm o r on the chest wall was accompanied by less frequent complications. Ac ceptance for the 2 more central positions was better than for the posi tion on the proximal forearm by the patients, physicians, and nurses i nterviewed.