İmplante edilebilir venöz port kateter uygulamalarımızın incelenmesi

Amaç: İmplante edilebilir santral venöz port kateterler (İESVPK), uzun dönemli intravenöz tedavi uygulanacak kanser hastalarında sıklıkla kullanılırlar. Literatürde bu işlemi onkolog, radyolog ve cerrahlar üstlenmiştir. Bu çalışmanın amacı anesteziyologların yerleştirdiği venöz port kateter ve sonuçlarını incelemektir. Gereç ve Yöntemler: Kliniğimizde 2008 Ocak ve 2010 Mart tarihleri arasında 79 hastaya yerleştirilen 83 adet subkutan implante edilen venöz port retrospektif olarak incelendi. Hastaların demografik verileri, primer tanıları, port yerleştirme endikasyonu, port günü ve port tipi kaydedildi. İşlem sırasında uygulanan anestezi yöntemi, girişimin lokalizasyonu, girişimle ilgili sorunlar, kullanılan teknik, portla ilgili girişim sırasında ve sonrasında gelişen komplikasyonlar ve çıkarılma nedenleri kaydedildi. Bulgular: Hastaların ortalama yaşı 53,5±11,72 yıl, 44'ü kadın 35'i ise erkekti. Bütün hastaların primer tanısı malignensiydi, port bir hastaya total parenteral nütrisyon diğerlerine ise kemoterapi amaçlı yerleştirildi. Portların 70'i sağ subklavian venden, 10'u sol subklavian venden ve 3'ü internal juguler venden Seldinger tekniğine göre perkütan olarak cavaatrial bileşkede olacak şekilde yerleştirildi. Toplam port günü 26.397 ve ortalama port günü ise 366 gündü. Girişimle ilgili komplikasyonlar olarak bir hastada pnömotoraks, dört hastada malpozisyon gelişti. Port kateter malpozisyon gelişen olgularda girişimin skopi eşliğinde uygulanmadığı gözlendi. Girişim sonrası ise dört hastada malfonksiyon, bir hastada kateterin çıkması, bir hastada enfeksiyon şüphesi ve bir hastada cilt nekrozu saptandı. Sonuç: Kanser hastalarındaki kemoterapi gibi uzun süreli tedavilerde İESVPK yerleştirilmesi tercih edilmektedir. Rutin sırasında santral venöz kateterizasyon yapan ve olası komplikasyonlarını ve başa çıkma yöntemlerini bilen Anesteziyologların da venöz port implantasyon işlemini gerçekleştirebileceklerini göstermek amacıyla 83 olguluk serimizi yayınlamak istedik.

A review of our implantable venous port catheter applications

Objective: Implantable Venous Port Catheters are frequently used in cancer patients on whom long term intravenous treatment will be applied. In literature, this process was undertaken by oncologists, radiologists and surgeons. The objective of this study is to review venous port catheters implanted by anesthesiologists and their results. Materials and Methods: 83 implantable venous ports, which were implanted in 79 patients between January, 2008 and March, 2010 in our clinic, have been examined retrospectively. Demographic data, port days and port types of the patients were recorded. Anaesthetic method applied during the process, localization of the intervention, problems with the intervention, the technique used, complications associated with the port which took place during the intervention and the reasons for their removal were noted. Results: The mean age of the patients was 53,5±11,72 year and 44 patients were female and 35 were male. Total number of port days was 26.397. As complications associated with the intervention, pneumothorax developed in one patient and malposition in 4 patients. In cases where port catheter malposition developed, it was seen that the intervention wasn't applied along with fluoroscopy. Following the intervention, malfunction was detected in 4 patients, catheter dislocation in 1 patient and suspected infection in 1 patient and skin necrosis in 1 patient. Conclusion: In order to show that Anesthesiologists, who perform central venous catheterization during routine and know the possible complications and their management methods, can also perform venous port implantation, we wanted to share our series.

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