The timing and sequence of multiple device-related complications in patients with indwelling subcutaneous ports

BACKGROUND: Multiple complications associated with venous access ports are a common occurrence. In an effort to define patterns of sequential complications in our community, we undertook a prospective analysis of adult cancer patients in whom a subcutaneous port was inserted. METHODS: One hundred nineteen consecutive adult cancer patients in whom a subcutaneous port was inserted were observed prospectively for the development of complications. RESULTS: Complications were identified in 70 of the 91 evaluable patients, while sequential complications were identified in 35 patients (38%). In aggregate, 121 complications were identified. The ball-valve effect, the most frequently identified problem, was found to occur disproportionately as a primary complication (52 of 70 versus 26 of 51, P < 0.02). In contrast, port-related venous thrombosis was identified most frequently as a subsequent complication (11 of 51 versus 4 of 70, P < 0.02). The only identified risk factor for the development of port-related complications was the ball-valve effect, found to be associated with the subsequent development of port-related venous thrombosis (9 of 52 versus 2 of 69, P < 0.02), CONCLUSIONS: Multiple sequential complications of subcutaneous ports are common and occur in a rather predictable order. The occurrence of port-related venous thrombosis in patients with an earlier, relatively minor vascular complication (ball-valve effect) suggests a cause-effect relationship. Insight into complication sequencing may lead to improved strategies for prevention and therapy. (C) 1997 by Excerpta Medica, Inc.