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

Abstract

Background Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method. Methods Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis. Results A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43–1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15–3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14–8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22–3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22–1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01–2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16–89.76, p = .41) between the two implantation paths. Conclusions There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.

Clinical Effect of Modified Ultrasound-Guided Subclavian Vein Puncture

“…The internal jugular vein is close to the oropharynx and respiratory tract and has a high rate of catheter infection and thrombosis, which limits its clinical application. The infection rate of subclavian vein catheter is low, which is convenient for nursing, but the incidence of puncture complications is high, which is easy to cause pneumothorax, and accidental artery puncture cannot stop bleeding, so the technical requirements for the operator are higher [ 11 ]. Femoral vein puncture and catheterization will not cause serious life-threatening complications.…”

“…Axillary vein catheterization is guided by real-time ultrasound. Studies have reported that axillary vein catheterization often passes through the pectoralis minor muscle, resulting in obvious traction discomfort when patients move their arms [ 11 ]. The risk of thrombosis in axillary vein catheterization is higher.…”

Tunneled Hemodialysis Catheter Insertion: Technical and Clinical Considerations

“…14,22,23 It should be noted that randomized trials comparing subcutaneous implantable port insertion via IJ and subclavian vein routes show equal rates of stenotic complications. [24][25][26] The number of previous catheterizations is potentially better correlated with CVS risk than site selection; the odds of CVS increase by 38% for each subsequent HD catheter placed. 27 The risk of catheter-related infection is the lowest with subclavian central venous catheters; the incidence of catheter-related bacteremia for subclavian lines is roughly half that of IJ lines.…”

“… 14 22 23 It should be noted that randomized trials comparing subcutaneous implantable port insertion via IJ and subclavian vein routes show equal rates of stenotic complications. 24 25 26 The number of previous catheterizations is potentially better correlated with CVS risk than site selection; the odds of CVS increase by 38% for each subsequent HD catheter placed. 27 …”

Psychological experiences and needs of tumor patients with implanted intravenous infusion ports: a qualitative study

“…Implanted Venous Access Port (IVAP) as the latest infusion pathway solves the above problems. It is mainly used in cancer patients (4)(5)(6). The port is a closed venous infusion system with a port body attached to a central venous catheter under the skin.…”