title: Risk factors for infectious and noninfectious complications of totally implantable venous catheters in cancer patients.
abstract: OBJECTIVE
  The aim of this study was to investigate the risk factors for complications of totally implantable catheters in a referral cancer center.
  
  
  METHODS
  This was a retrospective study of prospectively collected data of all consecutive cancer patients undergoing port placement, with a primary outcome of interest of major complication and subanalysis of the types of complications.
  
  
  RESULTS
  We studied 1255 nonvalved implanted port catheters inserted in 1230 patients, for a combined total of 469,882 catheter-days of use. Venous puncture was ultrasound (US)-guided in 1049 cases (84%). Inadvertent arterial puncture occurred in 14 cases (1.1%) and was more frequent in procedures not guided by US (P = .045). Among the outpatients, 90 (9%) developed infection, and 75 (29%) of the hospitalized patients (P < .001) developed infections. Infection was diagnosed in 131 catheters (13%) implanted through the internal jugular vein (IJV), 23 catheters (14%) implanted in the subclavian vein (SCV), 1 catheter (5%) implanted in the external jugular vein, and 10 catheters (31%) implanted in the femoral vein (P = .044). In the multivariate analysis, only the hospitalization regimen maintained statistical significance, with hospitalization presenting as a risk factor for infection (P < .001). Regarding the introduction site, ambulatory patients in whom the femoral vein was the site of access had more infections than the others (28.6% vs 9.4% of the IJV, 4.8% of the SCV, and 4.8% of the external jugular vein; P = .019), which did not occur among the hospitalized patients (33.3% vs 26.5% of IJV and 39.5% of the SCV; P = .218).
  
  
  CONCLUSIONS
  Not using US is a risk factor for iatrogenic arterial puncture. Port implantation in hospitalized patients and the use of femoral access are risk factors for infection.
authors.affiliation: Vascular and Endovascular Surgery Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: aezerati@uol.com.br.
authors.forename: Antonio Eduardo
authors.initials: AE
authors.lastname: Zerati
authors.affiliation: Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Tamires Rocha
authors.initials: TR
authors.lastname: Figueredo
authors.affiliation: Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Richard Diego
authors.initials: RD
authors.lastname: de Moraes
authors.affiliation: Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Amanda Monteiro
authors.initials: AM
authors.lastname: da Cruz
authors.affiliation: Interventional Radiology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Joaquim Mauricio
authors.initials: JM
authors.lastname: da Motta-Leal Filho
authors.affiliation: Infection Control Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Maristela Pinheiro
authors.initials: MP
authors.lastname: Freire
authors.affiliation: Vascular and Endovascular Surgery Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.affiliation: Vascular and Endovascular Surgery Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: de Luccia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010361:Patients; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013350:Subclavian Vein; D055815:Young Adult