title: Fractures of totally implantable central venous ports: more than fortuity. A three-year single center experience.
abstract: OBJECTIVE
  Totally implantable venous access devices (Ports) represent the mainstay for infusion therapy in patients undergoing chemotherapy, total parenteral nutrition and/or long-term antibiotic treatment. Amongst mechanical complications, lesions of the catheter wall represent a rare but potentially severe condition. We report our experience with the accidental detection of catheter ruptures in a series of ports removed for complication or for end of use.
  
  
  METHODS
  All ports removed from January 2011 to June 2013 were considered. All removed ports had been inserted according to a standardized protocol including ultrasound-guided percutaneous venipuncture (out-of-plane or in-plane approaches) and electrocardiogram-guided positioning of the tip. Once removed, each catheter was checked by inspection and saline instillation in order to evaluate the integrity of the device itself and rule out possible ruptures.
  
  
  RESULTS
  In over 338 removed ports, 12 Groshong catheters out of 65 (18.5%) had evidence of partial rupture of the catheter wall. Amongst considered variables, "out-of-plane" approach and type of port (silicon, closed tip with Groshong valve) were the only ones significantly associated with catheter ruptures (p=0.0003 and 0.0008, respectively). We could detect no evidence of rupture in any silicon open-ended catheter (Celsite ports) or in any catheter inserted by "in-plane" approach to the vein.
  
  
  CONCLUSIONS
  The actual advantage of using port connected with Groshong silicon catheters should be questioned, since apparently they are more fragile than standard catheters. Furthermore, ultrasound-guided "out-of-plane" puncture of the internal jugular vein should be discouraged.
authors.affiliation: 1 Department of Health Science, Section of Anaesthesiology, Intensive Care and Pain medicine, AOUC Careggi, Florence - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Balsorano
authors.forename: Giulia
authors.initials: G
authors.lastname: Galducci
authors.forename: Ilaria
authors.initials: I
authors.lastname: De Fanti
authors.forename: Samuel Kagan
authors.initials: SK
authors.lastname: Evans
authors.forename: Angelo Raffaele
authors.initials: AR
authors.lastname: De Gaudio
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pelagatti
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D020878:Device Removal / Q000379:methods; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007558:Italy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional