Objective To observe the effectiveness of IMPACT management mode on self-care and management abilities of breast cancer patients undergoing chemotherapy with implantable venous access port (VAP). Methods Breast cancer patients who underwent chemotherapy with VAP at Shangjin Hospital, West China Hospital, Sichuan University between March 2020 and June 2021 were prospectively included. IMPACT mode was used for self-management training guidance. The patient self-care abilities before training and at 1 month, 2 months, and 3 months of training were compared, and the patient self-management abilities at 1 month and 3 months of training were compared. Results A total of 74 patients with breast cancer undergoing chemotherapy with VAP were included. The total score of self-care ability of patients before training and at 1 month, 2 months, and 3 months of training was 112.11±14.63, 123.20±15.73, 127.95±13.89, and 131.92±13.60, respectively, and all the between-time-point differences were statistically significant (P<0.05). In terms of self-concept score, all the between-time-point differences were statistically significant (P<0.05) with increasing score over time, except the difference between the score at 3 months of training and that at 2 months of training (P>0.05). In terms of self-responsibility and self-care skill scores, all the between-time-point differences were statistically significant (P<0.05) with increasing scores over time, except the difference between the score at 2 months of training and that at 1 month of training (P>0.05). In terms of health knowledge level, the scores at 1 month, 2 months, and 3 months of training were higher than that before training (P<0.05), and the score at 3 months of training was higher than that at 1 month of training (P<0.05). The self-management ability scores in all dimensions at 3 months of training were higher than those at 1 month of training, and the differences were statistically significant (P<0.05). Conclusion The IMPACT management mode can effectively improve the self-care and management abilities of breast cancer patients undergoing chemotherapy with VAP, thereby ensuring the normal use of VAP, reducing the occurrence of complications, and reducing the burden on families and society.
Persistent left superior vena cava (PLSVC) with absence of right superior vena cava (SVC), also known as isolated PLSVC, is a relatively rare type of congenital body venous malformation. Isolated PLSVC is asymptomatic, however, it will bring clinical difficulties to the implantation of the totally implantable venous access port (TIVAP). We reported a 41 years, male patient with esophageal cancer, who needed neoadjuvant chemoimmunotherapy. Through doppler ultrasonography, computed tomography (CT) and vascular 3D-reconstruction, we found him to be a patient with PLSVC with absence of right SVC before the insertion of TIVAP. Hence, we chose the left approach in which the needle was inserted into the sternocleidomastoid clavicular head lateral notch in left supraclavicular fossa as the puncture point. The depth of the catheter tip from the root of the neck to the puncture point was 21.5 cm and the catheter tip was located at the junction of the PLSVC and the right atrium, at the dilated coronary sinus. The procedure was successful and the patient received expected neoadjuvant chemotherapy combined with immunotherapy after operation, and anticoagulant therapy was performed to prevent thrombosis in coronary sinus and superior vena cava. There was no major catheter-related complication during the period of TIVAP.