Produccion de corriente

review

Annals of Oncology 19: 9–15, 2008 doi:10.1093/annonc/mdm272 Published online 9 September 2007

Management of venous port systems in oncology: a review of current evidence
¨ S. Vescia1§, A. K. Baumgartner2§*, V. R. Jacobs2, M. Kiechle-Bahat2, A. Rody3, S. Loibl1,3 & N. Harbeck2
1

¨ ¨ German Breast Group, Neu Isenburg; 2Frauenklinik rechts der Isar, Technische Universitat Munchen;3Frauenklinik, Universitatsklinikum Frankfurt am Main, ¨ Germany

Received 17 March 2007; accepted 30 April 2007

Background: Over the last decades, many changes have occurred in oncology with new chemotherapy
combinations and more complex application schemes becoming available. Central venous catheters and implantable venous port systems have become widely used and have facilitated theproblem of vascular access. However, important complications are associated with permanent central venous catheters. Material and methods: This review summarizes evidence on venous port system use published in Medline up to February 2007. Moreover, recent guidelines for the prevention and management of catheter-related infections issued by the Infectious Diseases Society of America, the AmericanCollege of Critical Care Medicine, the Society for Healthcare Epidemiology of America, the Center for Disease Control and Prevention, Atlanta, and the Infectious Diseases Working Party of the German Society of Hematology and Oncology are included. Results: Sterile precautions are essential when implanting and accessing port systems. Infections must be treated with adequate antimicrobial therapy.Catheter-related thromboembolic complications were found at a rate of 12–64% in retrospective studies. Five current clinical trials investigated the effect of prophylactic anticoagulation with either low molecular weight heparin or warfarin in cancer patients with central venous devices. On the basis of these results, routine anticoagulation cannot be recommended. Conclusions: This article reviews thecurrent literature on long-term complications of venous port systems, focusing on infection and thrombosis. In addition, it summarizes the evidence regarding routine maintenance of port systems in follow-up care. Key words: central venous catheter, chemotherapy, infection, thrombosis, venous port system

introduction
In 1973, the first long-term central venous catheter (CVC) was used forparenteral nutrition [1]. In 1979, the Hickman catheter, a long-term venous access device, was used for chemotherapy for the first time [2]. The introduction of totally implantable port systems started in the early 1980s [3]. Today, these devices provide easy vascular access for delivery of chemotherapy, fluids, medications, blood products and parenteral nutrition solutions. Over the last few decades, manymanagement changes in oncology have occurred, particularly with respect to new chemotherapy combinations and more complex application schemes. Cancer patients usually require repeated venous punctures for treatment monitoring, application of chemotherapy or blood transfusions. Central venous catheters and implantable port
¨ *Correspondence to: Dr A. K. Baumgartner, Frauenklinik rechts der Isar derTechnische ¨ Universitat Munchen, Ismaninger Str. 22, 81675 Munchen, Germany. ¨ ¨ Tel: +49-(0)894140-6658; Fax: +49-(0)894140-4846; E-mail: annebaumgaertner@web.de
§

Both authors contributed equally to this manuscript.

systems have therefore substantially facilitated the problem of vascular access. To date, safe and easy-to-handle port systems have become an integral part of daily clinicalroutine in oncology [4]. However, there are several rare but nevertheless important complications associated with permanent central venous catheters [5]. After immediate perioperative and short-term complications such as accidental arterial puncture, haematoma, air embolism, pneumothorax or vessel perforation [6], clinical oncologists are most often concerned with major long-term complications...