Application Of Implantable Venous Access Port In Intravenous Chemotherapy Of Gynecological Malignancies

Background and ObjectiveGynecological malignancies such as ovarian cancer,gestational trophoblastic tumor,and endometrial carcinoma often require multiple courses of intravenous chemotherapy.Considering the commonly used chemotherapy drug,including 5-Fluorouracil,actinomycin D,and platinum,is associated with high concentration,long infusion time,and serious blood vessel irritation.Therefore,it is crucial to choose an appropriate vascular access for systemic therapy administration.In recent years,Implantable venous access port(IVAP or port),peripherally inserted central catheter(PICC),and peripheral intravenous access(PIVA)have been widely used in the delivery of chemotherapy drugs.Currently,there are relatively few literatures on the application of port in intravenous chemotherapy for gynecological malignant tumors at home and abroad;In addition,chemotherapy device selection often depends on doctors’ experience and patients’ preference;there is no evidence-based guide to the selection of the most optimal device for gynecological malignant tumor patients.The purpose of this study is to investigate the effect of implantable venous access port in intravenous chemotherapy of gynecological malignant tumors;and provide a theoretical basis for patients with gynecological malignant tumor to choose suitable intravenous chemotherapy.Research Objects and MethodsA retrospective cohort study was conducted for patients with gynecologic malignancies who underwent intravenous chemotherapy at the Gynecology Department of the First Affiliated Hospital of Zhengzhou University between November 2014 and December 2016,including 160 patients in the IVAP group,200 in the PICC group,and 216 in the PIVA group.The success rate of the first puncture,the incidence of complications,and the satisfaction of patients and nurses were compared among three groups.The data were recorded and analyzed using SPSS 21.0.Continuous variables were presented as mean ± standard deviation.The skewed distribution is expressed in median and quartile [M(P25～P75)].Chi-square test was used to evaluate the difference of enumeration data.Analysis of variance(ANOVA)was used to compare the difference of three groups for measurement data,and the LSD-t test was used for multiple comparisons between the three groups.The significance level was set at 0.05.Results1.No statistical differences among the three groups with regard to clinical characteristics such as age,tumor type,tumor staging and chemotherapy regimens(all P are >0.05).2.The first puncture success rate of IVAP group was higher than PIVA group(χ2=9.04,P=0.00).No statistical differences were noted between IVAP and PICC group(χ2=1.85,P=0.17).3.The incidence of catheter-related venous thrombosis in IVAP group was lower than that in PICC group(χ2=5.37,P=0.02),and the difference was not statistically significant compared with that in PIVA group(χ2=0.87,P=0.35).The incidence of phlebitis,drug extravasation and skin rash around catheterization in IVAP group was lower than that in PIVA group(all P are <0.05),and the difference was not statistically significant compared with that in PICC group(all P are >0.05).The rate of overall complication in IVAP group was 3.1%,is lower compared with PICC group(χ2=7.95,P=0.00)and PIVA group(χ2=13.38,P=0.00).4.There were 154 patients(96.2%)in IVAP group considered port simplified their treatment,higher than PICC group(χ2=7.92,P=0.00)and PIVA group(χ2=69.50,P=0.00).In the impact of bathing,swimming,housework,sleep and image,fewer patients in IVAP group were disturbed compared with PIVA group and PICC group(all P are <0.05).There were 5 patients in IVAP group,which indicated frequent pain at the catheter,lower than PICC group(χ2=12.63,P=0.00)and PIVA group(χ2=27.68,P=0.00).More patients(97.5%)in IVAP group did not mind a port implanted in the body,significantly higher than PICC group(χ2=48.22,P=0.00)and PIVA group(χ2=62.04,P=0.00).Patients in IVAP group were less concerned about potential complications than those in PICC group(χ2=10.15,P=0.00)and PIVA group(χ2=39.97,P=0.00).There were 137 patients(85.6%)in the IVAP group indicated that they could receive the cost,but lower than PICC group(χ2=12.16,P=0.00)and PIVA group(χ2=21.63,P=0.00).There were 155 patients(96.9%)in IVAP group were willing to recommend ports to future patients starting chemotherapy,higher than PICC group(χ2=28.88,P=0.00)and PIVA group(χ2=128.36,P=0.00).5.The average score of nurses in IVAP group was 92.7±4.46,significantly higher than PICC group(LSD0.05=7.64,P=0.00)and IV group(LSD0.05=18.35,P=0.00).Conclusions1.Port can decrease venous puncture times,which brings convenience to patients.2.Port,with the fewest device complications,the least nursing time,the best cosmetic results and the greatest patient and nurse satisfaction,is recommended as the first choice for the administration of chemotherapy of gynecologic malignant tumors.