title: The timing and sequence of multiple device-related complications in patients with indwelling subcutaneous ports.
abstract: BACKGROUND
  Multiple complications associated with venous access ports are a common occurrence. In an effort to define patterns of sequential complications in our community, we undertook a prospective analysis of adult cancer patients in whom a subcutaneous port was inserted.
  
  
  METHODS
  One hundred nineteen consecutive adult cancer patients in whom a subcutaneous port was inserted were observed prospectively for the development of complications.
  
  
  RESULTS
  Complications were identified in 70 of the 91 evaluable patients, while sequential complications were identified in 35 patients (38%). In aggregate, 121 complications were identified. The ball-valve effect, the most frequently identified problem, was found to occur disproportionately as a primary complication (52 of 70 versus 26 of 51, P <0.02). In contrast, port-related venous thrombosis was identified most frequently as a subsequent complication (11 of 51 versus 4 of 70, P <0.02). The only identified risk factor for the development of port-related complications was the ball-valve effect, found to be associated with the subsequent development of port-related venous thrombosis (9 of 52 versus 2 of 69, P <0.02).
  
  
  CONCLUSIONS
  Multiple sequential complications of subcutaneous ports are common and occur in a rather predictable order. The occurrence of port-related venous thrombosis in patients with an earlier, relatively minor vascular complication (ball-valve effect) suggests a cause-effect relationship. Insight into complication sequencing may lead to improved strategies for prevention and therapy.
authors.affiliation: Oncology Associates of West Kentucky, Paducah 42001, USA.
authors.forename: C
authors.initials: C
authors.lastname: Young
authors.forename: J R
authors.initials: JR
authors.lastname: Gould
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D013924:Thrombophlebitis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors