Application of implanted port systems during immunochemo- and infusion therapy in hematological patients
Background. Modern immunochemotherapy (ICT) and infusion therapy (IT) in the treatment of malignant lymphomas, further supportive and concomitant therapy require constant and reliable vascular access. Today, the hematology clinic uses both short-term and minimally invasive methods of vascular access (venipuncture, peripheral catheters) and long-term options (peripherally inserted central catheter, subclavian vein catheterization). The choice of the optimal method of access to vessels, its preservation and care, and the avoidance of complications associated with the functioning of such access require the joint efforts of many specialists.
Objective. To outline the indications for the establishment, advantages and disadvantages of the use of implanted port systems (IPS) in hematological patients.
Materials and methods. 8 patients with newly diagnosed malignant lymphomas and established IPS who received volumetric and long-term IT during antilymphoma treatment were observed. 7 patients were diagnosed with primary mediastinal large B-cell lymphoma (PMBCL), and 1 patient was diagnosed with Hodgkin’s lymphoma (HL). Gender distribution was the following: 7 women and 1 man. Age of patients ranged from 26 to 48 years (median – 29.8 years). Patients were implanted with one of the two IPS available on the Ukrainian market (U-port 6.6/8.4 Fr or B-Braun Celsite® ST301 6.5/8.5 Fr). Catheterization of the right or left subclavian vein was performed in the operating room using local anesthesia and under X-ray control. IPS began to be used immediately after implantation.
Results and discussion. Patients who were scheduled for long-term and volumetric infusions for the treatment of malignant lymphomas, or who had problems with short-term vascular access, were suggested to have IPS. As a result 7 patients with PMBCL received ICT, which involved a continuous 96-hour infusion of antilymphoma drugs and concomitant IT, the total volume of which was 5.0-6.5 liters per day. In 2 patients before the initiation of ICT there were significant obstacles to the establishment of short-term vascular access (phlebitis, postphlebotic changes in peripheral veins), another 1 patient had similar problems after the second course of ICT. The patient with HL at the time of chemotherapy had a poor condition of peripheral veins, which did not allow their frequent and prolonged catheterization, and the mode of application of antilymphoma drugs (every 2 weeks, 12 injections) made it inexpedient to catheterize the subclavian vein. Eventually, the presence of IPS has greatly simplified the permanent vascular access and care for the port system itself. In all of our patients, IPS ensured the continuity of the infusion and the planned volume. In the intercourse period, IPS did not require special care: patients followed their normal lifestyle, including taking a shower. Subsequently, in the long term (up to 24 months) IPS appeared to be functionally complete and with regular care (every 2-4 weeks) allowed for maintenance and concomitant therapy. One patient had a hematoma in the pocket area of the reservoir of the port system, which resolved spontaneously. No infection around the port area and no cases of catheter induced sepsis were observed. To date, IPS has been removed without complications in 5 patients, one continues ICT, and in another one IPS was decided not to be removed.
Conclusions. The use of IPS in hematological patients has shown its benefits in long-term and large-scale ICT and IT regimens to ensure persistent, multiple and safe access to blood vessels. The use of IPS is also indicated for patients with vascular lesions, venous diseases or their unsatisfactory condition. The medical staff avoids the constant search for “working vessels” for the placement of peripheral catheters or special care for the central catheter. IPS provides the opportunity to conduct initial, supportive and concomitant therapy for months with minimal care for vascular access. Complications during the installation and operation of IPS are extremely rare and minor. IPS placement can be considered an integral part of ICT and IT in the hematological practice.
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