Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access

Jung, Pil Young; Ryu, Hojun; Jung, Jae Hung; Lee, Eunbi; Oh, Joong Hwan; Byun, Chun Sung; Park, Il Hwan

doi:10.4266/kjccm.2015.30.4.365

Cited by 1 publication

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“…Of these, 14 were excluded because the data were not extractable, two studies were duplicate reports with different outcomes, and one was a RCT with only 30 days follow-up which did not fulfill the criteria of minimum follow-up of 180 days in this meta-analysis. In addition, one study [ 23 ] was identified from the citations of the study by Araujo [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, 12 studies [ 15 – 18 , 21 , 23 , 31 , 38 – 42 ] including 3905 patients (1824 patients in the IJV group and 2081 patients in the SCV group) published from 2008 to 2015 were included (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, there were three RCTs [ 16 , 39 , 41 ] and two prospective non-randomized controlled trials [ 15 , 31 ]. The remaining seven studies [ 17 , 18 , 21 , 23 , 38 , 40 , 42 ] were retrospective. The characteristics of the included studies are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Of the three RCTs, two [ 16 , 39 ] were considered to have low risk of bias, and one [ 41 ] had a moderate risk of bias. Among the nine nonrandomized studies, seven [ 15 , 17 , 18 , 21 , 23 , 40 , 42 ] were considered to be of high quality, and two [ 31 , 38 ] were regarded as being of low quality (Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…Demographics, clinical characteristics (age, brand of TIVAD used) and technique used (IJV percutaneous insertion, SCV percutaneous insertion, with or without ultrasound guidance or fluoroscopy) were collected. The complications of TIVAD were categorized into infectious complications, thrombotic complications, and mechanical complications [ 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

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Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies

Huang

Jiang

et al. 2016

BMC Cancer

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BackgroundA totally implantable venous access device (TIVAD) provides reliable, long-term vascular access and improves patients’ quality of life. The wide use of TIVADs is associated with important complications. A meta-analysis was undertaken to compare the internal jugular vein (IJV) with the subclavian vein (SCV) as the percutaneous access site for TIVAD to determine whether IJV has any advantages.MethodsAll randomized controlled trials (RCTs) and cohort studies assessing the two access sites, IJV and SCV, were retrieved from PubMed, Web of Science, Embase, and OVID EMB Reviews from their inception to December 2015. Random-effects models were used in all analyses. The endpoints evaluated included TIVAD-related infections, catheter-related thrombotic complications, and major mechanical complications.ResultsTwelve studies including 3905 patients published between 2008 and 2015, were included. Our meta-analysis showed that incidences of TIVAD-related infections (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.48–1.04, P = 0.081) and catheter-related thrombotic complications (OR 0.76, 95 % CI 0.38–1.51, P = 0.433) were not significantly different between the two groups. However, compared with SCV, IJV was associated with reduced risks of total major mechanical complications (OR 0.38, 95 % CI 0.24–0.61, P < 0.001). More specifically, catheter dislocation (OR 0.43, 95 % CI 0.22–0.84, P = 0.013) and malfunction (OR 0.42, 95 % CI 0.28–0.62, P < 0.001) were more prevalent in the SCV than in the IJV group; however, the risk of catheter fracture (OR 0.47, 95 % CI 0.21–1.05, P = 0.065) were not significantly different between the two groups. Sensitivity analyses using fixed-effects models showed a decreased risk of catheter fracture in the IJV group.ConclusionThe IJV seems to be a safer alternative to the SCV with lower risks of total major mechanical complications, catheter dislocation, and malfunction. However, a large-scale and well-designed RCT comparing the complications of each access site is warranted before the IJV site can be unequivocally recommended as a first choice for percutaneous implantation of a TIVAD.

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Section: Resultsmentioning

confidence: 99%