Bleeding from peptic ulcers and use of non-steroidal anti-inflammatory drugs in the Romford area.

Abstract

women the portal can often be concealed in the edge of the breast.The portal must be flushed both monthly with heparinised saline and after each use. PatientsPort-A-Cath systems were inserted in 40 patients (16 men, 24 women) at three centres.Thirty seven patients had malignant disease, two asplastic anaemia, and one Christmas disease.The cephalic vein was used for access in 26 patients, the internal jugular vein in 10, the subclavian vein in two, and the external jugular and external iliac veins in one each.Eleven patients received cover with prophylactic antibiotics when their portals were inserted.At insertion nine patients had abnormal white cell counts, two patients abnormal clotting variables, and five patients platelet counts below 20 x 109/1.The portal was used for blood sampling, as well as administration of virtually all the commonly used cytotoxic agents and blood and blood products.Thirty six patients found the Port-A-Cath entirely satisfactory, but four found it unacceptable, due largely to discomfort when inserting the needles.The six patients who had previously had an arteriovenous fistula or Hickman catheter for prolonged venous access much preferred the Port-A-Cath.The portals had been in position for an average of 11-6 months (range 1-24 months), and most were still in use, only six having been removed.Five important complications have occurred, all attributable to errors in the use of the portal.Two portals became infected.One portal was extruded spontaneously when the wound broke down after the start of high dose chemotherapy within 24 hours of inserting the portal.Two portals thrombosed, but one was cleared with urokinase.Four patients died with their Port-A-Cath in situ.None of these deaths could be attributed to the Port-A-Cath.Self sealing septum Skin line Suture Cathe*r Fluid flow Diagram of implanted portal.