Subcutaneously implanted central venous access devices in cancer patients: a prospective analysis

Long term intravenous access is a common requirement for cancer patients. This analysis was designed to determine device-related morbidity and factors predictive of poor long term outcome for patients with subcutaneous single lumen intravenous access ports.

Six hundred eighty patients who underwent subcutaneous intravenous port placement between June 1987 and May 1989 at Memorial Sloan-Kettering Cancer Center were followed prospectively until port removal, death, or a maximum of 1960 days. Indications for and circumstances of placement, patient diagnoses, patient demographics, and subsequent courses of treatment were recorded, as well as technical and microbiologic device-related complications. Total, device specific, and complication free device durations were calculated.

The median patient age was 52.4 years (range, 1.6-83.9 years). The female-to-male ratio was 1.5 to 1. Cancer diagnoses included solid organ tumors (84%), leukemia (4%), lymphoma (11%), and others (1%). Indications included access for systemic chemotherapy (98%), total parenteral nutrition (0.5%), and others (1.5%). One insertion complication and six insertion failures occurred, without mortality. The estimated mean overall actuarial device specific duration was 1191 days (range, 2-1960 days). Actuarial mean complication free, device specific duration was 952 days. Complications included sepsis (n = 31; 4.4%), site infection (n = 31; 4.4%), and accessibility failures such as thrombosis and leakage (n = 40, 5.7%). Reasons for end of port duration were patient death (72.4%), end of treatment (13.5%), functional failure or intractable infection (11.2%), and others (2.9%). Independent factors correlating with decreased port specific, complication free duration included placement site, age, tumor type, and catheter tip position.

Subcutaneous intravenous access ports in cancer patients are safe and well tolerated. Long term device duration is primarily influenced by patient survival. In this study, 90% of patients alive at 1 year and 70% of patients alive at 4 years had a functional port.