Rationale and Objectives
Totally implanted subcutaneous central venous access devices (chest ports) are an attractive option for patients in need of intermittent, recurrent venous access. In our department, these are placed by different operator types including interventional radiology (IR) attending physicians, dedicated IR nurse practitioners (NP), and IR fellows/radiology residents. The purpose of our study is to assess the rate of complications of subcutaneous chest port placement among the different operator types.
Materials and Methods
A retrospective review of all subcutaneous central venous access devices implanted in our department between October 8, 2004, and October 19, 2007, was undertaken. Total numbers of port days, overall complication rates for all operators, as well as complication rates for the various operator types were calculated and were compared using the chi square test.
Results
A total of 558 patients had totally implanted subcutaneous central venous access devices placed during the period of study. Of these, 536 had documented follow-up and comprise the study population. A total of 89 were placed by attending physician alone, 133 by an NP, and 314 by an IR fellow or resident, with supervision by an attending physician. Mean duration of port usage was 341 days with 182,522 total port days. A total of 39 complications occurred (7.28%), including 27 infections (5%). There was no statistically significant difference in overall complication rates, including infection rates, among operator groups ( P = .925).
Conclusions
Our results confirm that well-trained physician extenders and trainees can safely perform chest port placement and that these providers, under appropriate supervision, can help provide improved access to chest port placement for patients and referring clinicians.
Totally implanted subcutaneous central venous access devices are an attractive option for patients in need of intermittent, recurrent venous access. These are most commonly used for the administration of chemotherapy, but may be necessary in other clinical situations, such as the need for frequent blood draws, blood transfusions, or the chronic administration of intravenous medications in patients with poor venous access. These devices are attractive to patients because the lack of an external portion is cosmetically appealing and the devices are convenient. The daily dressing changes and frequent flushing required for chronic indwelling tunneled central venous catheters are unnecessary.
Venous access procedures—in particular, implanted subcutaneous chest port placement—constitute a significant percentage of our daily interventional radiology (IR) caseload. The number of implanted ports placed by IR at our institution has increased significantly each year since we began placing these. In 2005, the first year we offered this service, we placed 28; in 2008, we placed 260. To manage this case volume and efficiently run the IR practice, implanted subcutaneous ports are placed by the IR attending staff, IR nurse practitioner, and IR residents and fellows under the supervision of IR staff.
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Materials and methods
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Operator Training and Supervision
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Port Placement Technique
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Results
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Table 1
Procedure-related Port Placement Complications
Complications_n_ % of Total Ports Infection/suspected infection 27 5.04 Thrombosis 2 0.37 Catheter detachment/fracture/pinch off 1 0.19 Skin complication (erosion) 3 0.56 Pain 2 0.37 Port rotation/flip 1 0.19 Reservoir leak 1 0.19 Arrhythmia 2 0.37 Total 39 7.28
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Table 2
Complications by Operator Type
Operator Type_n_ % of Total Ports Attending 7 1.31 Nurse practitioner (ARNP) 11 2.05 VIR fellow 3 0.56 Resident 18 3.36 Total 39 7.28
ARNP, advanced registered nurse practitioner; VIR, vascular and interventional radiology.
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Discussion
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References
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