title: Incidence of mechanical malfunction in low-profile subcutaneous implantable venous access devices in patients receiving chemotherapy for gynecologic malignancies.
abstract: OBJECTIVE
  The purpose of this study was to investigate the incidence of mechanical complications associated with low-profile subcutaneous implantable venous access devices in gynecologic oncology patients.
  
  
  METHODS
  Gynecologic oncology patients with low-profile Port-a-Caths implanted between March 2005 and July 2006 were identified into a computerized database. Patient demographics, operative complications, number of chemotherapy cycles, duration of implantation, and mechanical complications were collected. Primary outcomes included port leakage, catheter fracture, and catheter embolization.
  
  
  RESULTS
  112 patients underwent 115 Port-a-Cath placements with low profile single-lumen plastic ports with Groshong-valved catheters. Mean Port-a-Cath indwelling duration was 197 days (range: 4-395) with a mean number of 12 chemotherapy cycles (range 0-64). The cumulative complication rate necessitating removal or replacement was 15%. Of the 14 Port-a-Caths removed, ten (8.7%) were secondary to mechanical malfunction: one for leakage at the port site, two for catheter fracture, and seven for fracture with catheter embolization to the heart or pulmonary vasculature-most commonly the right ventricle. Patients with embolization were asymptomatic and all embolized catheters were successfully retrieved by interventional radiology without complications.
  
  
  CONCLUSIONS
  The rates of catheter fracture and embolization have previously been reported to be low in patients with subcutaneous Port-a-Caths, and have not been studied in patients receiving low-profile subcutaneous Port-a-Caths. This study suggests that catheter fracture may be more common (8.7%) and must be considered in patients with malfunctioning low-profile Port-a-Caths. Embolized catheters can be removed by interventional radiology without significant adverse affects.
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35223, USA. akila.subramaniam@gmail.com
authors: Akila
authors: A
authors: Subramaniam
authors: Kenneth H
authors: KH
authors: Kim
authors: Shannon A
authors: SA
authors: Bryant
authors: Kristopher J
authors: KJ
authors: Kimball
authors: Warner K
authors: WK
authors: Huh
authors: J Michael
authors: JM
authors: Straughn
authors: Jacob M
authors: JM
authors: Estes
authors: Ronald D
authors: RD
authors: Alvarez
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents