Follow up of utility and value of totally implantable chemotherapy catheter in 233 brazilian patients receiving chemotherapy to treat cancer

ABSTRACT Objectives: the present study aims to evaluate cancer patients related to the catheter flow and the general satisfaction of these patients. Methods: we studied 233 individuals diagnosed with cancer who underwent chemotherapy treatment through venous access through portocath between January 2015 and December 2019. Results: 97% of the patients consulted had palliative chemotherapy, and 99.1% of patients reported satisfaction with the implantation process and treatment method. Regarding catheter flow according to venous return and drip during drug infusion, 98.7% of individuals presented good flow. Conclusions: the results show that catheter flow was satisfactory in all implant sites observed and emphasize the advantages of using a totally implanted catheter. This benefice happens due to the reduction of emotional factors that cause stress in cancer patients receiving chemotherapy, as well as the reduction of trauma and discomfort experienced by patients during the infusion of peripheral chemotherapy.


César
Follow up of utility and value of totally implantable chemotherapy catheter in 233 brazilian patients receiving chemotherapy to treat cancer of infection and greater durability compared with semiimplantable ones.The main indications for the placement of totally implantable catheters are the need for frequent venous access, use of vesicant drugs and inadequate peripheral venous system 1 .
PICC and Port-A-Cath can greatly improve patient quality of life and reduce nurses' workload.Port-A-Cath is best suited for patients who require long-term, high-dose chemotherapy, such as eight cycles or more, and those who live far from the hospital, while PICC is best suited for patients with chemotherapy of shorter durations, such as four-cycle regimes, or living close to the hospital 8 .
PICCs are associated with a higher risk of related deep vein thrombosis and other adverse events when compared with Port-A-Cath.This risk must be considered when choosing a vascular access device for chemotherapy, especially in patients with solid neoplasias 9 .
Complications with Port-A-Cath may be related to the implantation technique, handling, and maintenance for drug administration.

METHODS
This study has a descriptive character.The research was carried out in an oncology center in the Metropolitan Region of Belo Horizonte, with units in the cities of Betim, Contagem, and Belo Horizonte.The service assists patients in the scope of supplementary health (insurance-covered).
We selected a convenience sample with 233 patients from the three service units, who started chemotherapy treatment through venous access using Portocath, between January 2015 and December 2019.

Inclusion criteria involve patients from the Unified
Public Health System (SUS) and the supplementary health one undergoing a Port-A-Cath implant for chemotherapy treatment in the considered period.Exclusion criteria were patients whose registration regarding the catheter insertion was incomplete, since the sampling was carried out based on documentary and retrospective data collection.
Data were collected by the nurse responsible for the chemotherapy catheters in the institution's database, using an instrument developed specifically for this study, called 'Chemotherapy Catheter Questionnaire'.This questionnaire's sources of data were the electronic medical records accessed through the SpData Software.
We accessed data on medical evolution and prescription, catheter implantation, anatomopathological reports, evolution of the nurse's consultation, evolution of the pharmacist, and personal data.The information collected in the database can be categorized as follows: • implanted the catheter and did not complain about events related to its use were considered satisfied.
We evaluated catheter flow according to venous return and dripping during drug infusion: 230 subjects had good flow (98.7%), two patients had moderate flow (0.9%), and one, poor flow (0.4%).

DISCUSSION
Since their introduction in 1980, FIVC have been widely used for chemotherapy, especially in patients with poor peripheral venous circulation, mainly in the context of palliative chemotherapy, with prolonged treatment6.Initially, they had little use in Brazil, but after its incorporation into the SUS, it became a large volume procedure in all hospitals that treat cancer patients.
The fully implanted, long-term venous catheter is a practical venous access, with few risks for the patient's treatment, and which favors the quality of life of cancer patients, since these catheters practically do not restrict physical mobility, allow greater freedom in choosing their activities, and favor body image2.
The immediate complications of the catheter, such as pneumothorax, bruises, and hemorrhages have always attracted the attention of surgeons.Although potentially serious, they are rare and tend to become less and less prevalent with greater staff training, better catheters, and more appropriate surgical conditions, such as the use of image intensifiers and perioperative ultrasound.
According to the completed questionnaires, practically all patients monitored had a good flow in the catheter and good satisfaction with it (only two had a moderate flow and one had a poor flow), which can be considered excellent when compared with data in the literature 2 .Given that catheter flow is naturally almost always good, it is not possible to relate cases of poor flow quality to any other variable queried by the survey instrument (age, sex, catheter site,…).Therefore, poor flow in the catheter does not depend on the insertion site, but on other factors not addressed in the used questionnaire.No patient had treatment delayed or interrupted due to lack of venous access.
Given this practically unanimous behavior of catheter satisfaction, it is not possible to relate the cases of dissatisfaction with any other variable answered in the questionnaires (age, sex, catheter site,…).Therefore, dissartisfaction with the catheter is due to individual patient factors, not collected in the questionnaire and not detectable in statistical tests.
We believe that our results confirm that infusion through the chemotherapy catheter has positive aspects, such as greater safety in receiving treatment, a decrease in the number of punctures received, reduction of pain and stress during infusion, and especially greater adherence to treatment, without interruption of cycles per lack of venous access.The advantages of using a fully implanted catheter are highlighted in view of the reduction of emotional factors that cause stress in cancer patients receiving chemotherapy, as well as  We believe that the results were good, since most of the patients were receiving palliative treatment and required a long treatment period and several punctures.
In addition, only one catheter was placed in the arm, a site with a higher complication rate than the thorax, corroborating the good results.

CONCLUSION
The

R E S U M O R E S U M O
As this is a retrospective analysis of medical records in the last five years, it was not possible to locate all research subjects or legal guardians for the informed consent process, due to the estimated sample size, as well as due to the possibility of analyzing medical records of patients who died.For these reasons, we requested the waiver of the Informed Consent Form.
Sociodemographic: sex, date of birth, medical record number, profession, skin color, education level, and municipalities of

Table 1 -
Demographic data of patients with FIVC implantation.