Evaluation Use Of Totally Implantable Vascular Access Port For Chemoterapy 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
Wayan Wahyu Sutrisna , Gede Budhi Setiawan, IBM Surya Wisesa, Putu Anda Tusta Adiputra.
2
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 [57] 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/mm 3, INR > 1.5, neutrophil count
During Five Years in Sanglah General Hospital-Denpasar
1
Wayan Wahyu Sutrisna , Gede Budhi Setiawan, IBM Surya Wisesa, Putu Anda Tusta Adiputra.
2
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 [57] 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/mm 3, INR > 1.5, neutrophil count