Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients.

IF 2.6 4区 综合性期刊 Q2 MULTIDISCIPLINARY SCIENCES Science Progress Pub Date : 2024-07-01 DOI:10.1177/00368504241260374
V Maňásek, J Zapletalová, L Olosová, I Filáková, I Kociánová, K Drdová, J Škarda, V Chovanec, D Vrána
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Abstract

Introduction: Persistent withdrawal occlusion (PWO) is a specific catheter malfunction characterized by the inability to withdraw blood through the device. The most common cause of PWO in ports is the presence of a fibroblastic sleeve (FS). If malfunction occurs, medication can be applied incorrectly with the increased risk of complications.

Methods: One hundred seventy-seven cases of PWO in venous ports were managed. We focused on evaluating the cause of PWO, the frequency of occurrence of FS, and the options to address the malfunction. The patients underwent fluoroscopy with a contrast agent administration. Mechanical disruption (MD) with a syringe of saline using the flush method was used; in case of its failure, subsequent administration of a lock solution with taurolidine and urokinase, or low-dose thrombolysis with alteplase was indicated. Demographic data were compared with a control group.

Results: A significantly higher proportion of female patients was found in the cohort of patients with PWO (80.3% vs 66.3%, p = 0.004), dominantly patients with ovarian cancer (12.8% vs 4.8%, p = 0.022). No effect of the cannulated vein or the type of treatment on the incidence of PWO was demonstrated. The presence of FS was verified in 70% of cases. MD with a syringe was successful in 53.5% of cases. A significantly shorter time to referral (3 weeks) was demonstrated with successful management. The overall success rate of achieving desobliteration by MD alone or in combination with a thrombolytic (urokinase or alteplase) administration was 97.4%.

Conclusion: We created a method for resolving PWO using MD +/- application of thrombolytics with 97.4% success rate. Current evidence showed that FS is not likely to be affected by thrombolytic drugs; however, we have ascertained an effect of these drugs, proposing a hypothesis of microthrombotic events at the tip of the catheter if fibroblastic sleeve is present.

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肿瘤患者静脉端口持续抽出性闭塞的病因和处理方法。
导言:持续性抽取闭塞(PWO)是一种特殊的导管故障,其特点是无法通过设备抽取血液。导管端口出现 PWO 的最常见原因是存在纤维套管 (FS)。如果发生故障,可能会错误地使用药物,从而增加并发症的风险:方法:共处理了 177 例静脉输液港 PWO 病例。方法:我们对 177 例静脉端口 PWO 进行了处理,重点评估了 PWO 的原因、发生 FS 的频率以及解决故障的方案。患者接受了使用造影剂的透视检查。采用冲洗法用注射器注入生理盐水进行机械性阻断(MD);如果阻断失败,则随后使用含有妥洛尼定和尿激酶的锁定溶液,或使用阿替普酶进行小剂量溶栓。将人口统计学数据与对照组进行了比较:结果:在PWO患者群中,女性患者的比例明显更高(80.3% vs 66.3%,p = 0.004),主要是卵巢癌患者(12.8% vs 4.8%,p = 0.022)。插管静脉或治疗类型对 PWO 发生率没有影响。70%的病例证实存在FS。53.5%的病例使用注射器成功进行了 MD。成功治疗后,转诊时间明显缩短(3 周)。单独使用 MD 或结合使用溶栓药物(尿激酶或阿替普酶)实现去血栓的总成功率为 97.4%:我们创造了一种使用 MD +/- 溶栓剂解决 PWO 的方法,成功率高达 97.4%。目前的证据表明,溶栓药物不太可能影响FS;但是,我们已经确定了这些药物的影响,并提出了一个假设,即如果存在纤维套管,导管顶端会出现微血栓事件。
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来源期刊
Science Progress
Science Progress Multidisciplinary-Multidisciplinary
CiteScore
3.80
自引率
0.00%
发文量
119
期刊介绍: Science Progress has for over 100 years been a highly regarded review publication in science, technology and medicine. Its objective is to excite the readers'' interest in areas with which they may not be fully familiar but which could facilitate their interest, or even activity, in a cognate field.
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