OBJECTIVE: To evaluate the complications related to implantation and use of totally implantable venous access devices (TIVAD). METHODS: Retrospective study based on 116 TIVAD involving 113 adult patients (93M/20F, mean age 59 years). The implantation was achieved under local anaesthesia (69% of cases) and under general anaesthesia (31% of cases). RESULTS: The total TIVAD follow-up time was of 45 963 days (mean per device: 396 days). We used cephalic vein (95 cases), subclavian vein (13), internal jugular vein (4) and external jugular vein (4). A total of 27 complications were observed: 2 were related to the implantation (1 haematoma, 1 wrong positioning of the catheter), 25 were due to the use of the device, among which: 10 septicaemias (0.22/1 000 catheter days), 6 deep vein thrombosis (0.13/1 000 catheter days), 4 catheter obliterations (0.09/1 000 catheter days), one local infection (0.02/1 000 catheter days) and 4 catheter disconnections (0.09/1 000 catheter days) including 3 intra-cardiac migrations due to a defective model. These complications led to early removal of 14% of devices. The side of implantation and the type of venous access had no statistically significant incidence on postoperative complications. Operative accidents were avoided by the predominant use of venous access by dissection rather than by puncture. CONCLUSION: The complications described were considerable, notably during the intensive use of TIVAD. However they must not mask the benefits of such devices. They justify the training of medical staff and the development of preventive measures.
OBJECTIVE: To evaluate the complications related to implantation and use of totally implantable venous access devices (TIVAD). METHODS: Retrospective study based on 116 TIVAD involving 113 adult patients (93M/20F, mean age 59 years). The implantation was achieved under local anaesthesia (69% of cases) and under general anaesthesia (31% of cases). RESULTS: The total TIVAD follow-up time was of 45 963 days (mean per device: 396 days). We used cephalic vein (95 cases), subclavian vein (13), internal jugular vein (4) and external jugular vein (4). A total of 27 complications were observed: 2 were related to the implantation (1 haematoma, 1 wrong positioning of the catheter), 25 were due to the use of the device, among which: 10 septicaemias (0.22/1 000 catheter days), 6 deep vein thrombosis (0.13/1 000 catheter days), 4 catheter obliterations (0.09/1 000 catheter days), one local infection (0.02/1 000 catheter days) and 4 catheter disconnections (0.09/1 000 catheter days) including 3 intra-cardiac migrations due to a defective model. These complications led to early removal of 14% of devices. The side of implantation and the type of venous access had no statistically significant incidence on postoperative complications. Operative accidents were avoided by the predominant use of venous access by dissection rather than by puncture. CONCLUSION: The complications described were considerable, notably during the intensive use of TIVAD. However they must not mask the benefits of such devices. They justify the training of medical staff and the development of preventive measures.
Authors: C Pulcini; T Couadau; E Bernard; A Lorthat-Jacob; T Bauer; E Cua; V Mondain; R-M Chichmanian; P Dellamonica; P-M Roger Journal: Eur J Clin Microbiol Infect Dis Date: 2008-09-26 Impact factor: 3.267