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Totally Implantable Venous Access Ports Systems (TIVAPS). One cancer center prospective study. Totally Implantable Venous Access Ports Systems ( TIVAPS ). Patient Veinous integrity Normal physical activity. Medical team Access reliability Care. Prospective study 815 patients.

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Totally Implantable Venous Access Ports Systems (TIVAPS)

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TotallyImplantable Venous Access Ports Systems (TIVAPS)

One cancer center prospective study


TotallyImplantable Venous Access Ports Systems(TIVAPS)

  • Patient

  • Veinous integrity

  • Normal physical activity

  • Medical team

  • Access reliability

  • Care


Prospective study815 patients

May 2nd 2006 – April 30th 2007


TIVAPS

Polysite

PEROUSE (Ivry Le Temple-France)


Women: 64%

56.2 years(0.8 – 85.2)

BMI = 25.03 (12.7-58.4)

Use of lowweightheparin

14%


One-Year TIVAPS

24% in tumoral progression

Indication = 97% for chemotherapy

314

123

79

77

77

64

47

33


PEROPERATIVE DATA

  • Local anesthesia = 91%

  • Final venous access in 96%

    • External jugular vein

    • Cephalic vein

  • Number of attempts

    • >=2 in 17%


OPERATING DATA

Surgeon

Operating time

30 min skin to skin


FIRST USE OF TIVAPS

%

  • Median time= 8 days (0 – 135)

  • Use easiness

    • 0 = easy

    • 7 = hard


TIAPS and Morbidity2006-2007

16.1%

LITT = 8.6-31%

Schwarz RE et al . Cancer 1999;79:1635

Kock HJ et al. World J Surg 1998;22:12

Lersch C et al. Oncology 1999;57:269

Aldrighetti L et al. J Vasc Access 2000;1:28

Chang HM et al. Eur J Surg Oncol 2006;32:90

Shetty PC et al. J Vasc Interv Radiol 1997;8:991

Hata Y et al. Cardiovasc Intervent Radiol 1998;21:230

Zahringer M et al. Rofo 2006;178:324

Cil BE et al. Diagn Interv Radiol 2006;12:93

Marcy PY et al. Cancer 2007;110:2331


Morbidité CCI2006-2007

Morbidity=16.1%

Death=0

N=131/815


Causes for early removal of TIVAPS

  • N=55 (6.8%)

  • Median time before removal

    • 3.7 months (0.2-12)

  • 60%

    • Infection

    • Incision dehiscence


Facteurs prédictifs complications

DELAI pose-1ère utilisation

Difficulté de pose

  • Complications

    • Infection+++

    • Cutaneous troubles+++

    • Inflammation

    • Incision Dehiscence


Predictive factors of complication

Not to use TIVAPS before 8 days


Not to use TIVAPS before 8 days

Key points for improvement

Hind et al BMJ 2003;327:361. Metaanalysis

Narducci et al EJSO 2011;37,913

Decrease of early removal for complication

Infection

Cutaneous troubles

Incision dehiscence

Increase rate of success

with first attempt (> 83%)

  • ULTRA SOUND GUIDED VENIPUNCTURE

  • 90% success rate of puncture

  • complications (anatomic variations)

  • operating time (20 min)

  • patient comfort


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