LONG-TERM, TOTALLY IMPLANTABLE CENTRAL VENOUS ACCESS PORTS CONNECTED TO A GROSHONG CATHETER FOR CHEMOTHERAPY OF SOLID TUMORS - EXPERIENCE FROM 178 CASES USING A SINGLE TYPE OF DEVICE

The aim of this study was to examine the early and late complications rate of central venous access ports connected to the Groshong catheter for long-term chemotherapy delivering. All patients suffering from a neoplastic disease, who required long-term chemotherapy and underwent insertion of implantable ports during a 21-month period (1 October 199 4-30 June 1996) were prospectively studied. A single type of port was used, constructed of titanium and silicone rubber (Dome Port(TM), Bard Inc., Salt Lake City, U.S.A.), connected to an 8 F silastic Groshong( TM) catheter tubing (Bard Inc.). A team of different operators (two ge neral surgeons, one interventional radiologist and four anaesthesiolog ists) was involved in inserting the port. All devices were placed in t he operating room under fluoroscopic control. A central venous access form was filled in by the operator after the procedure and all ports w ere followed prospectively for device-related and overall complication s. Data from the follow-up of these patients were entered in the form and collected in a database. Follow-up continued until the device was removed, the patient died or the study was closed. 178 devices, compri sing a total of 32 089 days in situ, were placed in 175 patients. Thre e patients received a second device after removal of the first. Adequa te follow-up was obtained in all cases (median 180 days, range 4-559). 138 devices (77.5%) were still in situ when the study was closed. Ear ly complications included six pneumothoraxes, three arterial punctures and two revisions for port and/or catheter malfunction (overall early complications in 8 patients). Late complications included 3 cases (1. 68% of devices) of catheter rupture and embolisation (0.093 episodes/1 000 days of use), 2 cases (1.12% of devices) of venous thrombosis (0.0 62 episodes/1000 days of use), 1 case (0.56% of devices) of pocket inf ection (0.031 episodes/1000 days of use), and 4 cases (2.24% of device s) of port-related bacteraemias (0.124 episodes/1000 days of use). Inf ections were caused by coagulase-negative Staphylococcus aureus (4 cas es) and Bacillus subtilis (1 case); they required port removal in 3 ou t of 5 cases. This study represents the largest published series of pa tients with totally implantable access ports connected to Groshong cat heters; this device is a good option for long-term access to central v eins and delivery of chemotherapeutic regimens, including continuous i ntravenous infusions. The low incidence of major complications related to implantation and management of these devices support increased use in oncology patients. (C) 1997 Published by Elsevier Science Ltd.