Evaluation use of Totally Implantable Vascular Access port for Chemotherapy During Five Years in Sanglah General Hospital Denpasar.
Evaluation Use of Totally Implantable Vascular Access Port for Chemotherapy
During Five Years in Sanglah General Hospital-Denpasar
1
2
Wayan Wahyu Sutrisna , Gede Budhi Setiawan, IBM Surya Wisesa, Putu Anda Tusta Adiputra.
1
General surgery resident, Udayana Medical Faculty/Sanglah General Hospital Denpasar,Indonesia
Surgical Oncology Consultant, Subdivision of Surgical Oncology, Udayana Medical Faculty/ Sanglah
General Hospital Denpasar,Indonesia
2
Abstract
Background: Chemotherapy is generally administered intravenously, which poses a risk of
extravasation. Administration of chemotherapy through central venous access with Totally Implantable
Vascular Access Port (TIVAP) or known as the chemo port implantation in Bali are uncommon. The
purpose of this retrospective descriptive study to evaluate the results of the implantation of chemo port
that we did during the year 2011-2015 in Sanglah General Hospital Denpasar.
Method :This study is a retrospective descriptive study of all patients implanted TIVAP over the years
2011- 2015 in Sanglah General Hospital Denpasar.
Result :The total patients admisterated for TIVAP for five year is 70 patient and mostly women (78,5%).
Breast carcinoma is the most cases 48 patient (68,5%). The difficulty peripheral venous access is the
most indications to do impalantation 46 patients (65,5%) and type vesicant chemotherapy is the second
24 patient (34,2%). Area location where implantation located mostly in the upper chest 63 patient (90%)
and operation techniques most used is the percutaneous access to the right internal jugular vein 30
patients (42,8%).
Conclusion: Totally Implantable Vascular Access Port (TIVAP) for chemotherapy at present are a safe
enough, means for the administration of chemotherapy regiment or other substances, in view of the low
number of complications observed in this study.
Keywords: TIVAP, Chemoport,Safe
Background
Majority
Chemotherapy
regiment
were
administered intravenously, which had a risk of
extravasation. Despite the incidence are rare, but it
can cause risk serious tissue damage, especially
certain the type of vesicant. Vesicant chemotherapy
administration through central venous access is a
standard of care in developed countries.
Administration of chemotherapy through central
venous access with Totally Implantable Vascular
Access or better known as the chemo port
implantation in Indonesia, especially in Bali are
uncommon. The purpose of this retrospective
descriptive study to evaluate the results of the
implantation of chemo port that we did during the
year 2011-2015 in Sanglah General Hospital
Denpasar.
The use of Totally Implantable Venous Access
Devices (TIVAPs) had made changed the way of
care and quality of life for cancer patients
underwent treated with chemotherapy. TIVAPs
represent a confort situation when long-term
venous access is needed, especially for
administration of
cytotoxic medications or
intravenous targeted agents in cancer patients
over a long period of time [1]. The current
controvesies regarding TIVAP application in clinical
practice includes the insersion site (internal,
external jugular and subclavian vein) and the
insertion technique (open, percutaneous or with
ultrasound guidance). Many expert suggesting
Cephalic vein approach has the advantage of
safety and low incidence of early complications but
it is affected by a high rate of failure[2]. Subclavian
vein approach are located in an easy accessible
area but they are affected by a relatively high risk
of thrombosis, vein stenosis, catheter fatigue and
they have the highest risk of pneumothorax at
insertion [3].
The internal jugular approach is the preferred for
tunnelled infusion catheter with the lowest
incidence of venous thrombosis [4]. Usually
percutaneus techniques through the Seldinger
technique are preferred [5-7] but in some cases
surgeons prefer the open approach in the cephalic
or subclavian vein. Early complications include:
pneumothorax,
hemothorax,
air
embolism,
accidental arterial puncture, cardiac arrhythmia,
pericardial tamponade and brachial plexus injury
[6,7]. Delay complications include: bloodstream
infection, thrombosis,
catheter dysfunction,
rupture, migration or embolisation, “pinch-off”
syndrome, superior vein cava erosion and
perforation, extravasation, pocket infection and
port inversion [8].
The improvement of the technique and the
implanted devices led to a decreased rate of
potential life threatening complications. The aim
of this study was to evaluate the results of the
implantation of chemo port that we did during the
year 2011-2015 in Sanglah General Hospital
Denpasar.
Method
This study is a retrospective descriptive study of
all patients implanted TIVAP over the years 20112015 in Sanglah Hospital Denpasar. Patient
distribution recorded and divided according to
gender, diangnosis, port location, implantation
procedure, indication, and certain complications.
Routine as a standart preoperative evaluation
included
medical
history
and
physical
examination, focusing on possible anatomic pitfalls
(cervical or mediastinal adenopathy, chest wall
tumours, previous neck or thoracic surgery), body
habitus, previous vascular access placements and
complications. Laboratory consisted in full blood
count and haemostat functions. Several condition
were not allowed for TIVAP placement are platelet
count < 80.000/mm3, INR > 1.5, neutrophil count
During Five Years in Sanglah General Hospital-Denpasar
1
2
Wayan Wahyu Sutrisna , Gede Budhi Setiawan, IBM Surya Wisesa, Putu Anda Tusta Adiputra.
1
General surgery resident, Udayana Medical Faculty/Sanglah General Hospital Denpasar,Indonesia
Surgical Oncology Consultant, Subdivision of Surgical Oncology, Udayana Medical Faculty/ Sanglah
General Hospital Denpasar,Indonesia
2
Abstract
Background: Chemotherapy is generally administered intravenously, which poses a risk of
extravasation. Administration of chemotherapy through central venous access with Totally Implantable
Vascular Access Port (TIVAP) or known as the chemo port implantation in Bali are uncommon. The
purpose of this retrospective descriptive study to evaluate the results of the implantation of chemo port
that we did during the year 2011-2015 in Sanglah General Hospital Denpasar.
Method :This study is a retrospective descriptive study of all patients implanted TIVAP over the years
2011- 2015 in Sanglah General Hospital Denpasar.
Result :The total patients admisterated for TIVAP for five year is 70 patient and mostly women (78,5%).
Breast carcinoma is the most cases 48 patient (68,5%). The difficulty peripheral venous access is the
most indications to do impalantation 46 patients (65,5%) and type vesicant chemotherapy is the second
24 patient (34,2%). Area location where implantation located mostly in the upper chest 63 patient (90%)
and operation techniques most used is the percutaneous access to the right internal jugular vein 30
patients (42,8%).
Conclusion: Totally Implantable Vascular Access Port (TIVAP) for chemotherapy at present are a safe
enough, means for the administration of chemotherapy regiment or other substances, in view of the low
number of complications observed in this study.
Keywords: TIVAP, Chemoport,Safe
Background
Majority
Chemotherapy
regiment
were
administered intravenously, which had a risk of
extravasation. Despite the incidence are rare, but it
can cause risk serious tissue damage, especially
certain the type of vesicant. Vesicant chemotherapy
administration through central venous access is a
standard of care in developed countries.
Administration of chemotherapy through central
venous access with Totally Implantable Vascular
Access or better known as the chemo port
implantation in Indonesia, especially in Bali are
uncommon. The purpose of this retrospective
descriptive study to evaluate the results of the
implantation of chemo port that we did during the
year 2011-2015 in Sanglah General Hospital
Denpasar.
The use of Totally Implantable Venous Access
Devices (TIVAPs) had made changed the way of
care and quality of life for cancer patients
underwent treated with chemotherapy. TIVAPs
represent a confort situation when long-term
venous access is needed, especially for
administration of
cytotoxic medications or
intravenous targeted agents in cancer patients
over a long period of time [1]. The current
controvesies regarding TIVAP application in clinical
practice includes the insersion site (internal,
external jugular and subclavian vein) and the
insertion technique (open, percutaneous or with
ultrasound guidance). Many expert suggesting
Cephalic vein approach has the advantage of
safety and low incidence of early complications but
it is affected by a high rate of failure[2]. Subclavian
vein approach are located in an easy accessible
area but they are affected by a relatively high risk
of thrombosis, vein stenosis, catheter fatigue and
they have the highest risk of pneumothorax at
insertion [3].
The internal jugular approach is the preferred for
tunnelled infusion catheter with the lowest
incidence of venous thrombosis [4]. Usually
percutaneus techniques through the Seldinger
technique are preferred [5-7] but in some cases
surgeons prefer the open approach in the cephalic
or subclavian vein. Early complications include:
pneumothorax,
hemothorax,
air
embolism,
accidental arterial puncture, cardiac arrhythmia,
pericardial tamponade and brachial plexus injury
[6,7]. Delay complications include: bloodstream
infection, thrombosis,
catheter dysfunction,
rupture, migration or embolisation, “pinch-off”
syndrome, superior vein cava erosion and
perforation, extravasation, pocket infection and
port inversion [8].
The improvement of the technique and the
implanted devices led to a decreased rate of
potential life threatening complications. The aim
of this study was to evaluate the results of the
implantation of chemo port that we did during the
year 2011-2015 in Sanglah General Hospital
Denpasar.
Method
This study is a retrospective descriptive study of
all patients implanted TIVAP over the years 20112015 in Sanglah Hospital Denpasar. Patient
distribution recorded and divided according to
gender, diangnosis, port location, implantation
procedure, indication, and certain complications.
Routine as a standart preoperative evaluation
included
medical
history
and
physical
examination, focusing on possible anatomic pitfalls
(cervical or mediastinal adenopathy, chest wall
tumours, previous neck or thoracic surgery), body
habitus, previous vascular access placements and
complications. Laboratory consisted in full blood
count and haemostat functions. Several condition
were not allowed for TIVAP placement are platelet
count < 80.000/mm3, INR > 1.5, neutrophil count