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LONG TERM VENOUS ACCESS FOR INTERMITTENT PARENTERAL NUTRITION : ADVANTAGE OF TOTALLY IMPLANTABLE CENTRAL VENOUS ACCESS SYSTEMS. D.Perrot, B.Coiffier, J.R.Brudon, J.Motin (Anesthesiology, Hematology and Surgery Departments, Hopital Edouard Herriot, Lyon, France)

Long term intermittent parenteral nutrition needs a readily available venous access. We report an experience of 77 totally implantable central venous access system (TIVAS) in patients with malignant diseases.

Several types of TIVAS (37 PORT-A-CATHR, 31 BIOPERFR, 8 INFUSE-A-PORTR and one IMPLAN- TOFIXR) were implanted under local anesthesia (except for 2 patients who needed general anesthesia) with a percutaneous (62 cases) or surgical technique (15 cases) in 28 males and 49 females (age ranged from 20 to 78 years). Internal jugular vein was used in 63 cases, subclavian vein in 13 cases and superficial femoral vein in one case ; correct central position of the catheter tip was ascertained by chest X-ray. The TIVAS were flushed with 10 ml of heparinized saline solution prior to and at the completion of drug injections or infusions, and once by month between uses. The TIVAS were used for inter- mittent parenteral nutrition (PN) (75 cases) and/or chemotherapy (73 cases), for drug or blood products administration (39 cases) and blood sampling (37 cases).

Mean duration of venous access is 205 days, ranged from 2 to 763 days, with a cumulative duration of PN exceeding 2000 days. No severe complication occured during implantation, and no death was related to implantation or TIVAS use. Fourteen secondary complications were observed : 9 benign (2 local inflammations, 1 local infection, 3 local hematomas, 1 TIVAS displacement, 2 catheter obstructions) easily managed and without consequence on TIVAS use, 5 severe requiring its removal (1 catheter leakage, 1 jugular vein thrombosis 2 local infections with cicatrization defect, 1 TIVAS related septicemia). Patients’ acceptance was excellent (in addition to 3 patients with early severe complication), be- cause of no impediment to normal activities.

Acquired experience allow to justify early implantation of TIVAS for long term intermit- tent parenteral nutrition and/or chemotherapy.

THROMBOTIC RISK DURING PARENTERAL NUTRITION WITH SILICONE OR POLYURETHANE CATHETERS VIA THE AXILLARY VEIN. P. Saux, C. Martin, .I. Albanese, d'anesthesie-reanim8pital Sainte-Marguerite,

N. Bruder, F. Gouin (DCpartement 13009 - Marseille, FRANCE).

Venous thrombosis is a serious complication of prolonged intravascular perfusion. By ra- diography this complication has been shown to occur in more than 30 % of total parente- ral nutrition patients. This incidence might be reduced with the use of blood-compatible materials. This prospective study was designed to evaluate the thrombotic risk of two intravenous catheters inserted percutaneously via the axillary vein. into iwo groups. In group 1,

Patients were randqplly assigned 31 patients (27 males and 4 women mean age 52 - 4 -

mean SEM) were catheterized with a 2 mm external diameter silicone catheter (Vygon - Nutricath S 2181 - 20). In group 2, mean +-

29 patients (22 males and 7 women, mean age 56 ?: 5 - SEM) were catheterized with a 2 mm external diameter polyurethane catheter (Plas-

timed - Endoflex 1566 - 20). During catheterization patients were carefully followed-up for clinical signs of venous thrombosis (pain, arm swelling, collateral veins). At termination of parenteral nutri- tion each patient had phlebographic control of superior cava system. The two groups were similar according to the use of heparin or vaso-active drugs and the incidence of collap- ses. Statistical analysis was performed using Fisher exact probability test and student "t" test. No patient in group 1 and one patient in group 2 developped clinical evidence of thrombosis after catheterization. Phlebographic control showed an overall incidence of thrombosis of the axillary vein of 16 p. tial thrombosis).

cent in group 1 (one complete and four par- In group 2 incidence was 6.8 p.

thrombosis). cent (one complete and one partial

Owing to small numbers theses results are not statistically different. There was no significant diffzrence between the two groups for the mean duration of ca- theterization : 13.5 * 1.2 days in group 1 and 16 + 1.3 days in group 2. As a whole in our study phlebographic incidence of thrombosis appeared very low (11.6 p. cent) : polyurethane and silicone catheters should always be used for parenteral feeding.

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