Original ReportsAnalysis of the Outcomes in Central Venous Access Port Implantation Performed by Residents via the Internal Jugular Vein and Subclavian Vein
Introduction
Central venous access ports (CVAPs) have been widely used not only for the safe administration of chemotherapy but also to provide parenteral nutrition, especially in patients with malignant disease.1, 2 Several complications of CVAP implantation such as pneumothorax, catheter obstruction, catheter injury, and infection are known.3, 4 The subclavian vein (SV) approach is known to be a risk factor for pinch-off syndrome resulting in catheter obstruction or fracture, and some previous studies concluded that CVAP implantation via the internal jugular vein (JV) is an optimal procedure.5, 6, 7 On the contrary, some earlier studies reported that the complication rate and long-term patency of CVAPs implanted via the JV and SV were comparable, and concluded that radiologists and surgeons may select their preferred puncture site.8, 9 Regarding central vein catheterization, it was reported that adequate training increased the success rate in the first attempt, and the failure rate was associated with the amount of previous experience of the practitioner performing the implantation.10, 11 However, to the best of our knowledge, studies comparing the outcomes of different venous approaches and taking the experience of the practitioner into account have not been reported.
The aim of the present study was to evaluate the optimal venous site for the implantation of CVAPs that would be applicable even for less-experienced residents. To determine the optimal site, we retrospectively compared the outcomes and complications between CVAPs implanted using the internal JV approach and those implanted using the SV approach in a single institution.
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Patients and Methods
All CVAP implantations performed between January 2010 and January 2016 at Nagasaki Rosai Hospital were included. We retrospectively collected patient data including sex, age, body mass index (kg/m2), type of diseases, and laboratory data using medical records. CVAP implantations were divided into 2 groups according to the surgical experience of the interventionists: attending surgeons with more than 5 years of surgical experience and residents with 5 or less than 5 years of surgical experience.
Results
A total of 212 CVAP implantations were performed in 200 patients. The flow chart of this study is shown in Fig. 1. A total of 5 CVAP implantations performed along with other operative procedures such as gastrointestinal surgery under general anesthesia were excluded from this study. A total of 114 implantations were performed by 9 residents, and another 93 implantations were performed by 7 attending surgeons. The median levels of surgical experience of the residents and attending surgeons were
Discussion
In the present study, we retrospectively evaluated the outcomes of CVAP implantations performed by attending surgeons and residents, and then clarified the optimal access vein for residents to use by comparing the JV approach with the SV approach. Our results demonstrated that there were no significant differences in complications associated with CVAP implantations between the attending surgeon group and resident group, contrary to our expectations. However, a higher number of CVAPs were
Conclusion
We have reported a retrospective, single-center analysis comparing the outcomes of CVAP implantations between residents and attending surgeons. Residents can perform CVAP implantations via the JV or the SV as safely as attending surgeons, and the JV approach can be performed in a shorter operating time.
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