Background and rationale
Central venous access is a common requirement in oncology for administration of chemotherapy and laboratory monitoring. A subcutaneous infusion port (SIP), consists of a subcutaneous reservoir connected to a catheter inserted into a central vein. This invasive line is inserted using the modified Seldinger technique together with surgical fashioning of a subcutaneous pocket superior to the pectoralis fascia for the reservoir. SIPs can be associated with a number of complications, the most common being line infection and thrombosis (1). There are reports of significant morbidity associated with SIPs in the oncology patient (2). SIPs are inserted at our centre for patients with breast and colorectal cancer.
Random selection of patients with serious SIP related complications over a 6 year period.
We describe a series of 4 cases of rare SIP complications. The complications are intra-pleural cannulation with subsequent intra-pleural chemotherapy delivery, intra-arterial cannulation causing stroke requiring vascular surgical intervention, catheter fracture requiring endovascular retrieval from the right atrium and catheter migration into subcutaneous tissue. The morbidity of the complications was significant. Xray imaging and SIP fluoroscopy studies were helpful ascertaining catheter location and regional anatomy. There was no SIP complication related mortality in this series.
Although rare, SIP complications can be severe. SIP complication awareness and general management is an essential component of clinical care in oncology for both senior and junior doctors. In particular, re-assessment of catheter position if there is difficulty in access.