Incidence and Determinants of Port Occlusions in Cancer Outpatients: A Prospective Cohort Study.

BACKGROUND: Normal saline is considered a safe alternative for heparin as a locking solution in totally implantable venous access devices. The incidence rate of partial occlusion with the use of normal saline (easy injection, impossible aspiration) is estimated at 4%. OBJECTIVE: The aim of this study was to investigate determinants of partial occlusions with the use of normal saline solution and the maintenance of positive pressure in the catheter. METHODS: We enrolled 218 patients with different solid tumors who underwent pharmacologic treatment through the port with different frequencies: from once every week to at least once every month. The port was flushed with normal saline solution keeping a positive pressure in the catheter. RESULTS: We performed 4111 observations and documented normal port functioning in 99% of observations (n = 4057) and partial occlusions in 1% of observations (n = 54). Partial occlusions were significantly associated with frequency of port flushing (P < .05), chemotherapy (P < .001), and blood sample collection (P < .001). CONCLUSIONS: The use of positive pressure in addition to normal saline reduces the incidence rate of partial occlusions. The type of treatment, blood sample collection, and treatment schedule are important determinants of partial occlusions. IMPLICATIONS FOR PRACTICE: Nurses play a key role in maintaining a functioning port using positive pressure during the flushing techniques. Certain risk factors must be monitored to prevent partial occlusions, and certain patients are more likely to present with port-related problems.

A 15-min premedication for 1-h paclitaxel infusion: optimizing patients' care.

BACKGROUND: Paclitaxel is a plant product highly active in numerous cancers, but anaphylactic-like hypersensitivity reactions with it have been reported in about 28% of patients receiving the drug. Thirty to sixty minutes are needed to give a standard premedication with steroids and diphenhydramine, leading to patients and nurses' discomfort and stealing time from other infusional treatments. PATIENTS AND METHODS: Eighty-nine patients with advanced NSCLC never pre-treated with taxanes, received paclitaxel followed by gemcitabine on days 1, 8, 15 q4wks. Premedication consisted of prednisone 25 mg/os on day 0 and hydrocortisone plus clorfenamina maleato given intravenous on day 1 by a 15 min infusion immediately before paclitaxel administration. RESULTS: Hypersensitivity reactions occurred in 3/341 (0.8%) cycles. In all three cases we observed severe dyspnoea and bronchospasm, that required treatment discontinuation but one was probably due to gemcitabine and another had a protracting time after premedication. CONCLUSIONS: A 15-min premedication infusion administered immediately before paclitaxel appeared to be highly effective in patients treated with 1h-infusion paclitaxel.