Background: Totally implantable vascular access devices (TIVAD) are considered safe and reliable for the administration of intravenous therapies, including chemotherapy and blood sampling. They provide direct vascular access through a simple percutaneous puncture. However, in order to avoid paravenous injection, it is mandatory to check for blood withdrawal before administering medication: this simple procedure confirms both the system’s patency, correct needle position in the chamber and the catheter tip’s intravascular location. This study’s objective was to evaluate the incidence of partial and total blood withdrawal impairment in TIVADs directly after accessing the port system.
Material and Methods: From November 2003 to March 2004, nurses from 20 hospitals in Flanders (Belgium) agreed to take part in a prospective cohort study and collect data on TIVAD access procedures in cancer patients. In case of blood withdrawal problems or device occlusion, they recorded all actions needed for diagnosing the cause of the problem and restoring patency. In each hospital, TIVAD maintenance and solutions for troubleshooting were performed according to individual institutional protocols.
Results: The data included 8685 accesses in 2853 patients. The incidence of blood withdrawal occlusion and total occlusion were 11.11% and 0.24% respectively. Overall incidence varied between hospitals from 3.05% to 28.37%. Nurses restored full device patency in 53.25% of cases, mostly by changing patients’ position or intrathoracic pressure, additional flushing and repositioning of the Huber needle in the port septum. In 83.51% of persistent occlusions, no further investigation into the cause of the functional impairment was undertaken. Thirty-one events of occlusion (3.14%) were treated by thrombolytics or device replacement. Altogether, blood aspiration was regained in 55.17%.
Conclusions: Withdrawal and total occlusion problems occurred in 11.35% of TIVAD access and were resolved by nurses’ interventions in 53.25% of cases. The incidence expressed in function of the number of punctures reflects accurately the impact of this problem in daily practice. The differences between hospitals revealed that prevention of occlusion and established protocols for maintenance or troubleshooting solutions are important factors to maintain optimal TIVAD patency and deserves further analyses.