Long-term results of radiologic placement of a central vein access device.

OBJECTIVE: We describe our long-term experience with radiologic implantation of the Peripheral Access System (PAS) Port venous access device. Technical efficacy and complications are documented and compared with surgical and radiologic series involving other long-term venous access devices. SUBJECTS AND METHODS: Fifty-two PAS-Port catheters were implanted in 51 patients during a 30-month period. All procedures took place in the angiography suite and were performed by interventional radiologists with imaging guidance. Patients were followed up through the oncology clinic or the clinic that originally referred the patient. The durability of the catheter was evaluated, and complications were recorded during the study period. RESULTS: Fifty-two ports have been indwelling for a total of 18,357 patient-days. The mean time of implantation was 372 days, with a range of 30-825 days. Technical success in implanting the device was 100%. Device-related sepsis occurred in one patient (2%), superficial thrombophlebitis in one patient (2%), skin site dehiscence in one patient (2%), and deep vein thrombosis in one patient (2%). No instances of catheter occlusion occurred, and all catheters retained the ability to aspirate blood throughout their use. The overall complication rate was 8% (0.22/1000 patient days). CONCLUSION: Radiologic placement of this device is safe and effective. It offers many patients a superior alternative to surgically implanted chest wall ports. Complications are fewer, and chances for technical success are greater. In circumstances where cosmesis is deemed highly important, the PAS-Port device may be preferable to tunneled venous access catheters.

Comparison of L-hyoscyamine, glucagon, and placebo for air-contrast upper gastrointestinal series.

Previous studies have compared the use of anticholinergic drugs and glucagon for upper gastrointestinal (UGI) radiography. Many radiologists prefer glucagon because these comparisons showed it to have a shorter duration of action with fewer side effects. L-Hyoscyamine is the levo-rotatory form of atropine with minor adverse side effects. This study compared the effects of glucagon (N = 48), L-hyoscyamine (N = 43), and placebo (N = 45) on gastric and duodenal distension, mucosal coating, and patient tolerance. L-Hyoscyamine provided gastric and duodenal images equal in quality to glucagon. Except for the more frequent reporting of dry mouth with L-hyoscyamine, side effects were not different among the groups. L-Hyoscyamine is an economical alternative to glucagon for hypotonic gastrointestinal radiography.

Comparison of a new colon lavage solution (Golytely-RSS) with a standard preparation for air-contrast barium enema.

Golytely is a balanced electrolyte solution for per oral whole-gut lavage. It has been an accepted alternative to standard preparations for barium enema. Golytely-RSS is a new formulation designed to taste better through reduction in sodium and sulfate content. In addition, a slight increase in osmolality is intended to decrease further the net absorption/secretion ratio. One hundred outpatients who were to undergo air-contrast barium enema examinations were randomly assigned one of two colon-cleansing preparations. A standard 1-day diet/cathartic method was compared with Golytely-RSS plus oral bisacodyl. Radiographs were evaluated for the amount of fecal material present and the degree of mucosal coating by two radiologists independently of each other and without knowledge of the preparation used. Good to excellent feces removal was provided by Golytely-RSS in 98% of patients and by the standard method in 95% (p greater than .1, not significant). Mucosal coating also was similar between groups. Unpleasant side effects were reported significantly more often in the lavage group. Unwillingness to use the preparation a second time was reported in 36% of the Golytely-RSS group and in 8% of the standard preparation group (p = .03). Golytely-RSS is an acceptable alternative method to standard colon-cleansing methods for air-contrast barium enema and may be preferable in patients with certain renal or cardiovascular diseases. Side effects may preclude the use of this colon-cleansing regimen routinely.