Evaluation of three different techniques for insertion of totally implantable venous access device: A randomized clinical trial

Tagliari, Ana Paula; Staub, Fernanda Luiza; Guimarães, José Ricardo; Migliavacca, Alceu; Mossmann, Diego da Fonseca

doi:10.1002/jso.23962

Cited by 17 publications

(8 citation statements)

References 24 publications

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“…However, there are also undoubted advantages of a percutaneous procedure, particularly since it can be performed under local anesthesia, which reduces the total procedure time (with equivalent operation times), leading to reduced costs. In addition, its safety can be significantly increased when using fluoroscopy and ultrasound, especially when the internal jugular vein is used [ 15 , 16 ]. Therefore, the percutaneous procedure (using either the internal jugular or subclavian vein) is commonly used as a reliable exit strategy in scenarios where the cutdown technique of the cephalic vein fails or as primary approach, especially by non-surgical health care professionals.…”

Section: Discussionmentioning

confidence: 99%

Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

Becker

Wurche

Darscht

et al. 2021

Langenbecks Arch Surg

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Purpose Modern oncological treatment algorithms require a central venous device in form of a totally implantable venous access port (TIVAP). While most commonly used techniques are surgical cutdown of the cephalic vein or percutaneous puncture of the subclavian vein, there are a relevant number of patients in which an additional strategy is needed. The aim of the current study is to present a surgical technique for TIVAP implantation via an open Seldinger approach of the internal jugular vein and to characterize risk factors, associated with primary failure as well as short- (< 30 days) and long-term (> 30 days) complications. Methods A total of 500 patients were included and followed up for 12 months. Demographic and intraoperative data and short- as well as long-term complications were extracted. Primary endpoint was TIVAP removal due to complication. Logistic regression analysis was used to analyze associated risk factors. Results Surgery was primarily successful in all cases, while success was defined as functional (positive aspiration and infusion test) TIVAP which was implanted via open Seldinger approach of the jugular vein at the intended site. TIVAP removal due to complications during the 1st year occurred in 28 cases (5.6%) while a total of 4 (0.8%) intraoperative complications were noted. Rates for short- and long-term complications were 0.8% and 6.6%, respectively. Conclusion While the presented technique requires relatively long procedure times, it is a safe and reliable method for TIVAP implantation. Our results might help to further introduce the presented technique as a secondary approach in modern TIVAP surgery.

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Section: Discussionmentioning

confidence: 99%

Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

Becker

Wurche

Darscht

et al. 2021

Langenbecks Arch Surg

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“…To date, the most studied focus of port placement has been on the method of insertion, yet none have been identified as the gold standard. 8,9 We have evaluated the outcomes following 1200 port placements at a tertiary care center and have found that individual surgeons were the strongest predictors of increased operating room time, likelihood of switching to an alternative method, and procedural complications. Furthermore, for the surgeons who had consistently worse outcome measures, resident participation could not be blamed for their longer operating room times, need to switch to alternate methods or increased complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…Although clinical guidelines make no specific recommendations regarding insertion method, 5,6 studies have shown conflicting results with regard to speed, success rates, and complication rates. 2,[7][8][9][10][11][12] And while the influence of method and anatomical site of insertion have been well documented, the role of provider-specific factors has been unexplored, and differences in provider skill and/or training may account for observed variability in the operative outcomes. Furthermore, how these procedural variations impact operating room time and efficiency is unknown.…”

Section: Introductionmentioning

confidence: 99%

Surgeon, not technique, defines outcomes after central venous port insertion

Ertel

McHenry

Venkatesan

et al. 2017

Journal of Surgical Research

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“…An immediate complication was defined as an event occurring within 7 days after implantation. 17,18 Statistical analysis Demographic data were described by crude value and representative percentage. Categorical data were stratified by various factors and compared by chi-square test, while continuous data were compared with t-test.…”

Section: Data Collectionmentioning

confidence: 99%

An Appraisal of Totally Implantable Venous Access Devices in Pediatric Cancers

Sangkhathat

2020

Smj

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Objective: To appraise the experience of a pediatric cancer center in Thailand regarding employment of totally implantable venous access devices (TIVAD). Methods: The records of consecutive patients aged less than 15 years diagnosed with malignancy and underwent an implantation from the years 2010 to 2018 were reviewed with the main focus on effective duration and complications of the device. Changes in our practice in perioperative care were also reviewed. Results: A total of 150 lines in 144 patients (103 hematologic malignancies and 41 solid tumors) were included with average age 6.4 years. Neck vein access was used in 62 lines, subclavian vein access in 88 lines. The median follow-up period was 973 days. Immediate complications occurred in 13 cases (9.4%). Excluding cases with death from unrelated causes, the overall TIVAD survival was 985.1 days while event-free device survival was 797.6 days. In cases of hematologic malignancies, which were the main users, 1000-day overall survival and event-free survival of TIVAD were 83.7% and 78.2%, respectively. Catheter-related infections and mechanical obstruction were the 2 most prevalent problems, occurring in 0.20 and 0.08 events/1,000 catheter days, respectively. Infection occurred in 23 patients and gram-negative bacilli were most common. Moreover, subclavian access was significantly related with infectious complications when compared to the neck vein approach. Conclusion: A TIVAD can be used for chemotherapy longer than 3 years without serious complications. Refinement of surgical techniques and improving care process may improve the longevity of the line.

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Evaluation of three different techniques for insertion of totally implantable venous access device: A randomized clinical trial

Abstract: The findings of our study suggest superiority of the USG approach in terms of first puncture success rate and technique failure, without increasing the procedure duration. Long-term follow-up results should help to further clarify the current debates.

Cited by 17 publications

References 24 publications

Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

Surgeon, not technique, defines outcomes after central venous port insertion

An Appraisal of Totally Implantable Venous Access Devices in Pediatric Cancers

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