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  • Title: [Spectrum of indications and perioperative management in i. v. port-a-cath explantation--alternative administration of taurolin in case of i. v. port-a-cath infection].
    Author: Weber M, Meyer F, Halloul Z.
    Journal: Zentralbl Chir; 2009 Aug; 134(4):350-6. PubMed ID: 19688684.
    Abstract:
    BACKGROUND: The aims of this systematic investigation were to analyse i) causes and complications leading to i. v. port-a-cath explantation and ii) a specific therapeutic option (taurolin administration via i. v. port-a-cath) in the case of an i. v. port-a-cath infection in a pilot study with regard to the feasibility and efficacy to finally avoid -explantation. PATIENTS AND METHODS: Based on a prospective, unicentre observational study on the implantation of an i. v. port-a-cath (daily surgical practice) enrolling consecutive patients of a representative number and through a defined study period (design, case series), besides patient and intervention-associated characteristics, we investigated 1. the spectrum of causes for an i. v. port-a-cath explantation; 2. the option of a conservative i. v. port-a-cath-maintaining, endoluminal, antiseptic local therapy in a selected number of patients with microbiologically detected infection of the i. v. port-a-cath using 2 x 5.0 ml taurolin 2.0 % / d for 3 d as an accompanying clinical observation of initial therapeutic use and its effect. Thereafter, microbe detection was again compared between blood culture and the port-a-cath catheter. RESULTS: From 2002 to 2005, overall 1588 i. v. port-a-caths were implanted at the Department of -General, Abdominal and Vascular Surgery (University Hospital, Magdeburg, Germany). 1) In -total, 117 patients (69 females vs. 48 males; sex ratio, 1.44 : 1) with complications and subsequent indication for an explantation of the i. v. port-a-cath were observed (most frequent cause: infection of the i. v. port-a-cath, 40 %). 2) Taken together, 10 patients underwent systematic administration of taurolin and follow-up investigation: In 8 of 10 patients (success rate, 80 %), the infection of the i. v. port-a-cath could be successfully treated with taurolin-administration as described and, in addition, the threatening -explantation of the i. v. port-a-cath could be avoided. CONCLUSIONS: There are various indications for the necessary -explantation of an i. v. port-a-cath, which need to be precisely analysed to avoid long-term consequences. Infection of the i. v. port-a-cath is the main reason for explantation and may be successfully treated with taurolin in selected cases under short-term clinical and microbiological control. The up to now urgently indicated explantation of an i. v. port-a-cath can thus be circumvented. However, a further systematic case series with a representative case number and intermediate, case-specific follow-up investigations appear to be desirable.
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