| ObjectiveTo explore the clinical application of the Total Implantable Venous Port(TIVAP)in breast cancer chemotherapy patients,and to understand the clinical applicability and safety of peripheral vein TIVAP.To investigate and analyze the causes and treatment of peripheral TIVAP complications,and to provide reference for the clinical prevention and control of peripheral TIVAP related complications.MethodsThe follow-up survey method was used to collect clinical data of breast cancer patients who were placed in the peripheral TIVAP from March 2017 to June 2018 in our hospital.The complications,the incidence of complications,the summary and analysis of the causes of complications and their prevention and treatment measures were collected..Comparative study and analysis of the effect of conventional compression dressing and modified pressure bandaging on the treatment of incision hemorrhage,as well as the effect of conventional implantation and modified implantation methods on the incidence of primary catheter ectopic.Using the goodness of fit test(equal ratio)to compare the composition ratio of various complications;the comparison of catheter ectopic after left/right peripheral venous port placement;Cardiac test was used to compare the left and right peripheral veins in the port,the catheter ectopic,the modified pressurebandaging method and the conventional pressure dressing method for incision hemorrhage,the improved implantation method and the conventional implantation method for primary catheter ectopic.Results(1)In this study,a total of 203 breast cancer patients underwent peripheral TIVAP implantation,201 cases were successfully ported,and 2cases failed.The successful rate of puncture was 99.01%.There were 106 cases of TIVAP in the left peripheral vein and 95 cases of TIVAP in the right peripheral vein.The length of the tube was 33±3cm(20cm~42cm).Postoperative routine X-ray chest radiography showed that 186 of the 201 patients had correct catheter positioning,the catheter tip was located in the superior vena cava(the body surface projections were located in the 2nd to8 th vertebral bodies),and 15 cases had catheter ectopic.All 201 patients who were successfully followed up.All patients had complete follow-up data.The end point of follow-up was to take out TIVAP or die.Peripheral TIVAP indwelling time was 28d~395d,and there were 97 cases had been successfully treated and the TIVAP had been taken.6 cases had not been treated for treatment(3 cases were abandoned due to chemotherapy intolerance,and ectopic catheterization was concurrent).There were 1 case of thrombosis,1 case of TIVAP base exposed,1 case of unconditional use in local hospital,and the remaining 98 cases were in treatment and no death.(2)There were 50 cases of postoperative complications,the incidence rate was 24.87%(50/201).There were 15 cases of incision hemorrhage,the incidence rate was 7.46%(15/201);4 cases of catheter-related thrombosis,the incidence rate was 1.99%(4/201);3 cases of base exposure,the incidence rate was 1.49%(3/201);4 cases of sack infection,the incidence rate was 1.49%(4/201);12 cases of primary catheter ectopic,the incidence rate was 5.97%(12/201);3 cases of secondary catheter ectopic,theincidence rate 1.49%(3/201);7 cases with no blood withdrawal,the incidence was 3.48%(7/201);2 cases with catheter-related upper limb movement limitation,the incidence rate was 1.00%(2/201).After treatment,one case of ectopic catheter thrombosis and one case of TIVAP base exposure required removal of the infusion port,and the remaining infusions did not cause adverse events.(3)Using the goodness of fit test(equal ratio)to compare the composition ratio of various complications,χ2=30.520,P<0.001,the proportion of complications is not obeyed,and the proportion of incision hemorrhage and catheter ectopic is the highest.The ratio was30%,and the proportion of other complications was as follows: 14% of blood withdrawal,8% of catheter-related thrombosis and catheter-related infection,6% of base exposure,and catheter-related upper limb movement limitation.2%.(4)The difference in catheter ectopic position between the left/right peripheral venous ports was not statistically significant(χ2=0.02,P=0.962).By improving the catheter implantation method,it was found to be ectopically different from the catheter caused by conventional implantation methods.The proportion of the wound was significantly reduced;(5)the improved compression dressing method compared with the conventional pressure dressing method,the incidence of wound bleeding was significantly reduced.ConclusionThrough the clinical application of peripheral TIVAP,we found that ultrasound-guided peripheral TIVAP puncture success rate is high.Secondly,because of the peripheral vein puncture,complications such as blood clot,large blood vessel injury,and chylous leakage are avoided.Peripheral TIVAP still had some complications.In this study,the ratio of incision hemorrhage and ductal ectopic was the highest.The improvement of peripheral TIAVP implantation was effective in reducing the incidenceof incision hemorrhage and primary duct ectopic.Complications that are most likely to cause serious consequences,such as catheter-related thrombosis and infection,are only about 2%.Clinically,through careful observation and timely treatment,no serious consequences have occurred.Therefore,peripheral TIVAP is still a safer,long-term use of venous access.If there are no contraindications,it should be a better choice to choose peripheral TIVAP. |
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