Catheter-related Complications with Totally Implantable Venous Access Devices in Patients with Gynecologic Malignancies

Abstract Background: The implantation of a subcutaneous implantable venous access device in patients with a gynecological cancer disease could be necessary because of different causes, e.g. application of chemotherapy or parenteral nutrition in case of advanced cancer. 4 years after implementation of the Seldinger-technique in the subclavian vein as standard way of port-catheter-implantation at department of gynecology at the University-Hospital in Ulm a retrospective analysis of complication-rates was performed to define internal standards for this procedure. Methods: Between 01/2014 and 07/2018 we reviewed all patients who received a port implantation at the gynecological department. The standard way of port-implantation used in this cohort was Seldinger-technique. All Data assessed were used anonymously. Patients-characteristics, tumor-entity, surgical and anesthesiological management, morbidity and port catheter associated complications (thrombosis, infections etc.) were analyzed. Results: A total of 638 were included. The implantation was performed in Seldinger-technique. Port catheter implantation was successfully performed in 96.6%. The implantation on the left subclavian vein significantly showed a higher rate of success than in the right subclavian vein (98.2% vs. 95.3%, p=0,036). Significant higher rates of associated thromboses was found in patients with a port implantation on the left side (5.9% vs. 2.0%; p=0.036). Obesity (BMI ≥ 30 kg/ m2) leads to a significant higher rate of venous misplacements (p=0.027). Compared to local anesthesia and analgosedation, general anesthesia leads to a significant lower rate of perioperative complications (20.3% vs. 22.4% vs. 13.1%; p=0.014). Perioperative application of antibiotics seems to reduce postoperative infection rates, even if the results are not significant. Conclusion: Seldinger-Technique is an efficient way for port-implantation. Especially patients with a high potential of complications, like obesity with BMI >30kg/m², or other risk factors, the left subclavian vein should be preferred, as well as general anesthesia. Perioperative application of antibiotics (e.g. single-shot antibiotics) should be considered. Trial registration: retrospectively registered

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Port Placement via the Anterior Jugular Venous System: Case Report, Anatomic Considerations, and Literature Review

Case Reports in Radiology ◽

10.1155/2017/2790290 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Gernot Rott ◽

Frieder Boecker

Keyword(s):

Jugular Vein ◽

Central Venous Access ◽

Venous Access ◽

Venous System ◽

Port Catheter ◽

Central Venous ◽

Port Placement ◽

Total Occlusion ◽

Port Implantation ◽

The Right

We report on a patient who was referred for port implantation with a two-chamber pacemaker aggregate on the right and total occlusion of the central veins on the left side. Venous access for port implantation was performed via left side puncture of the horizontal segment of the anterior jugular vein system (AJVS) and insertion of the port catheter using a crossover technique from the left to the right venous system via the jugular venous arch (JVA). The clinical significance of the AJVS and the JVA for central venous access and port implantation is emphasised and the corresponding literature is reviewed.

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Power-injectable totally implantable venous access devices – analysis of success and complication rates of ultrasound-guided implantation and a patient satisfaction survey

VASA ◽

10.1024/0301-1526/a000802 ◽

2019 ◽

Vol 48 (6) ◽

pp. 524-530

Author(s):

Julia Kunz-Virk ◽

Karsten Krüger

Keyword(s):

Patient Satisfaction ◽

Venous Access ◽

Late Complications ◽

Subjective Rating ◽

Complication Rates ◽

Safe Procedure ◽

Success Rates ◽

Ultrasound Guided ◽

Port Implantation ◽

Venous Access Devices

Summary. Background: To retrospectively evaluate the success rates, peri-interventional, early and late complications and patient satisfaction associated with power-injectable totally implantable venous access devices (TIVAPs). Patients and methods: Between April 2011 and March 2016, a total of 1,203 TIVAPs were implanted in 1,169 patients. Ultrasound-guided, fluoroscopically controlled implantation was performed through the subclavian or internal jugular vein. The systematic analysis focused on the rate of successful port implantations, the frequency of peri-interventional, early and late complications and on how the experience of the implanting radiologist impacts these parameters. Additionally, a standardized questionnaire was administered to the 102 study patients in a telephone interview to survey their subjective rating of the port implantation. Results: 99.5 % of TIVAPs were implanted successfully. In 4 out of 6 patients, the implantation was repeated successfully at a later time. Complication rates were 1.4 % (0.0512/1.000 catheter days) for peri-interventional, 2.9 % (0.081 per 1,000 catheter days) for early and 8.3 % (0.2288 per 1,000 catheter days) for late complications. The radiologist’s experience level and vein selection did not have a significant impact. Most peri-interventional complications (82.4 %) were of minor severity. The early (61.5 %) and late (65.6 %) complications were more frequently of major severity. Interventions to manage complications comprised port explanation in 46.9 %, conservative therapy in 17.4 % and interventional therapy in 12.2 %. At 1 and 3 months after port placement, the majority were satisfied or very satisfied with the interventional port implantation. Conclusions: Ultrasound-guided, fluoroscopically controlled implantation of TIVAPs is a safe procedure with low complication rates, high success rates and high patient satisfaction.

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Subcutaneous Port Malfunction: A Retrospective Comparison Between Internal Jugular and Subclavian Vein Access

Journal of the Association for Vascular Access ◽

10.1016/j.java.2015.08.001 ◽

2015 ◽

Vol 20 (4) ◽

pp. 229-234

Author(s):

Mahmoud Samman ◽

Tomas Mujo ◽

John J. Harris ◽

Douglas M. Coldwell ◽

Melissa Hite-Potts ◽

...

Keyword(s):

Internal Jugular Vein ◽

Subclavian Vein ◽

Preventive Measures ◽

Jugular Vein ◽

Venous Access ◽

Port Catheter ◽

Port Placement ◽

Access Port ◽

Vein Access ◽

Retrospective Comparison

Abstract Purpose: To evaluate malfunction rates of subcutaneous chest ports placed via the internal jugular and subclavian veins. Analysis and preventive measures to reduce the risk of complication between the 2 sites of venous access will be discussed. Methodology: Retrospective review of 114 patients with malfunctioning subcutaneous port-a-catheters was performed. Of those 114 patients, 77 had venous access via a subclavian approach, whereas the remaining 37 had internal jugular vein access. Port insertion placement was evaluated and analysis of the malfunction rate was performed. Results: There were 36 patients with 38 subcutaneous port malfunctions from internal jugular vein access. Thirty-four of 38 complications (89%) were not related to insertion and 4 out of 38 (11%) were related to vascular access approach. Seventy-seven patients with malfunctioning subcutaneous ports placed via the subclavian vein had a total of 127 complications. Twenty-eight of 127 complications (22%) were not related to insertion and 99 out of 127 (78%) of the complications were directly related to venous access approach. Conclusions: Subcutaneous port placement complications can be avoided by measuring the length of the port catheter under fluoroscopic guidance and positioning the tip within 2 cm of the cavoatrial junction. Also, the jugular vein should be the first site for access unless patient circumstances do not permit this approach.

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Balloon-assisted venous access salvage through a thrombosed arteriovenous graft

The Journal of Vascular Access ◽

10.5301/jva.5000625 ◽

2016 ◽

Vol 18 (2) ◽

pp. 173-176

Author(s):

Chen Pong Wong ◽

Karthikeyan Damodharan ◽

Thijs A.J. Urlings ◽

Sivanathan Chandramohan

Keyword(s):

Vascular Access ◽

Subclavian Vein ◽

Venous Access ◽

Direct Access ◽

Central Vein ◽

Arteriovenous Graft ◽

Dialysis Catheter ◽

Percutaneous Puncture ◽

Left Subclavian Vein ◽

Arteriovenous Grafts

Introduction Maintaining vascular access by means of radiological intervention has become the mainstay of management of patients with central venous stenoses and occlusions (CVO), which can be challenging. We present a case of balloon-assisted percutaneous puncture of an occluded left subclavian vein, through a thrombosed arteriovenous graft, for a tunneled dialysis catheter insertion. Methods A thrombosed left arm arteriovenous graft was accessed, and the occluded left subclavian vein was traversed with 0.018 platform. An 8 mm 0.018 low platform balloon was inflated in the left subclavian vein as a target for percutaneous puncture to gain direct access into the occluded segment of the vein. This access was then used for routine placement of a tunneled left subclavian dialysis catheter. Results Successful placement of a tunneled dialysis catheter into an occluded left subclavian vein using a balloon- assisted puncture technique, through a thrombosed left-arm arteriovenous graft. Conclusions Thrombosed arteriovenous grafts are potential access sites into the central veins. Balloon-assisted punctures allow vascular access salvage into otherwise occluded segments of a central vein; in our case, it allowed access into an occluded left subclavian vein for dialysis catheter placement.

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Analysis of the Outcomes in Central Venous Access Port Implantation Performed by Residents via the Internal Jugular Vein and Subclavian Vein

Journal of Surgical Education ◽

10.1016/j.jsurg.2016.11.005 ◽

2017 ◽

Vol 74 (3) ◽

pp. 443-449 ◽

Cited By ~ 5

Author(s):

Hajime Matsushima ◽

Tomohiko Adachi ◽

Toru Iwata ◽

Takashi Hamada ◽

Hiroki Moriuchi ◽

...

Keyword(s):

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Access Port ◽

Port Implantation ◽

Venous Access Port

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Pneumothorax and Subclavian Vein Thrombosis in Patients With Venous Access Device Implantation

International Surgery ◽

10.9738/intsurg-d-15-00019.1 ◽

2017 ◽

Vol 102 (7-8) ◽

pp. 382-386

Author(s):

Valentina Bestetti ◽

Roman Zeller ◽

Anna S. Wenning ◽

Kim T. Mouton ◽

Wolfgang G. Mouton

Keyword(s):

Subclavian Vein ◽

Venous Access ◽

Secondary Outcome ◽

Chest Drain ◽

Complication Rates ◽

Access Device ◽

Vein Thrombosis ◽

Subclavian Vein Thrombosis ◽

Venous Access Device ◽

Length Of Hospitalization

The primary aim is to assess the length of hospitalization due to iatrogenic pneumothorax as a main complication of totally implantable venous access device (TIVAD) implantation. Secondary aim is to analyze the thrombogenic effects of different catheter diameters on the subclavian vein. Pneumothorax is a rare and may be underestimated, underdocumented, but serious complication in TIVAD of implantation using the subclavian vein puncture method. A total of 1155 consecutive patients with TIVAD implantation were assessed retrospectively over a 14-year time period. As primary outcome the length of hospitalization due to iatrogenic pneumothorax and as secondary outcome subclavian vein thrombosis (SVT) in relation to different TIVAD catheter sizes were analyzed. Pneumothoraces occurred 6 times (0.52%) and only when the subclavian vein was punctured. The median hospitalization for these patients was 8 days (5 of the 6 patients needed a chest drain). No pneumothoraces occurred when a peripheral vein was used for access (980 patients). SVTs were detected in 13 patients (1.1%) without any correlation to the diameter of the catheter. There was no significant correlation detected between the different tumor types and the complication rates. Iatrogenic pneumothorax may lead to hospitalization of 1 week or more. The costs then increase with additional chests x-rays, chest drain insertions, and hospitalization days. When making the choice for surgical venous cutdown or subclavian vein puncture to implant TIVAD, the consequences of iatrogenic pneumothorax should be considered as pneumothorax is a rare but serious complication of TIVAD implantation inherent to subclavian vein puncture.

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Atrial Septal Defect Closure via Left Subclavian Vein Approach in a Patient With Absent Inferior Vena Cava

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120983807 ◽

2021 ◽

pp. 215013512098380

Author(s):

Yusuke Enta ◽

Shunsuke Tatebe ◽

Yoshikatsu Saiki ◽

Norio Tada

Keyword(s):

Inferior Vena Cava ◽

Atrial Septal Defect ◽

Subclavian Vein ◽

Septal Defect ◽

Inferior Vena ◽

Transcatheter Closure ◽

Vena Cava ◽

Atrial Septal Defect Closure ◽

Azygos Continuation ◽

Left Subclavian Vein

Without the femoral venous approach, transcatheter closure of an atrial septal defect is challenging. We performed percutaneous closure via the left subclavian vein in a patient with absence of the inferior vena cava with azygos continuation. Considering that inferior vena cava anomalies are not extremely rare among those with congenital heart disease, the left subclavian vein approach can be an alternative to the femoral approach.

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A Comparison of Outcomes and Complications of Totally Implantable Access Port Through the Internal Jugular Vein Versus the Subclavian Vein

International Surgery ◽

10.9738/intsurg-d-13-00185.1 ◽

2014 ◽

Vol 99 (2) ◽

pp. 182-188 ◽

Cited By ~ 18

Author(s):

Yoshinobu Nagasawa ◽

Tomoharu Shimizu ◽

Hiromichi Sonoda ◽

Eiji Mekata ◽

Masato Wakabayashi ◽

...

Keyword(s):

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Statistical Significance ◽

Late Complication ◽

Insertion Site ◽

Multivariate Logistic Regression Analysis ◽

Late Complications ◽

Complication Rates ◽

Access Port

Abstract Totally implantable access ports (TIAPs) are generally used in oncology. Few studies have addressed complications associated with the insertion site. A total of 233 consecutive oncology patients were enrolled to receive TIAP inserts via internal jugular vein (IJV) or subclavian vein (SV). Data on clinicopathologic parameters and early/late complications were retrospectively collected. No differences were found early and late complication rates. Catheter injury was observed more frequently in the IJV group (2.9%) than in the SV group (1.0%) without statistical significance. Multivariate logistic regression analysis showed that age, switch to palliative use of TIAP, and the distribution of diseases (low risk in patients with colorectal cancer) were independent risk factors for determining complications. In conclusion, TIAP insertion site showed no impact on the early and late complication rates. Catheter injury appears to occur at the same frequency with both approaches. Therefore, medical doctors may choose their preferred puncture site when performing TIAP insertion.

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