Skip to main content

Advertisement

SpringerLink
Log in

The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

This systematic review and meta-analysis aimed to provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs).

Methods

A systematic search of PubMed, Web of science, Embase, and the Cochrane Library was carried out from inception through Oct 2018, with no language restrictions. Trials examining the risk of CLABSI in cancer patients who received TIVAPs compared with those who received external CVCs were included. Two reviewers independently reviewed, extracted data, and assessed the risk of bias of each study. A random-effect model was used to estimate relative risks (RRs) with 95% CIs.

Results

In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31–0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22–0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38–0.79]).

Conclusions

TIVAP can significantly reduce the risk of CLABSI compared with external CVCs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E (1982) Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 92(4):706–712

    CAS  PubMed  Google Scholar 

  2. Kurul S, Saip P, Aydin T (2002) Totally implantable venous-access ports: local problems and extravasation injury. Lancet Oncol 3(11):684–692

    Article  PubMed  Google Scholar 

  3. iData Research. U.S. Markets for Vascular Access Devices and Accessories (2012) Vancouver. In: BC: iData research

    Google Scholar 

  4. Pinelli F, Cecero E, Degl'Innocenti D et al (2018) Infection of totally implantable venous access devices: a review of the literature. J Vasc Access 19(3):230–242

    Article  PubMed  Google Scholar 

  5. Lebeaux D, Fernández-Hidalgo N, Chauhan A, Lee S, Ghigo JM, Almirante B, Beloin C (2014) Management of infections related to totally implantable venous-access ports: challenges and perspectives. Lancet Infect Dis 14(2):146–159

    Article  CAS  PubMed  Google Scholar 

  6. Fang S, Yang J, Song L, Jiang Y, Liu Y (2017) Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy. Patient Prefer Adherence 11:1197–1204

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wu O, Boyd K, Paul J, McCartney E, Ritchie M, Mellon D, Kelly L, Dixon-Hughes J, Moss J (2016) Hickman catheter and implantable port devices for the delivery of chemotherapy: a phase II randomized controlled trial and economic evaluation. Br J Cancer 114(9):979–985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lefebvre L, Noyon E, Georgescu D, Proust V, Alexandru C, Leheurteur M, Thery JC, Savary L, Rigal O, di Fiore F, Veyret C, Clatot F (2016) Port catheter versus peripherally inserted central catheter for postoperative chemotherapy in early breast cancer: a retrospective analysis of 448 patients. Support Care Cancer 24(3):1397–1403

    Article  CAS  PubMed  Google Scholar 

  9. Patel GS, Jain K, Kumar R, Strickland AH, Pellegrini L, Slavotinek J, Eaton M, McLeay W, Price T, Ly M, Ullah S, Koczwara B, Kichenadasse G, Karapetis CS (2014) Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies. Support Care Cancer 22(1):121–128

    Article  CAS  PubMed  Google Scholar 

  10. Beckers MM, Ruven HJ, Seldenrijk CA, Prins MH, Biesma DH (2010) Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer. Thromb Res 125(4):318–321

    Article  CAS  PubMed  Google Scholar 

  11. Pegues D, Axelrod P, McClarren C, Eisenberg BL, Hoffman JP, Ottery FD, Keidan RD, Boraas M, Weese J (1992) Comparison of infections in Hickman and implanted port catheters in adult solid tumor patients. J Surg Oncol 49(3):156–162

    Article  CAS  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  13. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sweeting MJ, Sutton AJ, Lambert PC (2004) What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 23(9):1351–1375

    Article  PubMed  Google Scholar 

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  16. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101

    Article  CAS  PubMed  Google Scholar 

  17. Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wetterslev J, Thorlund K, Brok J, Gluud C (2008) Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 61(1):64–75

    Article  PubMed  Google Scholar 

  19. Brok J, Thorlund K, Wetterslev J, Gluud C (2009) Apparently conclusive meta-analyses may be inconclusive--trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. Int J Epidemiol 38(1):287–298

    Article  PubMed  Google Scholar 

  20. Brok J, Thorlund K, Gluud C, Wetterslev J (2008) Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol 61(8):763–769

    Article  PubMed  Google Scholar 

  21. Handrup MM, Moller JK, Frydenberg M, Schroder H (2010) Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 55(2):309–313

    Article  PubMed  Google Scholar 

  22. Zganjer M, Cizmic A, Butkovic D et al (2008) Central venous catheters for chemotherapy of solid tumors--our results in the last 5 years. Coll Antropol 32(3):767–770

    PubMed  Google Scholar 

  23. Ng F, Mastoroudes H, Paul E, Davies N, Tibballs J, Hochhauser D, Mayer A, Begent R, Meyer T (2007) A comparison of Hickman line- and port-a-Cath-associated complications in patients with solid tumours undergoing chemotherapy. Clin Oncol (R Coll Radiol) 19(7):551–556

    Article  CAS  Google Scholar 

  24. Adler A, Yaniv I, Steinberg R et al (2006) Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients. J Hosp Infect 62(3):358–365

    Article  CAS  PubMed  Google Scholar 

  25. Johansson E, Bjorkholm M, Bjorvell H et al (2004) Totally implantable subcutaneous port system versus central venous catheter placed before induction chemotherapy in patients with acute leukaemia-a randomized study. Support Care Cancer 12(2):99–105

    Article  PubMed  Google Scholar 

  26. Dillon PW, Jones GR, Bagnall-Reeb HA, Buckley JD, Wiener ES, Haase GM, Children's Oncology Group (2004) Prophylactic urokinase in the management of long-term venous access devices in children: a Children's oncology group study. J Clin Oncol 22(13):2718–2723

    Article  CAS  PubMed  Google Scholar 

  27. Pracchia LF, Dias LC, Dorlhiac-Llacer PE, Chamone DA (2004) Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients. Rev Hosp Clin Fac Med Sao Paulo 59(5):291–295

    Article  PubMed  Google Scholar 

  28. Estes JM, Rocconi R, Straughn JM et al (2003) Complications of indwelling venous access devices in patients with gynecologic malignancies. Gynecol Oncol 91(3):591–595

    Article  PubMed  Google Scholar 

  29. Minassian VA, Sood AK, Lowe P, Sorosky JI, al-Jurf AS, Buller RE (2000) Longterm central venous access in gynecologic cancer patients. J Am Coll Surg 191(4):403–409

    Article  CAS  PubMed  Google Scholar 

  30. Silver DF, Hempling RE, Recio FO, Piver MS, Eltabbakh GH (1998) Complications related to indwelling caval catheters on a gynecologic oncology service. Gynecol Oncol 70(3):329–333

    Article  CAS  PubMed  Google Scholar 

  31. Eastridge BJ, Lefor AT (1995) Complications of indwelling venous access devices in cancer patients. J Clin Oncol 13(1):233–238

    Article  CAS  PubMed  Google Scholar 

  32. Gleeson NC, Fiorica JV, Mark JE, Pinelli DM, Hoffman MS, Roberts WS, Cavanagh D (1993) Externalized Groshong catheters and Hickman ports for central venous access in gynecologic oncology patients. Gynecol Oncol 51(3):372–376

    Article  CAS  PubMed  Google Scholar 

  33. Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, Armstrong D (1993) Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med 119(12):1168–1174

    Article  CAS  PubMed  Google Scholar 

  34. Mueller BU, Skelton J, Callender DP, Marshall D, Gress J, Longo D, Norton J, Rubin M, Venzon D, Pizzo PA (1992) A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients. J Clin Oncol 10(12):1943–1948

    Article  CAS  PubMed  Google Scholar 

  35. Wacker P, Bugmann P, Halperin DS, Babel JF, le Coultre C, Wyss M (1992) Comparison of totally implanted and external catheters in paediatric oncology patients. Eur J Cancer 28A(4–5):841–844

    Article  CAS  PubMed  Google Scholar 

  36. Kappers-Klunne MC, Degener JE, Stijnen T, Abels J (1989) Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection. Cancer -Am Cancer Soc 64(8):1747–1752

    CAS  Google Scholar 

  37. Carde P, Cosset-Delaigue MF, Laplanche A, Chareau I (1989) Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumors. Eur J Cancer Clin Oncol 25(6):939–944

    Article  CAS  PubMed  Google Scholar 

  38. Greene FL, Moore W, Strickland G, McFarland J (1988) Comparison of a totally implantable access device for chemotherapy (port-A-Cath) and long-term percutaneous catheterization (Broviac). South Med J 81(5):580–583

    Article  CAS  PubMed  Google Scholar 

  39. Ross MN, Haase GM, Poole MA, Burrington JD, Odom LF (1988) Comparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients. Surg Gynecol Obstet 167(2):141–144

    CAS  PubMed  Google Scholar 

  40. Wurzel CL, Halom K, Feldman JG, Rubin LG (1988) Infection rates of Broviac-Hickman catheters and implantable venous devices. Am J Dis Child 142(5):536–540

    CAS  PubMed  Google Scholar 

  41. Penel N, Neu J, Clisant S et al (2007) Risk factors for early catheter-related infections in cancer patients. Cancer -Am Cancer Soc 110(7):1586–1592

    Google Scholar 

  42. Fratino G, Molinari AC, Parodi S, Longo S, Saracco P, Castagnola E, Haupt R (2005) Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol 16(4):648–654

    Article  CAS  PubMed  Google Scholar 

  43. Mirro JJ, Rao BN, Stokes DC et al (1989) A prospective study of Hickman/Broviac catheters and implantable ports in pediatric oncology patients. J Clin Oocol 7(2):214–222

    Article  Google Scholar 

  44. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJA, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and Management of Intravascular Catheter-Related Infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by grants from the President Foundation of Nanfang Hospital of Southern Medical University (Grant No.2016B012) and grants from President Foundation of Nanfang Hospital, Southern Medical University (CX2018NO13).

Author information

Author notes

  1. Meng Jiang and Chang-li Li contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Meng Jiang & Chun-qiu Pan

  2. Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, 11 Lingjiaohu Avenue, Wuhan, 430015, Hubei Province, China

    Chang-li Li

  3. Department of Critical Care Medicine, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Li Yu

Authors
  1. Meng Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang-li Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chun-qiu Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meng Jiang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests. We have full control of all primary data and agree to allow the journal to review our data if requested.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Fig. S1

Test for publication bias. (PNG 77 kb)

High resolution image (TIF 11987 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, M., Li, Cl., Pan, Cq. et al. The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis. Support Care Cancer 28, 361–372 (2020). https://doi.org/10.1007/s00520-019-04809-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-04809-x

Keywords

Search

Navigation