title: Ultrasound guided versus direct vein puncture in central venous port placement.
abstract: BACKGROUND
  This study will report our experience on positioning of totally implanted venous catheter system (port-a-cath) as compared to ultrasound guidance versus blind technique.
  
  
  METHODS
  From July 1996 to November 1999 in the vascular suite of the Europen Institute of Oncology, 427 port-a-cath were implanted in patients with neoplastic disease. All devices were implanted through the subclavian vein. 198 with ultrasound guided puncture and 229 following anatomical landmarks. All patients underwent a close and specific clinical and instrumental follow-up to evaluate possible complications.
  
  
  RESULTS
  Use of Ultrasound (US) in subclavian vein catheterization has reduced the number of puncture attempts, with a better patient complicance, allowing a faster procedure and reducing peri-procedural complications. Ultrasound technique has shown reduction in early complications. In fact in our experience we had no pneumothorax events by using ultrasound guidance, versus 11 events with blind technique. US has shown no reduction in late complications: 3 thrombosis versus 6 thrombosis with US guidance, and 3 fractured and embolized catheter versus 2 cases. Fibrin-cuff percentage was the same in the two groups with only 1 case, as the dislocation of the catheter tip in the jugular vein with 2 cases in both groups. Moreover US let us to avoid the arterial puncture and to perform a more peripheral puncture of the subclavian vein, reducing the risk of 'pinch-off' phenomenon and of haematoma, with no cases reported under US guidance versus 1 case respectively in direct vein puncture.
  
  
  CONCLUSIONS
  US guided puncture of subclavian vein for the implantation of venous catheter system is faster by reducing procedure time, it is easier for the operator and safer for the patient than blind technique by exposing anatomical structures. Morevover US guidance reduces early complications and limits costs.
authors.affiliation: Radiology, European Institute of Oncology, Milan - Italy.
authors.forename: F
authors.initials: F
authors.lastname: Orsi
authors.forename: R F
authors.initials: RF
authors.lastname: Grasso
authors.forename: P
authors.initials: P
authors.lastname: Arnaldi
authors.forename: C
authors.initials: C
authors.lastname: Bonifacio
authors.forename: R
authors.initials: R
authors.lastname: Biffi
authors.forename: F
authors.initials: F
authors.lastname: De Braud
authors.forename: M
authors.initials: M
authors.lastname: Bellomi