Pinelli Fulvio, Cecero Elena, Degl'Innocenti Dario, Selmi Valentina, Giua Rosa, Villa Gianluca, Chelazzi Cosimo, Romagnoli Stefano, Pittiruti Mauro
1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
2 Department of Health Science, University of Florence, Florence, Italy.
J Vasc Access. 2018 May;19(3):230-242. doi: 10.1177/1129729818758999. Epub 2018 Mar 7.
Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient's quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients' morbidity and mortality-both in the hospital or outpatient setting-and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device-related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device-related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device-related infections.
完全植入式静脉通路装置，即端口，对于需要长期间歇性静脉治疗的患者的治疗管理至关重要。完全植入式静脉通路装置可确保安全输注化疗药物、输血、肠外营养以及采集重复血样。完全植入式静脉通路装置减少了频繁进行血管穿刺的需求，还提高了患者的生活质量。尽管如此，完全植入式静脉通路装置并非没有并发症。其中，感染最为相关，在医院或门诊环境中均会影响患者的发病率和死亡率，并增加医疗成本。了解完全植入式静脉通路装置相关感染的发病机制和危险因素对于根据最佳现有证据采用适当的置管包和维护包来预防这种情况至关重要。感染的早期诊断和及时治疗至关重要。当发生完全植入式静脉通路装置相关感染时，在治疗这种并发症时应选择移除装置或采取保守方法。对于预防和治疗而言，抗菌封管是一个主要的争议点，也是未来临床研究的一个有前景的领域。本文就完全植入式静脉通路装置相关感染的流行病学、发病机制和危险因素、诊断、预防及治疗方面的现有证据进行综述。
