Perioperative and Postoperative Complications of Supraclavicular, Ultrasound-Guided, Totally Implantable Venous Access Port via the Brachiocephalic Vein in Adult Patients: A Retrospective Multicentre Study

Abstract

Purpose The totally implantable venous access port (TIVAP) provides patients with safe, effective and long-term convenient venous access for the administration of medications such as chemotherapy drugs. The implantation and long-term use of TIVAP are related to thrombosis, infection and other complications. In this study, the medical records of multicentre patients were collected, and the perioperative and postoperative complications were retrospectively analysed to objectively evaluate the safety of the implantation of supraclavicular, ultrasound-guided TIVAP via the brachiocephalic vein (BCV). Patients and Methods We retrospectively analysed the clinical data of 433 adult patients who had undergone ultrasound-guided TIVAP implantation via the BCV at four hospitals in China from March 2018 to May 2019. The success rates of the first puncture, operation time, and perioperative and postoperative complications were analysed. Results All the TIVAPs were implanted successfully (100%). The average TIVAP carrying time was 318.15 ±44.22 days (range: 38–502 days) for a total of 197,694 catheter days. The success rate of the first puncture was 94.92% (411/433), and the average operation time was 29.66 ±7.45 min (range: 18–60 min). The perioperative complications included arterial puncture in 4 patients and pneumothorax in 1 patient. The incidence of postoperative complications was 5.08% (22/433), including poor incision healing (n = 2), catheter-related infection (n = 3), port infection (n = 6), thrombosis (n = 2) and fibrin sheath formation (n = 8). Another patient had infusion disturbance 2 days after the operation, and chest X-ray showed bending at the connection between the catheter and port. No other serious complications occurred, such as catheter rupture and drug leakage. The total incidence of complications was 6.24% (27/433). Conclusion This study showed excellent tolerance of supraclavicular, ultrasound-guided BCV puncture to implant TIVAP and a low incidence of complications. As a safe and effective method of TIVAP implantation, it can provide a new choice for clinicians.

Ultrasound‐guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut

“…Ultrasound-guided BCV approach has gained increasing popularity for CVC insertion in children [11][12][13] and TIVAP implantation in adults. [20][21][22] Anatomically, as the BCV being the confluence and continuation of a specific "Y-shape" vascular structure formed by IJV and SCV, the BCV approach has potential application advantages for TIVAP placement compared with its counterparts of IJV and SCV approach. On one hand, the BCV is located posterior to the sternoclavicular joint with fewer anatomical variants, whose caliber is also not affected by patient's hemodynamic status, respiratory motion, and ultrasound probe compression 17 ; while puncturing the BCV under ultrasound guidance, the entire needle trajectory, which is parallel to the pleura, can be visualized in real time by the operator, decreasing the risk of pneumothorax.…”

“…8 Likewise, Oulego-Erroz et al 17 This result is consistent with other published literature on children reporting complication rates ranging from 0.15 to 0.9 per 1000 catheter-days. 25,26 However, the incidence of complications after TIVAP placement via the BCV approach in adults ranged from 2.83% to 5.08%, 21,22 with one article displaying a complication rate of 0.11 per 1000 catheter-days. 22 Thus, it is easy to find that pediatric patients are associated with a higher incidence rate of complications 7,27,28 in comparison with adult patients.…”

“…25,26 However, the incidence of complications after TIVAP placement via the BCV approach in adults ranged from 2.83% to 5.08%, 21,22 with one article displaying a complication rate of 0.11 per 1000 catheter-days. 22 Thus, it is easy to find that pediatric patients are associated with a higher incidence rate of complications 7,27,28 in comparison with adult patients. Furthermore, it is assumed that such a difference in spectrum of complications between the pediatric and adult populations is likely attributable to differences in body size, vessel caliber, and vertical growth, which warrants further investigation.…”

“…Ultrasound‐guided BCV approach has gained increasing popularity for CVC insertion in children 11–13 and TIVAP implantation in adults 20–22 . Anatomically, as the BCV being the confluence and continuation of a specific “Y‐shape” vascular structure formed by IJV and SCV, the BCV approach has potential application advantages for TIVAP placement compared with its counterparts of IJV and SCV approach.…”

Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures

“…Totally implantable venous access port (TIVAP) is a closed venous access infusion device that can be completely implanted in the human body, which is mainly composed of an injection seat for puncture and a venous catheter system. 1,2 It can be used for infusion of various irritating or high permeability drugs, rehydration, nutritional support, blood product infusion, blood sample collection, etc., to provide patients with long-term venous access, especially for patients with poor peripheral veins. TIVAP implantation has the advantages of simple operation, low complication rate, and convenient use for patients.…”