A Venous Access Mini-Port Implanted on the Proximal Forearm, on the Distal Upper Arm or on the Chest Wall

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Abstract
Background: The main objective of this study was to compare 3 implantation sites for a new mini-port system (Pharmacia Deltec, Erlangen, FRG) on the proximal forearm, on the distal upper arm and on the chest wall in a prospective, nonrandom-ized fashion with respect to feasibility, complications and acceptance. Patients and Methods: The mini-port was used for central venous access in 61 patients. Fifteen patients (8 with solid tumors, 4 lymphomas, 3 acute leukemias) had the port positioned on their proximal forearm, 24 (with solid tumors) on the distal upper arm, and 22 (13 with solid tumors, 7 lymphomas, 1 acute leukemia, 1 CML) on the chest wall. Results: Observed life-span of mini-ports was 201 days (range 28-549) for the proximal forearm port, 130 days (range 29-261) for the distal upper arm port, and 87 days (range 0-480) for the chest wall port with cumulative observation periods of 3,778, 3,120 and 3,358 patient-days, respectively. Mini-ports were used for chemotherapy, supportive treatment including parenteral nutrition and transfusion of blood products and for taking blood samples. No complications were observed in 8 of 15 patients with the proximal forearm port, 23 of 24 patients with the distal upper arm port, and 18 of 22 patients with the chest wall-positioned port. There were 6 patients with peripheral vein thrombosis, 3 with reversible port occlusion, and 3 with port infections for the proximal forearm port. One port infection occurred in the group with the distal upper arm port. For the chest wall position we have found 1 patient with port infection, 1 with dislocation of the catheter tip, 1 with unsuccessful implantation, 2 patients with paravasations, and 1 patient with port occlusion. However, loss of function and/or explantation were the consequences for only 6 mini-ports (proximal forearm port, n = 2, distal upper arm port, n = l, chest wall port, n = 3). A new electromagnetic catheter tracking system (Cath-Finder, Pharmacia) was used in 32 patients for implantation of peripheral access port. When compared with X-ray detection the system predicted the catheter tip accurately in 29 patients and changed surgical procedure by predicting wrong positioning in 4 patients. Conclusions: The new mini-port can be used like the older and larger systems with less cosmetic damage. Positioning of the port on the distal upper arm or on the chest wall was accompanied by less frequent complications. Acceptance for the 2 more central positions was better than for the position on the proximal forearm by the patients, physicians, and nurses interviewed.

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