Analysis of the Outcomes in Central Venous Access Port Implantation Performed by Residents via the Internal Jugular Vein and Subclavian Vein

Objective

The central venous access port (CVAP) has played an important role in the safe administration of chemotherapy and parenteral nutrition. The aim of the present study was to clarify the optimal access vein for CVAP implantation when performed by residents rather than attending surgeons.

Methods

A consecutive cases of CVAP implantation via the subclavian vein (SV) using a landmark-guided technique or via the internal jugular vein (JV) using an ultrasound-guided technique were divided into 2 groups according to whether the intervention was performed by a resident or an attending surgeon. Early and late complications were compared retrospectively between the 2 groups, and the outcomes of the CVAPs were compared between those implanted via the SV and those implanted via the JV in resident group.

Results

A total of 207 cases of CVAP implantation were performed. Overall, 114 implantations were performed by residents, and another 93 implantations were performed by attending surgeons. Early complications were seen more frequently in the resident group (6.1%) than in the attending-surgeon group (1.1%), but the difference was not significant. No differences in operating time or late complications were observed between the 2 groups. In the resident group, CVAP implantations via the JV using the ultrasound-guided technique were associated with a shorter operating time compared with the SV approach.

Conclusions

Residents can perform CVAP implantations safely using both the SV and JV approaches. However, the JV approach using an ultrasound-guided technique can be performed in less time than the SV approach.

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.