A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients.
OBJECTIVE
The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons. Alternative settings for the introduction of totally implantable venous access devices (TIVAD) and the search for lower rates of morbidity led to the choice of other central veins. This study compares two different venous accesses, the subclavian (SC) versus the internal jugular (IJ), in terms of early and late morbidity.


METHODS
This is a prospective, non-randomized, observational, uni-institutional (tertiary cancer centre) study. From March 2003 to March 2006, 1231 TIVADs were placed (1201 patients), in an ambulatory operating room, under vital signs and EKG monitoring, using local anaesthesia and without perioperative radiological control.


RESULTS
Of the 1231 TIVAD, 617 were inserted via the SC and 614 via the IJ vein. The two groups (SC vs. IJ) were comparable as to general patient characteristics. Immediate complications were more frequent in the SC than in the IJ approach (respectively, 5.0% vs. 1.5%; p<0.001); Catheter malposition occurred in 2.3% when using the SC vein and in 0.2% for the IJ (p=0.001). Long term morbidity was also more frequent in the SC than in the IJ group (respectively, 15.8%, 87/551, vs. 7.6%, 39/512; p<0.001). Venous thrombosis developed in 2.0% of patients with an SC TIVAD as compared to 0.6% with an IJ TIVAD (p=0.044). Catheter malfunction was significantly dependent on the vein used: SC - 9.4% vs. IJ - 4.3% (p=0.001).


CONCLUSIONS
Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD.
Araújo
C
C
Department of Surgical Oncology, Portuguese Institute of Oncology Francisco Gentil, Porto Centre, Portugal.
Silva
J P
JP
Antunes
P
P
Fernandes
J M
JM
Dias
C
C
Pereira
H
H
Dias
T
T
Fougo
J L
JL
D000556:Ambulatory Surgical Procedures; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D020878:Device Removal; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D066298:In Vitro Techniques; D015918:Infusion Pumps, Implantable; D007601:Jugular Veins; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D011336:Probability; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013350:Subclavian Vein; D013997:Time Factors
D000970:Antineoplastic Agents