Occlusion of central venous port catheters after simultaneous 24 h infusions of 5-FU and calcium-folinic acid in patients with gastrointestinal cancer

• Published in: Wiener medizinische Wochenschrift 2004-05, Vol.154 (9-10), p.182
• Main Authors: Fackler-Schwalbe, I, Schwalbe, B, Epple, M, Becker, A, Prügl, L, Gassel, W D, Stoffels, D, Südhoff, T
• Format: Article
• Language: ger
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Calcium Carbonate - analysis; Catheterization, Central Venous - instrumentation; Catheters, Indwelling; Chemical Precipitation; Colorectal Neoplasms - drug therapy; Crystallization; Device Removal; Equipment Failure Analysis; Female; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Humans; Leucovorin - administration & dosage; Leucovorin - adverse effects; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms - drug therapy; Stomach Neoplasms - drug therapy; Surface Properties
• ISSN: 0043-5341

Folinic acid-modulated 5-FU regimens are standard elements in several chemotherapy combinations like FOLFIRI, FOLFOX or AIO-regimen in the palliative treatment of patients with gastrointestinal cancer. When the simultaneous mixed infusion of 5-FU and calcium-folinic acid (Leucovorin) was authorized by the BfArM in 2002, we introduced this application regimen in the treatment of our cancer patients. 19 patients (AIO-regimen [5], FOLFIRI [12] and FOLFOX [2]) received a simultaneously mixed infusion of calcium-folinic acid and 5-FU over 24 hours with a total of 110 applications. 5-FU doses varied between 2000 and 2600 mg/m2, calcium-folinic acid was given with 500 mg/m2, infusion rate was 10 ml/hour using a 24 h pump. Central venous catheters employed included single Barth-Port in 18 cases, 1 patient had a Viggon-Port. In 3 out of the 19 patients catheter occlusion was noticed after 8-10 weekly applications of the mixed infusion. Heparine and subsequently urokinase were not successful in reversing the obstruction. All three catheters had to be explanted. Catheter tips in all cases showed a yellow cristalline precipitation. The crystallographic analysis exhibited calcium carbonate (CaCO3) in its polymorphic form (calcite). Thus, we confirmed calcite formation causing catheter occlusion as a frequent complication during a continuous 24 h-infusion of mixed high dose 5-FU and calcium-folinic acid. This reaction could not be avoided by increasing infusion volume and the application flow rate. As a result of our findings, recommending using calcium-folinic acid mixed with 5-FU has been withdrawn in the meantime.