Evaluation of infectious complications of the implantable venous access system in a general oncologic population

Objectives: This study was conducted to evaluate the infectious morbidity associated with 2 common types of implantable port systems used in a cancer center in Taiwan. Methods: This study is retrospective and descriptive. Five hundred seventy-two patients who received implantable ports at the cancer center between January 1994 and December 1998 were included. The following 4 types of catheter-related infections were defined in this study: bloodstream, pocket, exit-site, and tunnel. Semiquantitative methods (rolling plate) were used for cultures of removed catheters. Results: The average duration for ports after placement in patients was 358 days (range, 1-1742 days), and the median duration was 242 days. The port-related infection rate was 5.6% in 586 ports and 0.15 per 1000 device-days. Our data indicate that when a port is in use, more frequent dressing changes of the needle exit site (every 3 days vs every 7 days) appear to have no significant impact on the catheter-related infection rate (5.2% vs 7.3%, P = .3). Our observation also indicates that if the catheter is used for total parenteral nutrition (TPN), the patient has a significantly increased chance of developing an infection from the Candida species (71% vs 8%, P = .005). Furthermore, the catheters associated with infections caused by the Candida species had a shorter catheter life (median, 44 days). Conclusions: Infection is the most common complication of venous port system use among cancer patients. According to our data, it is safe and cost-effective to change exit-site needles and transparent dressings every 7 days. It is clearly demonstrated by our study that patients with ports used for the administration of TPN had a significantly greater chance of developing infection from the Candida species. Further investigation is needed to compare the relative advantages of using ports versus other devices for the administration of TPN in cancer patients.