Upper Arm Central Venous Port Implantation: A 6-Year Single Institutional Retrospective Analysis and Pictorial Essay of Procedures for Insertion

Abstract

BackgroundThe requirement of central venous (CV) port implantation is increasing with the increase in the number of cancer patients and advancement in chemotherapy. In our division, medical oncologists have implanted all CV ports to save time and consultation costs to other departments. Recently, upper arm implantation has become the first choice as a safe and comfortable method in our unit. Here we report our experience and discuss the procedure and its potential advantages.MethodsAll CV port implantations (n = 599) performed in our unit from January 2006 to December 2011 were analyzed. Procedural success and complication rates between subclavian and upper arm groups were compared.ResultsBoth groups had similar patient characteristics. Upper arm CV port and subclavian implantations were equivalently successful and safe. Although we only retrospectively analyzed data from a single center, the upper arm group had a significantly lower overall postprocedural complication rate than the subclavian group. No pneumothorax risk, less risk of arterial puncture by ultrasound, feasibility of stopping potential arterial bleeding, and prevention of accidental arterial cannulation by targeting the characteristic solitary basilic vein were the identified advantages of upper arm CV port implantation. In addition to the aforementioned advantages, there is no risk of “pinch-off syndrome,” possibly less patient fear of manipulation, no scars on the neck and chest, easier accessibility, and compatibility with the “peripherally inserted central catheter” technique.ConclusionsUpper arm implantation may benefit clinicians and patients with respect to safety and comfort. We also introduce our methods for upper arm CV port implantation with the videos.

Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan

“…The overall complication rates in the chest (7.4 %) and neck (6.8 %) groups reported in this study are similar to those mentioned in a previous report regarding complication rates of central venous catheterization by site [10]. Furthermore, although related studies regarding sites other than the chest and neck are scarce, our results concerning the incidence of complications stratified by CVPI sites/methods are similar to those of previous reports [19,23,[25][26][27][28][29][30][31].…”

“…Using the upper arm as the venipuncture site itself prevents pneumothorax, for anatomical reasons. However, the vein in the upper arm is thinner than at other sites, can hardly be seen grossly, and lacks anatomical landmarks, because of which the real-time US-guided method is more useful for upper arm CVPI than other non-real-time imaging methods [23]. As expected, the upper arm group showed the most frequent usage of the real-time US-guided procedure and least frequent usage of the landmark and US-mark methods.…”

“…This should be validated by a multicenter prospective RCT [21,23,[36][37][38], in addition to factors such as a patient's quality of life, psychological distress, and costeffectiveness related to CVPI [38][39][40].…”

Clinical Course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

“…Diagnostic ultrasonography guidance prevented pneumothorax and artery puncture during the CV-port placement procedure. Recently, Shiono et al [9] reported that the complication rates associated with CV-port implantation in the subclavian vein and upper arm were 10.2% and 4.7%, respectively. Therefore, it was concluded that upper arm implantation might be better, while considering patient safety and comfort.…”

“…In patients with a variety of solid neoplastic diseases, outpatient chemotherapy is viable through the placement of a subcutaneously implanted CV-port and the use of a portable disposable pump [8] [9]. However, to the best of our knowledge, there have been no reports concerning the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer.…”