title: Cephalic vein cut-down verses percutaneous access: a retrospective study of complications of implantable venous access devices.
abstract: BACKGROUND
  Central venous access devices play an integral role in providing long-term venous access. Percutaneous and cut-down techniques have been used with varying complications.
  
  
  METHODS
  Between January 1998 and July of 2001, 358 venous access devices were placed at Albert Einstein Medical Center in Philadelphia, Pennsylvania. A retrospective study was performed to compare complications and operative times for 2 methods of catheter insertion.
  
  
  RESULTS
  Overall complication rate was 14%. In lines successfully placed percutaneously, the complication rate was 15% (25 of 163) compared with 11% (16 of 148) in the successful cephalic cut-down group, P = .11. Complications including -- pneumothorax, late catheter transection, and bradycardia -- only occurred in percutaneously placed lines. Mean operative times were similar for both groups.
  
  
  CONCLUSIONS
  Use of the cut-down approach for long-term venous access may result in improved patient safety. The cut-down technique should be considered a safe initial approach for placement of venous access devices.
authors.affiliation: Marion Louise Saltzman Women's Center, Albert Einstein Medical Center, 5501 Old York Rd., Philadelphia, PA 19141, USA. jablonl@einstein.edu
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Jablon
authors.forename: Katie R
authors.initials: KR
authors.lastname: Ugolini
authors.forename: Nissin C
authors.initials: NC
authors.lastname: Nahmias
mesh_terms: D016121:Brachiocephalic Veins / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016748:Venous Cutdown / Q000009:adverse effects* / Q000379:methods