Central venous infusion port inserted via high versus low jugular venous approaches: retrospective comparison of outcome and complications.
OBJECTIVE
To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches.


METHODS
The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n=7), operation scar (n=6), radiation scar (n=5), failure of low jugular vein puncture (n=2), and abnormal course of right subclavian artery (n=1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port.


RESULTS
The procedure-related complications were all minor (n=14, 8.6%) in both groups; hematoma (n=4, 2.8% in low jugular puncture group and n=1, 4.8% in high jugular puncture group, p=0.6295), air embolism (n=2, 1.4% in low jugular puncture group and n=0 in high jugular puncture group, p=0.5842) and minor bleeding (n=5, 3.5% in low jugular vein puncture group and n=2, 9.5% in high jugular vein puncture group, p=0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p=0.0349). The reasons for catheter removal were patients' death (59 in low jugular puncture group and 14 in high jugular puncture group, p=0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p=0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p=0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein puncture group and there was no significant difference (p=0.4232).


CONCLUSIONS
Right high jugular vein approach can be a feasible alternative to right low jugular vein approach.
Park
Hong Suk
HS
Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 411-764, Republic of Korea. hpark@dreamwiz.com
Kim
Young Il
YI
Lee
Sang Hyun
SH
Kim
Jung Im
JI
Seo
Hyobin
H
Lee
Sang Min
SM
Lee
Youkyung
Y
Lim
Min Kyung
MK
Park
Young Suk
YS
D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000379:methods*; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology*; D055815:Young Adult