[Spectrum of indications and perioperative management in i. v. port-a-cath explantation--alternative administration of taurolin in case of i. v. port-a-cath infection].
BACKGROUND
The aims of this systematic investigation were to analyse i) causes and complications leading to i. v. port-a-cath explantation and ii) a specific therapeutic option (taurolin administration via i. v. port-a-cath) in the case of an i. v. port-a-cath infection in a pilot study with regard to the feasibility and efficacy to finally avoid -explantation.


METHODS
Based on a prospective, unicentre observational study on the implantation of an i. v. port-a-cath (daily surgical practice) enrolling consecutive patients of a representative number and through a defined study period (design, case series), besides patient and intervention-associated characteristics, we investigated 1. the spectrum of causes for an i. v. port-a-cath explantation; 2. the option of a conservative i. v. port-a-cath-maintaining, endoluminal, antiseptic local therapy in a selected number of patients with microbiologically detected infection of the i. v. port-a-cath using 2 x 5.0 ml taurolin 2.0 % / d for 3 d as an accompanying clinical observation of initial therapeutic use and its effect. Thereafter, microbe detection was again compared between blood culture and the port-a-cath catheter.


RESULTS
From 2002 to 2005, overall 1588 i. v. port-a-caths were implanted at the Department of -General, Abdominal and Vascular Surgery (University Hospital, Magdeburg, Germany). 1) In -total, 117 patients (69 females vs. 48 males; sex ratio, 1.44 : 1) with complications and subsequent indication for an explantation of the i. v. port-a-cath were observed (most frequent cause: infection of the i. v. port-a-cath, 40 %). 2) Taken together, 10 patients underwent systematic administration of taurolin and follow-up investigation: In 8 of 10 patients (success rate, 80 %), the infection of the i. v. port-a-cath could be successfully treated with taurolin-administration as described and, in addition, the threatening -explantation of the i. v. port-a-cath could be avoided.


CONCLUSIONS
There are various indications for the necessary -explantation of an i. v. port-a-cath, which need to be precisely analysed to avoid long-term consequences. Infection of the i. v. port-a-cath is the main reason for explantation and may be successfully treated with taurolin in selected cases under short-term clinical and microbiological control. The up to now urgently indicated explantation of an i. v. port-a-cath can thus be circumvented. However, a further systematic case series with a representative case number and intermediate, case-specific follow-up investigations appear to be desirable.
Weber
M
M
Aus dem Gefässchirurgischen Arbeitsbereich, Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Universitätsklinik, Magdeburg. mathias.weber@med.ovgu.de
Meyer
F
F
Halloul
Z
Z
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000628:therapy*; D001424:Bacterial Infections / Q000628:therapy*; D002408:Catheters, Indwelling; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000628:therapy*; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013829:Thiadiazines / Q000008:administration & dosage*; D055815:Young Adult
D000890:Anti-Infective Agents; D013829:Thiadiazines; D013654:Taurine; C012566:taurolidine