Chest Port Placement in Freestanding Outpatient Vascular Access Centers

TL;DR

This study shows that placing chest ports in outpatient centers is safe and effective for short-term use.

Contribution

The paper reports the first peer-reviewed experience of port placement in freestanding outpatient vascular access centers.

Findings

No short-term malfunctions were reported among 5,890 port placements.

Most complications were minor, with no leaks reported and low mean peak pain scores.

Port placement in outpatient settings appears safe and effective based on the study's results.

Abstract

Background

Ports have traditionally been inserted in hospitalized inpatients; however, there has been an increasing transition to outpatient placement by interventionalists in hospital imaging suites. To our knowledge, port implantation in nonhospital settings has not been reported in peer-reviewed literature. Here, we report our experience with port placement in freestanding outpatient vascular centers.

Methodology

The electronic medical record for 47 centers was retrospectively searched to identify port placements between January 1, 2012, and December 31, 2018. Data included indications, platelet inhibitor/anticoagulants, American Society of Anesthesiologists (ASA) classification, port type, site, tip position, peri-procedure medications, procedure time, and pain scores. Complications were determined by phone calls at 48-72 hours.

Results

No short-term malfunctions were reported. In total, 5,890 ports were placed for chemotherapy (n = 5,531), IV therapy (n = 77), antibiotics (n = 74), hyperalimentation (n = 19), phlebotomy (n = 7), medications (n = 4), miscellaneous (n = 74), and unknown (n = 104). Regarding ASA classifications, 1% (n = 65) were categorized as Class I, 20% (n = 1,203) as Class II, 78% (n = 4,592) as Class III, and 0.5% (n = 30) as Class IV. Overall, 3,712 were single-lumen power ports, 341 dual-lumen, 19 unknown, 7 arm, 1 other, and 1,810 were unspecified. There were 5,855 chest, 19 arm, 1 thigh, and 15 unspecified ports. Tips were positioned in the superior vena cava (n = 1,582), superior vena cava-right atrium (n = 497), right atrium (n = 272), inferior vena cava (n = 2), inferior vena cava-right atrium (n = 1), or not specified (n = 3,536). The mean procedure time was 29 minutes (range = 6-137). The mean peak pain score was 0.86 (range = 0-10). Complications (n = 33) included 16 emergency/hospital admissions <24 hours for port-site bleeding (2), infection (1), pneumothorax (1), EKG changes (1), respiratory symptoms (3), tachycardia (2), unconfirmed infection (1), fall (1), chest pain (1), syncope (1), pain (1), or other (1). Furthermore, 17 Other complications included unrelated/unconfirmed infection (4), death <30 days (1), shortness of breath (1), infection (1), reversal agent (1), hypoglycemia (1), fall (1), and other (7). No leaks were reported.

Conclusions

According to the study findings, port placement in outpatient centers appears to be safe and provides short-term effectiveness.