Venous cutdown versus the Seldinger technique for placement of totally implantable venous access ports

Hsu, Charlie; Kwan, Gigi N. C.; Driel, Mieke van; Rophael, John A.

doi:10.1002/14651858.cd008942

Cited by 24 publications

(39 citation statements)

References 10 publications

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“…However, multiple studies, including a recent meta‐analysis of 1006 patients, demonstrated no difference in the overall rate of complications (including hemothorax, pneumothorax, infection, catheter thrombosis, stenosis, kinking or extravasation, migration of the catheter or dislodging of the port reservoir, hematoma, seroma, nerve palsy, thoracic duct injury, and death) or, in particular, in the rates of infection with either technique. It is worth noting that, when the analysis was limited to a subclavian site for the PT group, there was a higher rate of catheter‐related complications (thrombosis, fibrin sheath, stenosis, kinking, extravasation, migration of the catheter, or dislodgement of the reservoir) compared with ST …”

Section: Implantation Technique and Sitementioning

confidence: 99%

“…12 However, multiple studies, 2,31 including a recent meta-analysis of 1006 patients, demonstrated no difference in the overall rate of complications (including hemothorax, pneumothorax, infection, catheter thrombosis, stenosis, kinking or extravasation, migration of the catheter or dislodging of the port reservoir, hematoma, seroma, nerve palsy, thoracic duct injury, and death) or, in particular, in the rates of infection with either technique. It is worth noting that, when the analysis was limited to a subclavian site for the PT group, there was a higher rate of catheter-related complications (thrombosis, fibrin sheath, stenosis, kinking, extravasation, migration of the catheter, or dislodgement of the reservoir) compared with ST. 32 The decision of which technique to choose ultimately may depend on the presence of risk factors that make the patient prone to particular complications associated with a technique. In patients with severe dehydration, neutropenia, prior radiation to the area, and other factors that may increase the primary failure rate, preference should be for the use of PT with ultrasound guidance via the internal jugular or cephalic route (over the subclavian route) to minimize failure and pneumothorax incidence.…”

Section: Implantation Technique and Sitementioning

confidence: 99%

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Implanted vascular access device options: a focused review on safety and outcomes

Blanco-Guzman

2018

Transfusion

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Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports. Since the first report of a fully implantable vascular access device (IVAD) in 1982, 1 the use of these devices has grown exponentially. They consist of a reservoir cradled in the subcutaneous tissue that is connected to a catheter, with its tip terminating into a major vein. IVADs are frequently used in patients who have poor peripheral venous access and are in need of long-term administration of vesicant drugs, antimicrobials, blood products, or parenteral nutrition.2,3 They also are used as access for long-term therapeutic apheresis procedures. 4 Although nonimplanted, long-term catheters can be used for all of these purposes as well, the lack of an external component in IVAD ports provides multiple advantages; patients have improved perceptions of quality of life and body image and less limitation in their mobility. 5 These ports also minimize the need for maintenance care and risk of infectious complications when the IVAD is not in use. 6 These benefits of IVAD port use have also been demonstrated in pediatric cancer patients, with the added advantage of allowing the child to participate in normal activities and preserving body image. 7Despite the vast experience accrued over the years and the large volume of literature studying factors associated with IVAD port outcomes, early perioperative and late postoperative complications still occur (see Table 1). 8,9 Overall complication rates for IVAD ports reportedly occur in the range from 2% to 18% of all implanted devices. 10-12Port-related infections and venous thrombosis are particularly important, because they are associated with additional morbidity and costs and require removal of the IVAD as part of their treatment in as many as 6.5% of patients. 10 An additional complication specific to the use of IVAD ports during therapeutic apheresis is the occurrence of frequent pressure-related alarms, 13-15 which do not always result in a need to abort the procedure but can delay the duration of the treatments and require additional interventions. 13Here, we present a review focused on techniques, materials, and long-term management options of ports as IVAD options that have an impact on the relevant complications and overall safety profile of th...

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Section: Implantation Technique and Sitementioning

confidence: 99%

Section: Implantation Technique and Sitementioning

confidence: 99%

Implanted vascular access device options: a focused review on safety and outcomes

Blanco-Guzman

2018

Transfusion

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“…Although this system has been proven to have less chance of infection when compared to the exteriorized catheter, CRBSI remain a concern. During the on-going period of this study, we found that the neck vein approach was superior to the subclavian approach in terms of a significantly lower incidence of CRBSI 7,19 , and based on this finding we modified our surgical protocol to perform internal jugular venous puncture under ultrasonographic guidance as the first choice. Now in our institution the use of fluoroscopy and flow check before the end of a TIVAD procedure are mandatory.…”

Section: Discussionmentioning

confidence: 99%

“…4 Recent studies have shown that the preferred technique used in TIVAD implantation is percutaneous venipuncture, commonly via the subclavian the internal jugular vein. [5][6][7] If a venipuncture is not possible, open venesection is an alternative approach. Although TIVAD was designed to reduce catheter-related infections by tunneling the catheter within the subcutaneous plane, infectious complications can occur when the line has been used for a long period.…”

Section: Introductionmentioning

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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“…The implantation of TIVADs can be performed using various techniques: direct percutaneous puncture of the subclavian vein and insertion of a catheter by an interventional radiologist or surgeon via the Seldinger technique, or surgical venous cutdown into the cephalic vein at the deltopectoral groove by a surgeon. 2,3 Subclavian venipuncture is the most popular route for transition and long-term central venous cannulation; however, perioperative complications such as pneumothorax, arterial puncture, hematoma, catheter misplacement or nerve palsy occur in up to 12% of patients. 4,5 In contrast, surgical cutdown of the cephalic vein is associated with minimal risk of severe early complications.…”

Section: Discussionmentioning

confidence: 99%

Surgical Venous Cutdown for the Insertion of Totally Implantable Venous Access Devices

Tsukiyamam

Shimomura

Toyota

et al. 2018

International Surgery

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Purpose: Stable insertion of totally implantable venous access devices (TIVADs) is mandatory for the administration of chemotherapy and parenteral nutrition. Subclavian venipuncture is the most popular route; however, perioperative complications occur in up to 12% of patients. We inserted TIVADs by surgical venous cutdown of the cephalic vein at the deltopectoral groove with the intention of a safe and stable implantation. Methods: We implanted TIVADs in 318 consecutive patients (331 cases) from January 2011 to December 2015. We retrospectively analyzed short- and long-term treatment outcomes and risk factors for primary failure of implantation and removal due to catheter-related complications. Results: The aim of implantation was chemotherapy in 198 cases, nutrition in 92 cases, and frequent intravenous drip in 41 case. Surgical venous cutdown was performed in 321 of 331 cases (97%); primary failure occurred in 42 cases (13.1%). Short-term complications occurred in 4 cases (1.2%), and there were no serious complications, such as pneumothorax. In the analysis of risk factors for primary failure, aim of implantation (chemotherapy versus nutrition versus frequent intravenous drip) was the only risk factor ( P = 0.02). Removals occurred in 35 cases (11.5%). In the analysis of risk factors for removal due to complications, presence of infectious disease was identified as the only significant risk factor ( P < 0.001). Conclusions: We confirmed the safety and efficacy of the cutdown method and clarified the risk factors for primary failure and removal. The cutdown method was safe and was not associated with serious complications; however, selective implantation was needed to achieve a high success rate.

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Venous cutdown versus the Seldinger technique for placement of totally implantable venous access ports

Abstract: Venous cutdown versus the Seldinger technique for placement of totally implantable venous access ports.

Cited by 24 publications

References 10 publications

Implanted vascular access device options: a focused review on safety and outcomes

Implanted vascular access device options: a focused review on safety and outcomes

An Appraisal of Totally Implantable Venous Access Devices in Pediatric Cancers

Surgical Venous Cutdown for the Insertion of Totally Implantable Venous Access Devices

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