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Totally Implantable Venous Access Ports Systems (TIVAPS)

Totally Implantable Venous Access Ports Systems (TIVAPS). One cancer center prospective study. Totally Implantable Venous Access Ports Systems ( TIVAPS ). Patient Veinous integrity Normal physical activity. Medical team Access reliability Care. Prospective study 815 patients.

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Totally Implantable Venous Access Ports Systems (TIVAPS)

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  1. TotallyImplantable Venous Access Ports Systems (TIVAPS) One cancer center prospective study

  2. TotallyImplantable Venous Access Ports Systems(TIVAPS) • Patient • Veinous integrity • Normal physical activity • Medical team • Access reliability • Care

  3. Prospective study815 patients May 2nd 2006 – April 30th 2007

  4. TIVAPS Polysite PEROUSE (Ivry Le Temple-France)

  5. Women: 64% 56.2 years(0.8 – 85.2) BMI = 25.03 (12.7-58.4) Use of lowweightheparin 14%

  6. One-Year TIVAPS 24% in tumoral progression Indication = 97% for chemotherapy 314 123 79 77 77 64 47 33

  7. PEROPERATIVE DATA • Local anesthesia = 91% • Final venous access in 96% • External jugular vein • Cephalic vein • Number of attempts • >=2 in 17%

  8. OPERATING DATA Surgeon Operating time 30 min skin to skin

  9. FIRST USE OF TIVAPS % • Median time= 8 days (0 – 135) • Use easiness • 0 = easy • 7 = hard

  10. TIAPS and Morbidity2006-2007 16.1% LITT = 8.6-31% Schwarz RE et al . Cancer 1999;79:1635 Kock HJ et al. World J Surg 1998;22:12 Lersch C et al. Oncology 1999;57:269 Aldrighetti L et al. J Vasc Access 2000;1:28 Chang HM et al. Eur J Surg Oncol 2006;32:90 Shetty PC et al. J Vasc Interv Radiol 1997;8:991 Hata Y et al. Cardiovasc Intervent Radiol 1998;21:230 Zahringer M et al. Rofo 2006;178:324 Cil BE et al. Diagn Interv Radiol 2006;12:93 Marcy PY et al. Cancer 2007;110:2331

  11. Morbidité CCI2006-2007 Morbidity=16.1% Death=0 N=131/815

  12. Causes for early removal of TIVAPS • N=55 (6.8%) • Median time before removal • 3.7 months (0.2-12) • 60% • Infection • Incision dehiscence

  13. Facteurs prédictifs complications DELAI pose-1ère utilisation Difficulté de pose • Complications • Infection+++ • Cutaneous troubles+++ • Inflammation • Incision Dehiscence

  14. Predictive factors of complication Not to use TIVAPS before 8 days

  15. Not to use TIVAPS before 8 days Key points for improvement Hind et al BMJ 2003;327:361. Metaanalysis Narducci et al EJSO 2011;37,913 Decrease of early removal for complication Infection Cutaneous troubles Incision dehiscence Increase rate of success with first attempt (> 83%) • ULTRA SOUND GUIDED VENIPUNCTURE • 90% success rate of puncture • complications (anatomic variations) • operating time (20 min) • patient comfort

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