Tashi Sonam, Tan Alfred Bingchao, Chua Jasmine Ming Er, Lim Gek Hsiang, Venkatanarasimha Nanda, Chandramohan Sivanathan
Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
Health Services Research Unit, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2024 Dec 3;54(1):27-35. doi: 10.47102/annals-acadmedsg.2024166.
Totally implantable venous access devices (TIVADs) or ports are increasingly used in oncology settings to provide long-term, easy venous access. This study reports our experience and results with 1180 cases in Singapore.
Data from January 2019 to January 2022, obtained from a hospital-approved secure database application called the Research Electronic Data Capture registry, were reviewed and analysed retrospectively.
A total of 1180 patients underwent TIVAD implantation with a 100% technical success rate. The mean age of the cohort was 61.9 years. The mean dwell duration was 342 days (standard deviation [SD] 223; range 3-1911). By 1 February 2022, 83% of patients were still using the TIVAD, 13.6 % underwent removal after completion of treatment, 2.1% were removed due to infection, 0.6% due to malfunction, 0.6% due to port extrusion and 0.1% at patient's request. The right internal jugular vein (IJV) was the most commonly accessed site (83.6%), followed by the left IJV (15.6%). The early post-procedure complications were pain (24.7%), bruising (9.2%), swelling (3.6%), bleeding (0.5%), fever (0.4%), itchiness (0.2%) and allergic dermatitis (0.1%). The delayed post-procedure complications were TIVAD site cellulitis (3.80%); discharge (1.10%); skin erosion with device extrusion (0.60%); malpositioned catheter (0.33%), which was successfully repositioned, catheter-related bloodstream infections (0.25%); migration of TIVAD leading to catheter dislodgement (0.25%); venous thrombosis (0.25%); fibrin sheath formation requiring stripping (0.10%) and TIVAD chamber inversion (0.10%).
TIVAD implantation via the jugular vein under radiological guidance provides a safe, reliable and convenient means of long-term venous access in oncology patients. By sharing our experience and acceptable outcomes from a large oncology cohort, we aim to increase the awareness and adoption of TIVAD usage in oncology patients, especially in Asia.
完全植入式静脉通路装置（TIVADs）或端口在肿瘤治疗环境中越来越多地被用于提供长期、便捷的静脉通路。本研究报告了我们在新加坡1180例病例中的经验和结果。
回顾性分析2019年1月至2022年1月的数据，这些数据来自一个名为研究电子数据采集登记处的医院批准的安全数据库应用程序。
共有1180例患者接受了TIVAD植入，技术成功率为100%。该队列的平均年龄为61.9岁。平均留置时间为342天（标准差[SD]223；范围3 - 1911天）。截至2022年2月1日，83%的患者仍在使用TIVAD，13.6%在治疗完成后拔除，2.1%因感染拔除，0.6%因故障拔除，0.6%因端口挤压拔除，0.1%应患者要求拔除。右颈内静脉（IJV）是最常穿刺的部位（83.6%），其次是左颈内静脉（15.6%）。术后早期并发症包括疼痛（24.7%）、瘀斑（9.2%）、肿胀（3.6%）、出血（0.5%）、发热（0.4%）、瘙痒（0.2%）和过敏性皮炎（0.1%）。术后延迟并发症包括TIVAD部位蜂窝织炎（3.80%）；分泌物（1.10%）；皮肤糜烂伴装置挤压（0.60%）；导管位置不当（0.33%，已成功重新定位）、导管相关血流感染（0.25%）；TIVAD移位导致导管脱位（0.25%）；静脉血栓形成（0.25%）；需要剥离的纤维蛋白鞘形成（0.10%）和TIVAD腔倒置（0.10%）。
在放射学引导下经颈静脉植入TIVAD为肿瘤患者提供了一种安全、可靠且便捷的长期静脉通路方式。通过分享我们在一个大型肿瘤队列中的经验和可接受的结果，我们旨在提高对肿瘤患者使用TIVAD的认识和采用率，尤其是在亚洲。
