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Impact of Port-A-Cath device management in cancer patients with candidaemia
1Division of Haematology and Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
Retaining a Port-A-Cath central venous access device during candidaemia in cancer patients is linked to worse outcomes. Device removal may be considered for patients without severe complications or specific risk factors.
Area of Science:
- Oncology
- Infectious Diseases
- Medical Devices
Background:
- Central venous access devices like Port-A-Cath are crucial for cancer patient treatment.
- Candidaemia, a fungal infection, poses a significant risk in immunocompromised cancer patients.
- The management of these devices during invasive fungal infections is critical for patient outcomes.
Purpose of the Study:
- To investigate the impact of Port-A-Cath management on cancer patients with candidaemia.
- To determine if retaining the Port-A-Cath device influences patient outcomes.
- To identify factors associated with poorer outcomes in this patient group.
Main Methods:
- Retrospective analysis of 98 cancer patients diagnosed with candidaemia.
- Evaluation of Port-A-Cath device management (retention vs. removal).
- Assessment of clinical outcomes and correlation with device status and patient factors.
Main Results:
- Port-A-Cath retention was significantly associated with poorer patient outcomes.
- This association remained significant even after adjusting for breakthrough candidaemia, high APACHE II scores, and poor ECOG performance.
- Patients without definite catheter-related candidaemia, total parenteral nutrition, severe sepsis, or poor performance scores might be candidates for device retention.
Conclusions:
- Management of Port-A-Cath devices in cancer patients with candidaemia requires careful consideration.
- Device retention is linked to adverse outcomes, independent of other severity markers.
- Individualized patient assessment is crucial to decide on Port-A-Cath management during candidaemia.
Abstract:
This study investigated the impact of management of a totally implantable central venous access port device, Port-A-Cath (Smith Medical, St. Paul, MN, USA), on the outcome of 98 cancer patients with candidaemia. Port-A-Cath retention was found to be significantly associated with poorer outcome, independent of other significant adverse factors [breakthrough candidaemia, Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 21, and worse Eastern Cooperative Oncology Group (ECOG) performance score (3-4)]. However, retention of Port-A-Cath devices could be considered in patients who do not have definite catheter-related candidaemia, are not using total parenteral nutrition, do not have poor ECOG performance scores or APACHE II scores, and do not have septic shock.
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