Nor, Sobri
(2018)
A five years review of complications of implantable venous access devices (IVAD) in cancer patient through the cephalic vein cut down approach.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: Implanted venous access device (IVAD) is one of the options that give access
to the central venous circulation. It is widely used nowadays and can be used for various
reasons. It can be retained in the body for a period of up to two years with minimal care and
low risk of infection thus it is suitable for patients especially for those who had the difficult
vascular access example in cancer patients. Cephalic vein cut down approach is one of the
methods of insertion of IVAD with minimal complication associated to this technique,
however, it is not widely used as it needs to be done in operating theatre setting and it took
longer duration. This study was done to evaluate the complication of the IVAD that
implanted in cancer patient through cephalic vein cut down approach.
Methodology: This is a retrospective study involving cancer patients that were implanted
with IVAD through cephalic vein cut-down approach in HUSM from January 2010 to
December 2014. All medical records reviewed and evaluated for demographics, surgical
procedure, and types of IVAD, complications post implantation and possible associated
factors with the complications studied. All the information collected and analyzed with SPSS
programme 22.0.
Results: There were 197 patients included in this study which involved 54.3% male patients
and 45.7% female patients. The procedure performed by orthopaedic surgeons in 132(67%)
patients, 65 patients (33%) performed by the medical officers. All patients received
intravenous antibiotic prophylaxis, Cefuroxime prior to implantation. The mean duration of
surgery was 59.37 minutes while the mean duration of follow up, was 715 days. The overall
complication rate was 12.7% (n= 25). There were 7.6% (n=15) infection rate, 3.6% (n=7)
thrombosis, 1.0% (n= 2) for fracture and migration and 0.5% (n=1) mal-position of IVAD.
There was no association between the types of catheter with the overall complication rate.
There was an association between the types of cancer with the infections rate. We found no
association between age and absolute neutrophil count (ANC) with the infection rates and the
platelet levels with thrombosis rates.
Conclusions: Cephalic vein cut down approach is a safe approach for IVAD implantation
with an overall low rate of complications. These treatments offer an alternative and provide
benefits to patients in HUSM.
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