Power Injectable Versus a Non-Power Injectable, Upper Arm, TIVAD for Chemotherapy

Assessment of a Power Injectable vs. a Non-Power Injectable, Upper Arm, Totally Implanted Venous Access Devices for Chemotherapy

Patients with cancer often require intravenous chemotherapy for long periods of time.

Ensuring that these patients have safe and reliable access to the veins for chemotherapy is challenging, and sometimes a medical device is required to administer the chemotherapy into the veins.

A totally implanted venous access device, or port, is implanted under the skin of the arm and is attached to a small plastic catheter that enters into the veins. This device can be punctured with a needle when needed for treatment or testing.

Some types of these vein ports can rapidly inject fluids (power injection), and can be used for follow-up imaging studies, such as computed tomography, that are required to follow cancer treatment effectiveness. There are no publications of randomized patients discussing the impact of power injection upon TIVAD complications and device longevity for arm implantation. The investigators propose to compare the effectiveness of power injectable against non-power injectable ports to determine if they have different clinical performance and complications. Our results will impact the care provided to cancer patients.

Study Overview

• Status: Completed
• Conditions: Malignancy
• Intervention / Treatment: Device: Power Injectable Port (AngioDynamics Smart Port CT Mini); Device: Non-Power Injectable Port (Cook Vital Mini Port)

Detailed Description

Hypothesis:

The null hypothesis envisions both devices performing similarly in regards to chemotherapy and complications. However, the power injectable population will experience the high flow, large volume injections, may experience complications of injection extravasation and port damage due to the more vigorous injection parameters.

Trial Objectives:

1. To prospectively assess the functionality and complications of a power injectable vs. a non-power injectable TIVAD in a cohort of breast cancer patients requiring intravenous chemotherapy. The TIVAD will be randomly assigned to each patient.
2. Assess quality of life for subjects who have the two different TIVADs.
3. Facilitate device selection for future cancer patients requiring chemotherapy.

We will perform a randomized, prospective clinical trial of patients with cancer to compare a non-power injectable port, Cook Vital Mini Port (Cook Canada, Mississauga, ON), with a power injectable port, the AngioDynamics Smart Port CT Mini (AngioDynamics Inc., Manchester, GA, USA).

Adverse events, such as arm swelling, skin rash, and incision dehiscence, etc., will be tracked via an online reporting system, a patient registry, and by follow-up strategies related to imaging and clinical assessments at regular time intervals.

Patient Follow-up:

From the Insertion date, a 7 day post insertion telephone interview will be performed. Subsequently the following will be obtained at 3 months and 12 months post port insertion.

Clinical examination Venous Doppler US (arm/neck) Chest and arm X-ray QLQC30 questionnaire QLAVD-PA questionnaire Adverse Event Record

Details of Follow-up:

Clinical Examination:

Visual inspection of the arm, port implantation site, neck, and anterior chest.

1. Distended arm, neck or chest veins - Y/N - details
2. Swollen or edematous arm, neck, chest - Y/N - details
3. Skin rash - Y/N - details
4. Signs of arm infection - redness, swelling, purulent discharge - Y/N - details
5. Abnormal incision site of port insertion - Y/N - details

Venous Doppler Ultrasound (arm/neck):

Ultrasound will assess for vein thrombosis or narrowing.

Chest and arm x-rays:

Standard x-rays to include the arm from at least the elbow to axilla, full chest x-ray.

QLCC30 and QLAVD-PA:

Quality of Life surveys.

Adverse Events:

7 days, 3 months, 12 months, up to 24 months if possible - The patient will be contacted by telephone to determine if they have experienced any adverse events.

• Study Type: Interventional
• Enrollment (Actual): 209
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Saskatchewan
    • Saskatoon, Saskatchewan, Canada, S7N 0W8
      • Medical Imaging, Royal University Hospital, 103 Hospital Drive

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Consecutive patients breast cancer requiring intravenous chemotherapy, referred from our local Cancer Agency for arm TIVAD, will be included.

Exclusion Criteria:

• • Those under the age of 16 years;

  • Those with uncorrectable blood clotting disorder;
  • Pregnant women, as they will not be candidates for chemotherapy;
  • Any person with an active infection or immunocompromised state;
  • Those on oral or intravenous antibiotics on the day of TIVAD implantation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Power Injectable Port; The subjects randomized to this group will receive the newer, power injectable port.	Device: Power Injectable Port (AngioDynamics Smart Port CT Mini); The subjects will all receive power injectable port.
Active Comparator: Non-Power Injectable Port; The subjects randomized to this group will receive the older, non-power injectable port.	Device: Non-Power Injectable Port (Cook Vital Mini Port); The subjects will all receive non-power injectable port.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Device Failure (Failure secondary to occlusion, leakage, catheter fracture, wound dehiscence)	Failure secondary to occlusion, leakage, catheter fracture, wound dehiscence	2 years after insertion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Venous Thrombosis	Ipsilateral US of veins of arm and neck to detect venous thrombosis	2 years after implantation
Quality of Life Related to Port	Surveys of quality of life will be performed for each device	2 years after implantation
Infection	Detect implantation site or systemic infection related to the port.	2 years after implantation

Collaborators and Investigators

• Sponsor: University of Saskatchewan
• Investigators: Principal Investigator: Brent E Burbridge, MD, FRCPC, Medical Imaging, 103 Hospital Drive, Royal University Hospital, Saskatoon, SK, Canada S7N 0W8

Publications and helpful links

General Publications

• Goossens GA, Stas M, Jerome M, Moons P. Systematic review: malfunction of totally implantable venous access devices in cancer patients. Support Care Cancer. 2011 Jul;19(7):883-98. doi: 10.1007/s00520-011-1171-3. Epub 2011 May 10.
• Marcy PY, Chamorey E, Amoretti N, Benezery K, Bensadoun RJ, Bozec A, Poissonnet G, Dassonville O, Rame M, Italiano A, Peyrade F, Brenac F, Gallard JC. A comparison between distal and proximal port device insertion in head and neck cancer. Eur J Surg Oncol. 2008 Nov;34(11):1262-9. doi: 10.1016/j.ejso.2007.09.011. Epub 2007 Nov 5.
• Goltz JP, Machann W, Noack C, Hahn D, Kickuth R. Feasibility of power contrast injections and bolus triggering during CT scans in oncologic patients with totally implantable venous access ports of the forearm. Acta Radiol. 2011 Feb 1;52(1):41-7. doi: 10.1258/ar.2010.100238.

Study record dates

Study Major Dates

• Study Start: September 1, 2013
• Primary Completion (Actual): July 1, 2016
• Study Completion (Actual): July 1, 2016

Study Registration Dates

• First Submitted: October 30, 2014
• First Submitted That Met QC Criteria: November 3, 2014
• First Posted (Estimate): November 4, 2014

Study Record Updates

• Last Update Posted (Estimate): October 26, 2016
• Last Update Submitted That Met QC Criteria: October 24, 2016
• Last Verified: October 1, 2016

More Information

Terms related to this study

• Keywords: Chemotherapy; Venous access device; Port catheters
• Additional Relevant MeSH Terms: Neoplasms
• Other Study ID Numbers: 13-42