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LETTER TO EDITOR
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 97-98
 

Subcutaneous intravenous infusion port rotation causing extravasation in an obese patient


1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication15-Nov-2018

Correspondence Address:
Dr. Neeraj Kumar
Room No. 216, PG-1, All India Institute of Medical Sciences Campus, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_40_18

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How to cite this article:
Kumar N, Dubey PK, Kumar A. Subcutaneous intravenous infusion port rotation causing extravasation in an obese patient. Indian Anaesth Forum 2018;19:97-8

How to cite this URL:
Kumar N, Dubey PK, Kumar A. Subcutaneous intravenous infusion port rotation causing extravasation in an obese patient. Indian Anaesth Forum [serial online] 2018 [cited 2019 Sep 16];19:97-8. Available from: http://www.theiaforum.org/text.asp?2018/19/2/97/245547




Sir,

Subcutaneous intravenous infusion port has become an increasingly and widely adopted technique in the management of oncology patients. This route has been used not only for chemotherapy but also for parenteral nutrition provision, blood transfusion, medication administration, blood sample collection, hemodialysis, and so on. This system provides a safe vascular access with a low complication rate. Extravasation of the chemotherapeutic agent to the subcutaneous tissue can lead to infection and soft-tissue necrosis. Presented here is a case of port inversion leading to extravasation of the chemotherapeutic agent docetaxel. The creation of a large port pocket in an obese patient probably led to this situation after an apparently correct needle placement.

A 58-year-old, 92 kg female, with a subcutaneous infusion port in situ in the right infraclavicular region, had to undergo chemotherapy following radical mastectomy. A needle was placed successfully with all aseptic precaution. Free flow of blood on aspiration was established, and the chemotherapy infusion was started.

After some time, a swelling around the infusion needle site was noticed. However, the speed of the infusion solution remained unchanged. The infusion was stopped, and no blood could be aspirated through the needle.

On palpating the port, it was felt that the port had rotated. It was also noticed that the subcutaneous pocket was quite spacious allowing easy rotation of the port on arm movements made by the patient. This was probably facilitated by the large amount of the subcutaneous fat or loose tissue. It was felt that the port got inverted later on due to a patient movement that led to the dislodgement of a correctly placed needle. Due to the large amount of subcutaneous space available, initially, there was no change in the flow rate.

Oral antibiotics were prescribed to the patient, and a peripheral vein was used to finish the chemotherapy. There was ulceration that appeared later [Figure 1] but responded to conservative measures. The port was used uneventfully for subsequent cycles of chemotherapy.
Figure 1: Aftermath of extravasation: Healing ulcer lateral to the port placement scar

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Normally, the port base is secured to the pectoralis major muscle surface with nonabsorbable sutures.[1] However, port migration and port inversion are not unknown. In a series of 476 port placements, one case of port inversion was reported.[2] Unlike this case, that did not happen during the administration of chemotherapy.

We suggest the creation of a tight port pocket in which the port barely fits when performing this procedure in obese patients. Fixing the port with nonabsorbale sutures will further help in avoiding this serious complication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jan HC, Chou SJ, Chen TH, Lee CI, Chen TK, Lou MA. Management and prevention of complications of subcutaneous intravenous infusion port. Surg Oncol 2012;21:7-13.  Back to cited text no. 1
    
2.
Cil BE, Canyiğit M, Peynircioğlu B, Hazirolan T, Carkaci S, Cekirge S, et al. Subcutaneous venous port implantation in adult patients: A single center experience. Diagn Interv Radiol 2006;12:93-8.  Back to cited text no. 2
    


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