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There have been no significant complications related to the use of this ambulatory hyperalimentation vest. The potential positive impact that increased use of this vest at home might have upon hospital stay and cost containment is obvious. It is further anticipated that, as advances are made in the technology of plastic bags, tubing, miniature pumps and microprocessors, ambulatory or home hyperalimentation delivery systems exemplified by this vest will achieve a much higher degree of sophistication, practical application, economy and favorable clinical results.

This is a simple technique that requires a little more time than the use of forceps to make a subcutaneous tract. It keeps disruption of the subcutaneous tract to a minimum and, therefore, decreases the risk of bleeding in this area which may be significant in a compromised host.

We evaluated 15 adult patients in whom subcutaneous infusion ports (SIP) were implanted exclusively for the administration of parenteral nutrition at home (HPN). The SIP were in place for a total of 4,939 days, with a mean of 259 days, and used for delivery of HPN 2,534 times. The devices were implanted on the anterior part of the wall of the chest and the catheters introduced percutaneously through the subclavian vein into the superior vena cava under fluoroscopic guidance. There were two episodes of sepsis related to insertion of catheters (1.0 per 6.8 catheter years) and six mechanical complications. Three patients with multiple previous episodes of sepsis associated with Hickman catheters (long term Silastic [silicone rubber] central venous catheter) had no further infections after conversion to SIP. All eight patients with previous Hickman catheters preferred the SIP. The SIP compare favorably with Hickman catheters with respect to the incidence of sepsis related to the catheters and mechanical complications. SIP are our current choice for cyclic administration of HPN because of optimal acceptance by patients and a low rate of major complications.

In 94 patients, 137 permanent Silastic central venous catheters were inserted. Of these, 53 catheters were removed because of catheter related problems. The average duration of catheter use was 12 months. However, the catheter was only removed once every 31 patient months because of catheter dysfunction and once every 82 months because of catheter related sepsis. None of the patients died from catheter related septicemia. We believe this low complication rate of catheter related complications represents an acceptable risk for those patients who will benefit from home parenteral nutrition.

Two Broviac catheters were placed simultaneously in 93 patients who required prolonged intravenous support while receiving chemotherapy or a bone marrow transplant. The technique involved two venotomies in a single vein and was performed under local anesthesia in the operating room. Pancytopenia was not considered a contraindication. Blood sampling and intensive treatment with blood products, chemotherapy, parenteral nutrition and multiple antibiotics were facilitated by these durable, well-tolerated Silastic catheters. Patients were taught to care for them following discharge, and the majority of catheters were used for outpatient treatment. The few complications encountered were compensated for by the convenience and safety of the double Broviac method. The danger of chemotherapy extravasation was completely obviated, as were the complications of repeated central line insertion, and the anxiety and pain associated with multiple unsuccessful attempts at venipuncture. Because of the enthusiastic acceptance of long term Silastic catheters by patients and nursing staff, we regard this technique was a step forward in solving the problem of difficult vascular access in cancer patients.