Pre-Operative Indicators for Venous Complications Associated With Implanted Ports
Jill Zink, MD, Patricia Labbe, CNP, Sean Healy, BS, Neil Rangwani, BS, Robert Netzley, MD, Dennis Wright, MD.
Cleveland Clinic Akron General, Akron, OH, USA.
OBJECTIVES: Complications of implanted ports cause significant morbidity and delay in treatment of patients requiring prolonged intravenous access. Predicting these complications may allow for prevention or alternative therapies, resulting in improved outcomes and patient care.
METHODS: A retrospective review of 446 charts was preformed over 15 years (1999-2014). Evaluation of placement site, indication for procedure, and diagnostic laboratory values were reviewed to determine significance as they related to complications.RESULTS: A total of 446 ports were placed (372 arm, 74 chest). The overall complication rate (infection, thrombosis, erosion, mechanical failure) was 13.7%. There was no significant difference in complication rate with respect to the implantation site (p = 0.272). One hundred twenty-three patients had a pre-procedure white blood cell count (WBC) within five days of port placement, with 13 patients having a WBC <4.4x103/mcL and 34 having a WBC>9.7x103/mcL. Overall, 15 patients (12.2%) developed a port infection and 3 patients (2.4%) had deep vein thrombosis (DVT) or thrombosis. There was a significant increase in complication of port infection, thrombosis, or both when a patient had a WBC>9.7x103/mcL within five days (p<0.05 - Table 1). Three hundred sixty-one ports were placed for malignancy and 85 were placed for other non-malignant indications. There was a statistically significant increase in complication rates in the malignancy group (p <0.001). There was a significant association between specific indications for placement and port complication rate (p < 0.01) with anemia, hematopoetic, and gynecologic malignancies having a higher risk of port complication.CONCLUSIONS: WBC appears to have a significant association with post implant complication rates. Both infection and thrombosis rates were increased with elevated WBC raising the possibility that elevated WBC is a surrogate indicator of systemic inflammatory response, increasing the risks of infection and thrombosis. If possible one should consider delaying permanent port placement until WBC normalizes utilizing alternative venous access to decrease serious complications. Site of implantation has no impact on complication rate. Ports placed for an indication of malignancy, especially hematopoetic or gynecologic malignancy, have an increased complication rate. Further evaluation is needed to determine if alternative access will improve outcomes in this group of patients.
|Total # pts||# with infection||# with thrombosis||# with infection or thrombosis|
|4.4x103/mcL>WBC>9.7x103/mcL||47||13 (27.7%)||3 (6.4%)||16 (34%)|
|4.4x103/mcL<WBC<9.7x103/mcL||76||2 (2.6%)||0 (0%)||2 (2.6%)|
|WBC<4.4x103/mcL||13||2 (15.4%)||0 (0%)||2 (15.4%)|
|WBC>4.4x103/mcL||110||13 (11.8%)||3 (2.7%)||16 (14.5%)|
|WBC>9.7x103/mcL||34||11 (32.4%)||3 (8.8%)||14 (41.2%)|
|WBC<9.7x103/mcL||89||4 (4.5%)||0 (0%)||4 (4.5%)|
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