Incidence and management of catheter occlusion in implantable arm ports: results in 391 patients.
OBJECTIVE
To evaluate the incidence and management of catheter occlusion in implantable arm ports.


METHODS
Findings were prospectively examined in 391 patients in whom 393 arm ports were placed. The indications for port placement included chemotherapy (n = 347), antibiotic administration (n = 35), combination chemotherapy/antibiotic use (n = 7), transfusion (n = 3), and phlebotomy (n = 1). Of the total catheters, 323 (82.2%) underwent tip modification prior to placement. Malfunctioning catheters were usually treated with urokinase instillation.


RESULTS
Three hundred ninety-three devices were implanted with 247 mean days of catheter use (total, 97,256 days; range, 1-694 days). The overall incidence of catheter occlusion was 0.14 per 100 catheter days. A single catheter occlusion occurred in 90 (22.9%) catheters, with a mean of 90.1 days before the event. A second occlusion occurred in 36 (9.2%) of the above catheters, with a mean of 60.1 catheter days before the second event. Eighty-five (24.0%) of the 347 cancer patients had at least one occlusive event, yielding a complication rate of 0.098 per 100 catheter days at risk (95% confidence interval [CI]; 0.079-0.114). Of the 35 patients receiving antibiotics, three (8.6%) had at least one occlusive event. This represented a complication rate of 0.032 per 100 catheter days at risk (95% CI; 0.010-0.061). Seventeen (24.3%) of the nonmodified catheters developed an occlusion versus 72 (22.3%) of the modified (P > .05; Fisher exact test). Of the catheters with a first occlusive event, 75 (98.7%) were treated successfully with urokinase instillation. Four (1.0%) patients developed symptomatic subclavian vein thrombosis. No bleeding complications occurred.


CONCLUSIONS
Catheter occlusion is a common complication of long-term arm port placement, with a significantly higher incidence in the cancer patients in our series (P <. 05, Fisher exact test). Catheter tip modification, however, does not considerably affect the incidence of occlusion. Low-dose urokinase therapy is a safe and efficacious treatment of catheter occlusion, obviating the need for catheter removal.
Whigham
C J
CJ
Baylor College of Medicine, Houston, TX 77030, USA.
Greenbaum
M C
MC
Fisher
R G
RG
Goodman
C J
CJ
Thornby
J I
JI
Thomas
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001803:Blood Transfusion / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016001:Confidence Intervals; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005337:Fibrin; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000295:instrumentation; D010960:Plasminogen Activators / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013350:Subclavian Vein / Q000473:pathology; D013499:Surface Properties; D013927:Thrombosis / Q000188:drug therapy; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D005337:Fibrin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator