Authors (including presenting author) :
Yik NY, Yuen MH, Chan SMM, Chan LT, Liu TK, Hung YK, Lau KHT, Wan WM, MAK SSS
Affiliation :
Department of Clinical Oncology, Prince of Wales Hospital
Introduction :
Totally implantable venous access port (TIVAP) is widely used in cancer patients for intravenous delivery of anti-cancer drugs. It consists of a subcutaneously implanted reservoir connected to a catheter usually made of either silicone or polyurethane. Catheter fracture is rare but life-threatening complication. However, a number of cases with spontaneous TIVAP catheter fracture were identified recently in HA hospital.
Objectives :
To identify factors of TIVAP catheter fracture and develop strategies and actions in response to it.
Methodology :
A continual cycle including practice review, literature search, clinical data analysis of patients with catheter fracture and quality improvement was employed.
Result & Outcome :
5 patients with catheter fracture were identified by 12/2022. TIVAP clinical audit was conducted immediately ensuring complied standard in staff's manipulation and flushing techniques. To our knowledge, no similar report has been published in Hong Kong. Therefore, a task group comprising departmental senior nurses conducted a retrospective review. Major findings included:
(1) All fractured catheters were silicone catheters which are commonly used in department (88.5%).
(2) All were inserted via internal jugular vein (IJV). Fracture occurred at entry into IJV or at clavicular subcutaneous part.
(3) No complete catheter fracture was found. All were identified by clinical presentations such as symptoms and functioning verification, while 2 fractures were seen in X-ray.
(4) Brief patient interview was conducted to identify risk factors in daily activities. One identified friction and compression by seatbelt at catheter and one reported frequent ipsilateral limb stretching due to household work.
As such, following interventions were implemented:
(1) X-ray would be used as a preliminary surveillance to review all TIVAPs' integrity.
(2) Ongoing clinical assessment would be performed by nurses with alertness during regular maintenance.
(3) With support by literature, chronic stress at catheter induced by motion of neck or arm and compression force against clavicle, such as seatbelt and tight clothing, may be the risk factor of catheter fracture. Staff training and patient education are reinforced, including information booklet production.
(4) With physicians' support, removal of TIVAPs over 2 years and unused would be considered.
In conclusion, besides guideline development, clinical audit, staff training and patient education, a live monitoring system with periodic review of catheter is certainly required to prevent catheter fracture.
