Effect of prolonging the maintenance interval for totally implantable venous access ports on complications in patients during the period of non-treatment：a meta-analysis

doi:10.3761/j.issn.0254-1769.2022.05.004

Abstract

Abstract:

Objective To evaluate the effect of prolonging the maintenance interval for totally implantable venous access ports on complications in patients during the period of non-treatment by meta-analysis. Methods We searched CNKI,VIP,Wanfang,CBM,PubMed,Cochrane Library,Embase and Web of Science databases for publications that examined the effect of prolonging the maintenance interval during the period of non-treatment from the inception of databases to October 6,2021. 2 reviewers independently conducted the literature screening,data extraction and quality assessment. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 11 publications including 2 268 patients were included. The meta-analysis showed that compared with the intervals less than 4 weeks,there were no statistically significant differences in the incidence of catheter-related total complications[RR=0.82,95%CI（0.56,1.19）,P=0.30],occlusion[RR=0.84,95%CI（0.54,1.31）,P=0.44] or infection[RR=1.47,95%CI（0.38,5.73）,P=0.58] for the intervals longer than 4 weeks. Descriptive analysis indicated that prolonging the maintenance interval did not increase the incidence of thrombosis,but significantly reduced maintenance costs. Conclusion Prolonging the maintenance interval of totally implantable venous access ports is safe and feasible without increased incidence of complications,which can reduce economic costs. More high-quality randomized controlled trials are needed for verification of the optimal maintenance interval.

Key words: Totally Implantable Venous Access Port, Period of Non-Treatment, Maintenance, Complications, Meta-Analysis, Nursing Care

摘要：

目的评价延长维护间隔时间对非治疗期患者输液港相关并发症的影响。方法检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science数据库中关于延长非治疗期患者输液港维护间隔时间的文献,检索时限为建库至2021年10月6日。由2名研究者独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行统计分析。结果共纳入11篇文献,2 268例患者。Meta分析结果显示,维护间隔时间>4周与≤4周相比,导管相关并发症总发生率[RR=0.82,95%CI（0.56,1.19）,P=0.30]及导管堵塞发生率[RR=0.84,95%CI（0.54,1.31）,P=0.44]、导管相关性感染发生率[RR=1.47,95%CI（0.38,5.73）,P=0.58]差异均无统计学意义。描述性分析显示,延长维护间隔时间未增加血栓的发生率,并可减少输液港的维护费用。结论延长非治疗期患者输液港维护间隔时间是安全可行的,不会增加其并发症的发生率,并可减少输液港的维护费用。未来需要更多高质量的随机对照试验验证输液港最佳的维护间隔时间。

关键词: 完全植入式静脉输液港, 非治疗期, 维护, 并发症, Meta分析, 护理

WANG Xifeng, JU Yang, YANG Yiqun. Effect of prolonging the maintenance interval for totally implantable venous access ports on complications in patients during the period of non-treatment：a meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(5): 536-543.

汪惜凤, 鞠阳, 杨益群. 延长维护间隔时间对非治疗期患者输液港并发症影响的Meta分析[J]. 中华护理杂志, 2022, 57(5): 536-543.

Figures/Tables 5

Figure 1 Flow chart of literature screening

Table 1 Baisc characteristics of the included studies（n=11）

Table 2 Risk of bias assesment for randomized controlled trials（n=4）

Figure 2 Effect of maintenance intervals longer than 4 weeks on the overall incidence of catheter-related complications in patients during the period of non-treatment

Table 3 Risk of bias assesment for cohort study（n=7）

References 38

[1]	徐海萍, 周琴, 韩伟, 等. 手臂输液港与胸壁输液港常见并发症发生率比较的Meta分析[J]. 中华护理杂志, 2018, 53(3):352-358.
	Xu HP, Zhou Q, Han W, et al. Common complications of arm port and chest port:a meta-analysis[J]. Chin J Nurs, 2018, 53(3):352-358.
[2]	李颖, 姜浩, 韩哲洙, 等. 颈内静脉与锁骨下静脉植入输液港并发症发生率的对比分析[J]. 实用放射学杂志, 2020, 36(9):1496-1499.
	Li Y, Jiang H, Han ZZ, et al. A contrastive analysis of the complication rate in infusion port implantation between internal jugular vein and subclavian vein[J]. J Pract Radiol, 2020, 36(9):1496-1499.
[3]	Cook IC, Cottrill HM. Comparison of short and long interval flush maintenance for implanted catheters in gynecologic malignances[J]. Gynecol Oncol, 2019, 153(3):e17-e18.
[4]	谢琼, 卢咏梅, 方少梅, 等. 植入式静脉输液港相关性感染预防及管理的最佳证据总结[J]. 护理学杂志, 2020, 35(12):49-53.
	Xie Q, Lu YM, Fang SM, et al. Evidence summary for prevention and management of implantable venous access port-related infection[J]. J Nurs Sci, 2020, 35(12):49-53.
[5]	中心静脉通路上海协作组. 完全植入式输液港上海专家共识[J]. 介入放射学杂志, 2015, 24(12):1029-1033.
	Shanghai Cooperation Group on Central Venous Access. Shanghai expert consensus on totally implantable access port[J]. J Interv Radiol, 2015, 24(12):1029-1033.
[6]	Oh SB, Park K, Kim JJ, et al. Safety and feasibility of 3-month interval access and Flushing for maintenance of totally implantable central venous port system in colorectal cancer patients after completion of curative intended treatments[J]. Medicine(Baltimore), 2021, 100(2):e24156.
[7]	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice,8th edition[J]. J Infus Nurs, 2021, 44(suppl 1):S1-S224. DOI URL
[8]	Hope S, Nahid B, McGowan A. Maintenance flushing interval time of totally implantable venous access devices(TIVADs):is it time to review the evidence and change the guidance[J]. J Cyst Fibros, 2020, 19:S152.
[9]	Wu XH, Zhang TT, Chen LC, et al. Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer:a systematic review and meta-analysis[J]. J Vasc Access, 2021, 22(5):814-821. DOI URL
[10]	Clari M, Spoto M, Franceschi G, et al. Short versus long timing of flushing of totally implantable venous access devices when not used routinely: a systematic review and meta-analysis[J]. Cancer Nurs, 2021, 44(3):205-213. DOI URL
[11]	国家卫生健康委办公厅医政医管局. 血管导管相关感染预防与控制指南(2021版)[J]. 中国感染控制杂志, 2021, 20(4):387-388.
	General Office of the National Health Commission,Hospital Administration. Guidelines for the prevention and control of vessel catheter associated infection(2021 edition)[J]. Chin J Infect Control, 2021, 20(4):387-388.
[12]	赵林芳, 曾旭芬, 王雅萍, 等. 经大腿中段股静脉留置PICC在78例患者中的应用[J]. 中华护理杂志, 2018, 53(9):1089-1092.
	Zhao LF, Zeng XF, Wang YP, et al. Application of PICC placement via inferior vena cava in 78 patients[J]. Chin J Nurs, 2018, 53(9):1089-1092.
[13]	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews:a new edition of the Cochrane handbook for systematic reviews of interventions[J]. Cochrane Data-base Syst Rev, 2019, 10:ED000142.
[14]	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. DOI URL
[15]	Zhang YJ, Zhao RY, Jiang N, et al. A retrospective observational study on maintenance and complications of totally implantable venous access ports in 563 patients:prolonged versus short flushing intervals[J]. Int J Nurs Sci, 2021, 8(3):252-256.
[16]	Fornaro C, Piubeni M, Tovazzi V, et al. Eight-week interval in flushing and locking port-a-cath in cancer patients:a single-institution experience and systematic review[J]. Eur J Cancer Care(Engl), 2019, 28(2):e12978.
[17]	Yan WP, Zhang CY, Luo CG, et al. Management of outpatient with totally implantable venous access ports during the COVID-19 epidemic[J]. Medicine(Baltimore), 2021, 100(7):e24720.
[18]	苏金娜, 焦俊琴, 王建新, 等. 静脉输液港植入患者非治疗期间维护间隔时间的研究[J]. 中华现代护理杂志, 2015, 21(16):1893-1895.
	Su JN, Jiao JQ, Wang JX, et al. Maintenance of interval time for intravenous infusion port implanted patients during off-treatment period[J]. Chin J Mod Nurs, 2015, 21(16):1893-1895.
[19]	俞新燕, 林咏, 许佳兰, 等. 非治疗期延长植入式静脉输液港维护间隔的研究[J]. 医院管理论坛, 2020, 37(1):23-25,45.
	Yu XY, Lin Y, Xu JL, et al. Research on prolonging maintenance interval of TIVAP during non-treatment period[J]. Hosp Manag Forum, 2020, 37(1):23-25,45.
[20]	张玉娟. 静脉输液港植入患者在非治疗期间延长维护间隔时间对导管堵塞及感染的影响[J]. 心电图杂志(电子版), 2020, 9(1):221.
	Zhang YJ. Effect of prolonged maintenance interval on catheter blockage and infection in patients with intravenous infusion port implantation during non-treatment[J]. J Electrocardiogram Electron Ed, 2020, 9(1):221.
[21]	宋丹丹, 张荣, 冯利芸, 等. 不同时间间隔对植入式输液港封管效果的影响[J]. 国际护理学杂志, 2016, 35(7):1002-1004.
	Song DD, Zhang R, Feng LY, et al. Influence of different time intervals on port sealing effect of implantable infusion[J]. Int J Nurs, 2016, 35(7):1002-1004.
[22]	Palese A, Baldassar D, Rupil A, et al. Maintaining patency in totally implantable venous access devices(TIVAD):a time-to-event analysis of different lock irrigation intervals[J]. Eur J Oncol Nurs, 2014, 18(1):66-71. DOI URL
[23]	Ignatov A, Ignatov T, Taran A, et al. Interval between port catheter flushing can be extended to four months[J]. Gynecol Obstet Invest, 2010, 70(2):91-94. DOI URL
[24]	Kefeli U, Dane F, Yumuk PF, et al. Prolonged interval in prophylactic heparin flushing for maintenance of subcutaneous implanted port care in patients with cancer[J]. Eur J Cancer Care(Engl), 2009, 18(2):191-194.
[25]	Kim HK, Choi SE, Lee JH, et al. Current status of interval of heparin flushing for maintenance of an implanted port in solid tumor patients[J]. J Korean Biol Nurs Sci, 2014, 16(3):251-257.
[26]	Pittiruti M, Bertoglio S, Scoppettuolo G, et al. Evidence-based criteria for the choice and the clinical use of the most appropriate lock solutions for central venous catheters(excluding dialysis catheters):a GAVeCeLT consensus[J]. J Vasc Access, 2016, 17(6):453-464. DOI PMID
[27]	仇晓霞, 金光鑫, 郭艳, 等. 肿瘤患者上臂植入输液港相关感染发生率及危险因素研究[J]. 上海交通大学学报(医学版), 2019, 39(10):1183-1187.
	Qiu XX, Jin GX, Guo Y, et al. Incidence and risk factors of infection related to totally implantable access port in upper arm in cancer patients[J]. J Shanghai Jiaotong Univ (Med Sci), 2019, 39(10):1183-1187.
[28]	Goossens GA. Flushing and locking of venous catheters: available evidence and evidence deficit[J]. Nurs Res Pract, 2015, 2015:985686.
[29]	孟庆波, 王凤玲, 王国兴, 等. 改良中心静脉导管置入术在肿瘤化疗患者中的应用[J]. 中华护理杂志, 2017, 52(12):1464-1468.
	Meng QB, Wang FL, Wang GX, et al. Clinical application of located subcutaneous jugular vein inserted central catheter in cancer patients[J]. Chin J Nurs, 2017, 52(12):1464-1468.
[30]	Schilcher G, Scharnagl H, Horina JH, et al. Trisodium citrate induced protein precipitation in haemodialysis catheters might cause pulmonary embolism[J]. Nephrol Dial Transplant, 2012, 27(7):2953-2957. DOI URL
[31]	Baptistella CDPA, Batista Santini PH, de Almeida Mendes C, et al. Evaluation of the activity of heparin injected into the fully implantable catheter for chemotherapy(portocath) between two moments of use[J]. Ann Vasc Surg, 2019, 61:165-169. DOI PMID
[32]	Wang KR, Zhong J, Huang N, et al. Economic evaluation of peripherally inserted central catheter and other venous access devices:a scoping review[J]. J Vasc Access, 2020, 21(6):826-837. DOI URL
[33]	王凯蓉, 周英凤, 张晓菊, 等. 两种中心静脉输液技术的成本效果分析[J]. 中华护理杂志, 2021, 56(4):574-581.
	Wang KR, Zhou YF, Zhang XJ, et al. A cost-effectiveness analysis of peripherally inserted central catheter versus totally implanted venous port[J]. Chin J Nurs, 2021, 56(4):574-581.
[34]	张进泓, 罗凤. 应用完全植入式静脉输液港病人满意度与生活质量的研究进展[J]. 护理研究, 2019, 33(7):1166-1169.
	Zhang JH, Luo F. Research progress on satisfaction and quality of life in patient with totally implantable vascular access port[J]. Chin Nurs Res, 2019, 33(7):1166-1169.
[35]	Wu XH, Chen LC, Liu GL, et al. Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients:a systematic review and meta-analysis[J]. Int J Nurs Pract, 2021, 27(2):e12913.
[36]	Najarzadeh Z, Zaman M, Sereikaite V, et al. Heparin promotes fibrillation of most phenol-soluble modulin virulence peptides from staphylococcus aureus[J]. J Biol Chem, 2021, 297(2):100953.
[37]	Solinas G, Platini F, Trivellato M, et al. Port in oncology practice:3-monthly locking with normal saline for catheter maintenance,a preliminary report[J]. J Vasc Access, 2017, 18(4):325-327. DOI URL
[38]	吴超君, 缪晶, 张昕童, 等. 成人植入式静脉输液港相关感染危险因素的系统评价[J]. 中国循证医学杂志, 2018, 18(2):156-162.
	Wu CJ, Miao J, Zhang XT, et al. The risk factors of related infections on adult totally implantable venous access device (TIVAD):a systematic review[J]. Chin J Evid-Based Med, 2018, 18(2):156-162.