***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose We aim ed to compare the complication rate between port catheters ( PC ) and peripherally inserted central catheters ( PICC ) for the administration of postoperative chemotherapy for breast cancer . Methods All patients treated from January 2010 to August 2012 at the Centre Henri Becquerel for early breast cancer requiring postoperative chemotherapy were retrospectively screened . The primary endpoint was the occurrence of a major complication related to the central venous catheter . Major complications were defined as any grade 3 event according to CTCAE 4.0 , delay in chemotherapy > 7 days , change of the device , life-threatening event , event requiring a hospitalization , or a prolongation of hospitalization . Results A total of 448 patients were included ; 290 had a PC and 158 a PICC .  Overall , 31 major complications related to the central venous catheter were observed : 13 for patients with a PC ( 4.5 % ) and 18 for patients with a PICC ( 11.4 % ) . In univariate analysis , having a PICC was the only factor significantly associated with a higher risk of major complications ( HR = 2.83 , p = 0.0027 ) . We observed a trend for a higher risk of major complications for patients older than 60 years or with BMI > 25 ( p = 0.06 ) . In multivariate analysis , having a PICC was the only predictive factor of major complications ( HR = 2.89 , p = 0.004 ) . Conclusions In univariate and multivariate analysis , having a PICC instead of a PC was the only predictive factor of device-related major complication . If confirmed prospect ively by the NCT02095743 ongoing trial , this result might modify the management of adjuvant chemotherapy administration A group of 43 adult patients with acute leukaemia ( AL ) were r and omized to receive a double-lumen totally implantable subcutaneous port system ( PORT , n=19 ) or a double-lumen central venous catheter ( CVC , n=24 )  before induction chemotherapy . Six patients were excluded due to protocol violation ( n=4 , CVC ) and technical difficulties ( n=2 , PORT ) . A st and ardized catheter record form was used for recording of catheter function , local infection and bleeding . The study was prematurely closed due to extensive subcutaneous bleeding after placement in five patients with a PORT . Intention to treat ( n=43 ) or per protocol ( PP ) analysis ( n=37 ) did not reveal a significant difference between the two groups with regard to catheter survival time ( PP PORT , median 113 days , range 2–634 days ; CVC , 55 days , 11–223 days ) . The number of positive blood cultures per 100 central venous access device days was significantly higher in the CVC group ( median 3.6 per 100 days ) than in the PORT group ( 0.9 per 100 days ; P=0.02 ) . In addition , the time to the first blood culture positive for coagulase-negative staphylococcus was shorter in the CVC group ( median 14 days ) than in the PORT group ( 52 days ; P=0.02 ) . Despite fewer infectious complications in the PORT group the use of a double-lumen CVC is advocated in patients with AL undergoing induction treatment due to the risk of extensive local bleeding after placement of the PORT BACKGROUND The use of indwelling central venous catheters ( CVCs ) has become commonplace in the management of children undergoing anticancer treatment . Several types of CVC are available , while information on complications observed in children is scarce . We describe the experience of two tertiary care centers in Italy that prospect ively followed up three types of CVC used at both institutions over a 30-month period . PATIENTS AND METHODS Between January 2000 and May 2002 , double-lumen ( DL ) or single-lumen ( SL ) Hickman-Broviac ( HB ) catheters , and single-lumen pressure-activated safety valve ( PASV ) catheters were used and prospect ively evaluated . Four types of possible complication were defined a priori : mechanical , thrombotic , malfunctioning and infectious . RESULTS Four hundred and eighteen CVCs ( 180 SL-HB , 162 DL-HB and 76 PASV ) were inserted in 368 children , for a total of 107 012 catheter days at risk of complication . At least one complication occurred while using 169 of the devices ( 40 % ) : 46 % of the DL-HB , 46 % of the PASV and 33 % of the SL-HB ( P=0.02 ) catheters . Subjects with hematological malignancies or non-malignant diseases had significantly more complications  than those with solid tumors ( P < 0.0001 ) . Overall , 234 complications were documented : 93 infectious [ complication rate per 1000 catheter days at risk (CR)=0.87 ] , 84 malfunctioning ( CR=0.78 ) , 48 mechanical ( CR=0.45 ) and nine thrombotic ( CR=0.08 ) . SL-HB had statistically fewer infectious complications , while PASV had more mechanical complications . In a multivariate regression model , the most significant risk factors for having a CVC complication were hematological disease [ relative risk (RR)=3.0 ; 95 % confidence interval ( CI ) 1.8 - 4.8 ] and age < 6 years at CVC insertion ( RR=2.5 ; 95 % CI 1.5 - 4.1 ) . As for the type of CVC , compared with SL-HB , the DL-HB catheter had a statistically significant two-fold increased risk of any complication ( RR=2.1 ; 95 % CI 1.2 - 3.6 ) , while the PASV catheter had a borderline RR of 1.8 ( 95 % CI 1.0 - 3.6 ) . Analysis by tumor type showed a higher risk of any kind of complication in patients with solid malignancies who had received a DL-HB catheter as compared with an SL-HB catheter ( RR=7.2 ; 95 % CI 2.8 - 18.7 ) . CONCLUSIONS CVCs may cause complications in up to 40 % of patients , with type of CVC , underlying disease and patient age being the three main factors that affect the incidence of CVC-related complications . SL-HB catheters have the best performance Background Central venous catheters ( CVCs ) have been an effective access for chemotherapy instead of peripherally intravenous catheters . There were limited studies on the choices and effects of different types of CVCs for chemotherapy . The aim of this study was to compare the complications , cost , and patients ’ quality of life and satisfaction of three commonly used CVCs for chemotherapy , such as implanted venous port , peripherally inserted central catheters ( PICCs ) , and external non-tunneled central venous catheters ( NTCs ) . Methods A double-center prospect i ve cohort study was carried out from March 2014 to December 2016 .  Catheterization situation , complications , catheter maintenance , cost , and patients ’ quality of life and satisfaction were recorded , investigated , and analyzed . Forty-five ports , 60 PICCs and 40 NTCs were included . All the CVCs were followed up to catheter removal . Results There was no statistical difference in catheterization success rates between port and PICC . NTC had less success rate by one puncture compared with port . Ports had fewer complications compared with PICCs and NTCs . The complication rates of ports , PICCs and NTCs were 2.2 % , 40 % , and 27.5 % , respectively . If the chemotherapy process was < 12 months , NTCs cost least , and the cost of port was much higher than PICC and NTC . When the duration time was longer than 12 months , the cost of port had no difference with the cost of PICC . Quality of life and patients ’ satisfaction of port group were significantly higher than the other two groups . Conclusion Although port catheterization costs more and needs professional medical staff and strict operational conditions , ports have fewer complications and higher quality of life and patients ’ satisfaction than PICCs and NTCs . Therefore , not following consideration of the economic factor , we recommend port as a safe and an effective chemotherapy access for cancer patients , especially for whom needing long chemotherapy process From June 1982 until December 1989 , 93 permanent central venous catheters [ 59 external catheters ( ECs ) and 34 implanted catheters ( ICs ) ] were placed in 69 patients . The median age of these patients at placement was 5.6 years for ECs and 8.8 years for ICs ( P less than 0.05 ) . Follow-up evaluation was possible on 86 catheters ( 58 ECs and 28 ICs ) . The median time of insertion was 236 days and 316 days for ECs and ICs , respectively ( P less than 0.05 ) . The median number of open days was 58 for ECs and 66 for ICs ( not significant ) . 17 catheters ( 6 ECs and 11 ICs ) were transiently obstructed ( P less than 0.005 ) . 30 episodes of bacteraemia were documented in 20 patients . The incidence of catheter sepsis and bacteraemia of unknown source was one in 278 and 283 open days for ECs and ICs , respectively ( not significant ) . In this retrospective study , ECs appeared to be as safe as ICs when infection was correlated with use of the catheter , but this finding should be confirmed in a r and omised design Background : In the United Kingdom , totally implantable venous access systems ( TIVAS ) are not routinely used . Compared with Hickman catheters , these devices are more expensive and complex to insert . However , it is unclear whether the higher costs may be offset by perceived greater health benefits . This pilot trial aim ed to generate relevant data to inform the design of a larger definitive r and omised controlled trial . Methods : This was a phase II prospect i ve , r and omised , open trial from two UK oncology centres . The primary end point was overall complication rate . Secondary end points included individual complication rates , time to first complication and quality of life . Analysis was by intention to treat . An economic evaluation was also carried out . Results : A total of 100 patients were r and omised in a 3 : 1 ratio to receive a Hickman or a TIVAS . Overall , 54 % of patients in the Hickman arm suffered one or more complications compared with 38 % in the TIVAS arm ( one-sided P=0.068 ) . In the Hickman arm , 28 % of the devices were removed prematurely due to a complication compared with 4 % in the TIVAS arm . Quality of life based on the device-specific question naire was greater in the TIVAS arm for 13 of the 16 questions . The economic evaluation showed that Hickman arm was associated with greater mean cost per patient £ 1803 ( 95 % CI 462 , 3215 ) , but similar quality -adjusted life years −0.01 ( 95 % CI −0.15 , 0.15 ) than the TIVAS arm . However , there is much uncertainty associated with the results . Conclusions : Compared with Hickman catheters , TIVAS may be the cost-effective option . A larger multicentre trial is needed to confirm these preliminary findings Purpose Indwelling central venous catheters ( CVCs ) have been increasingly used to enable delivery of intravenous chemotherapy . We aim ed to compare the safety and cost of two commonly used CVCs , peripherally inserted central venous catheter ( PICCs ) and ports , in the delivery of chemotherapy in patients with non-haematological malignancies . Methods Seventy patients were r and omly assigned to receive either a PICC or a port . The primary endpoint was occurrence of major complications , which required removal of the CVC and secondary endpoints included occurrence of any complications . Results Port devices were associated with fewer complications compared with PICC lines ( hazard ratio of 0.25 , CI , 0.09–0.86 , P = 0.038 ) . Major complication rate was lower in the port arm compared to the PICC arm ( 0.047 versus 0.193 major complications/100 catheter days , P = 0.034 ) with 6 versus 20 % of patients experiencing major complications , respectively . Thrombosis , the most common complication , was significantly higher in the PICC arm compared to the port arm ( 25 versus 0 % , P = 0.013 ) . Quality of life and cost estimates did not differ significantly between the two arms . Conclusions Port devices are associated with a lower risk of complications , with no difference in cost , compared to PICC lines in patients with non-haematological malignancies receiving intravenous chemotherapy OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 2 
    Output:
    
Conclusions TIVAP can significantly reduce the risk of CLABSI compared with external CVCs