Right- and Left-Subclavian Vein Port-A-Cath Systems: Comparison of Complications

Abstract

Background: Central venous access systems are frequently used for delivery of medications; however, few studies have compared surgical and postoperative complications of right versus left access via the subclavian vein (SCV). The aim of this study was to compare the surgical and postoperative complications associated with Port-A-Cath system insertion via the right and left SCV. Methods: The medical records of patients who received Port-A-Cath insertion via the SCV for parenteral chemotherapy between August 2004 and July 2008 were reviewed. The incidence of surgical and postoperative complications was compared between patients who received right- versus left-SCV Port-A-Cath insertion. Results: A total of 1,848 patients were included in the study. Right-SCV catheterization was attempted in 1,029 (55.7%) patients and was successful in 866 (84.2%). Left-SCV catheterization was attempted in 819 (44.3%) patients and was successful in 651 (79.5%). The mean length of postoperative follow-up was 417.3 ± 401.3 and 396.7 ± 379.9 days for the right- and left-SCV groups, respectively. The incidence of SCV puncture failure was significantly lower in the right-SCV group (12.3%) compared with the left-SCV group (16.8%, p = 0.006). The incidence of catheter knotting at the ipsilateral brachiocephalic vein was also significantly lower in the right-SCV group (0.0%) compared with the left-SCV group (0.5%, p = 0.038), as was the incidence of catheter occlusion (1.0% for right SCV vs. 3.5% for left SCV, p = 0.001). Conclusion: These findings suggest that the right-SCV approach is superior to the left-SCV approach for Port-A-Cath insertion.

Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection

“…with flow‐related issues in 3–64% of patients (Table ). This is particularly true of left subclavian CVCs, which have a 16–50% AE rate during A‐HPCC and account for 19% of severe procedure‐related AE at our institution . The increased length associated with left subclavian lines inherently increases resistance to flow and the potential for anatomic obstruction .…”

“…This is particularly true of left subclavian CVCs, which have a 16-50% AE rate during A-HPCC and account for 19% of severe procedure-related AE at our institution. 15,38,[57][58][59][60] The increased length associated with left subclavian lines inherently increases resistance to flow and the potential for anatomic obstruction. 57 The distal tip can either adhere along the lateral superior vena cava with intermittent occlusion, or reflect back into the left brachial cephalic vein with intravascular knotting.…”

“…15,38,[57][58][59][60] The increased length associated with left subclavian lines inherently increases resistance to flow and the potential for anatomic obstruction. 57 The distal tip can either adhere along the lateral superior vena cava with intermittent occlusion, or reflect back into the left brachial cephalic vein with intravascular knotting. 4,57 In summary, we report our experience using short-term femoral CVC for A-HPCC in young children.…”

“…57 The distal tip can either adhere along the lateral superior vena cava with intermittent occlusion, or reflect back into the left brachial cephalic vein with intravascular knotting. 4,57 In summary, we report our experience using short-term femoral CVC for A-HPCC in young children. Femoral CVC provided adequate venous access with few flow-related alarms or complications when compared to thoracic CVC in our pediatric population.…”

Vascular access for red blood cell exchange

“…The right IJ vein has a wider diameter and runs more superficially than the left IJ vein; this makes a right‐sided approach more acceptable than a left‐sided one for CVC insertion, because it reduces the risks of vessel perforation and thrombosis . A right subclavian vein approach for catheter insertion is also superior to a left subclavian vein approach, because it is associated with fewer complications and insertion failures …”