Jugular versus subclavian totally implantable access ports: Catheter position, complications and intrainterventional pain perception

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Abstract

Purpose

To determine the safest and most tolerable method for totally implantable access ports (TIAPs) particularly in regard to patient's pain perception and catheter-related complications.

Materials and methods

From January 2007 to October 2008 a subcutaneous TIAP (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18–85 years old; mean age of 56 ± 6 years) by experienced interventional radiologists. 94 TIAP were implanted through the subclavian vein (subclavian group) and 44 TIAP were implanted through the internal jugular vein (jugular group). Intrainterventional pain perception (visual analogue scale from 1 to 10), postinterventional catheter tip migration and radiation dose were documented for each method and implantation side and differences were compared with Wilcoxon t-test. For ordinal variables, comparison of two groups was performed with the Fisher's exact test.

Results

No severe periinterventional complication occurred. Inadvertent arterial punctures without serious consequences were reported in one case for the jugular group versus four cases in the subclavian group. Significantly (p < 0.05) lower pain perception, radiation dose and tip migration rate were observed in the jugular group. Catheter occlusions occurred in 4% (n = 4) of the subclavian group versus 2% (n = 1) of the jugular group. The corresponding values for vein thrombosis and catheter dislocation were 3% (n = 3) and 1% (n = 1) in the subclavian group, while none of those complications occurred in the jugular group.

Conclusion

Both techniques, the TIAP implantation via fluoroscopy-guided subclavian vein puncture and via ultrasound-guided jugular vein puncture, are feasible and safe. Regarding intrainterventional pain perception, radiation dose, postinterventional catheter tip position and port function the jugular vein puncture under ultrasound guidance seems to be advantageous.

Introduction

Over the past 20 years, long-term venous catheter-systems like totally implantable access ports (TIAPs) have become a commonly used method for the intravenous application of chemotherapeutic agents, parenteral alimentation or antibiotic therapy. Introduced in 1982 by Niederhuber [1], TIAPs are currently implanted with a high success rate [2], [3], [4], [5], [6]. For catheter placement ultrasound-guided or fluoroscopy-guided puncture techniques via the internal jugular or the subclavian veins have been described as reliable and feasible [7], [8], [9], [10], [11], [12]. The implantation under local anaesthesia immensely reduces the operating expense and allows a quick and safe implantation on an outpatient basis. Nevertheless periprocedural, early and late port-catheter-related complications are still present and without therapy or intervention they can cause an irreparable damage with consecutive failure of the port-system. Port-catheter occlusion or catheter related vein thromboses are frequent early and late complications with regard to port function [13]. However, pneumothorax and haematoma belong to the most frequent periprocedural complications [13]. Even if the implantation of a long-term venous access device remains a minimal invasive procedure, it should not be underestimated with respect to the comorbidity of the patients.

The purpose of our study was to compare two different placement techniques, an ultrasound-guided jugular access and a fluoroscopy-guided subclavian approach using the same 6-French port-device (Bardport, Bard Access System, UT, USA). Our objective was to determine the safest and best tolerable method with particular interest in patient's acceptance during the intervention and catheter-related complications.

Section snippets

Materials and methods

From January 2007 to October 2008 a TIAP with a 6 F catheter (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18–85 years old; mean age of 56 ± 6 years) by experienced interventional radiologists. In all patients the indication for placement was systemic intravenous chemotherapy. In a period between January 2007 and February 2008 94 port-systems were placed through the subclavian vein under fluoroscopy guidance. During the following period,

Results

All procedures were successfully completed without any serious periinterventional complications. In one case an inadvertent arterial puncture of the carotid artery instead of the jugular vein occurred. After compression of the puncture site for 10 min and ultrasonographical exclusion of severe haematoma the procedure was finished uneventfully. Using the subclavian approach 4 inadvertent arterial punctures of the subclavian artery occurred. After compression of the puncture side for at least 10 

Discussion

TIAP implanted by interventional radiologists can be placed via different access pathways with low complication rates and high success rate [16]. Implantation under local anaesthesia, without the need for further sedation, makes the intervention feasible on an outpatient basis with a significant reduction of cost.

In our study we focussed our attention on two different port placement techniques with two different venous access pathways with respect to patient pain perception and

References (19)

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