title: Complication rates and outcomes of 536 implanted subcutaneous chest ports: do rates differ based on the primary operator's level of training?
abstract: OBJECTIVE
  Totally implanted subcutaneous central venous access devices (chest ports) are an attractive option for patients in need of intermittent, recurrent venous access. In our department, these are placed by different operator types including interventional radiology (IR) attending physicians, dedicated IR nurse practitioners (NP), and IR fellows/radiology residents. The purpose of our study is to assess the rate of complications of subcutaneous chest port placement among the different operator types.
  
  
  METHODS
  A retrospective review of all subcutaneous central venous access devices implanted in our department between October 8, 2004, and October 19, 2007, was undertaken. Total numbers of port days, overall complication rates for all operators, as well as complication rates for the various operator types were calculated and were compared using the chi square test.
  
  
  RESULTS
  A total of 558 patients had totally implanted subcutaneous central venous access devices placed during the period of study. Of these, 536 had documented follow-up and comprise the study population. A total of 89 were placed by attending physician alone, 133 by an NP, and 314 by an IR fellow or resident, with supervision by an attending physician. Mean duration of port usage was 341 days with 182,522 total port days. A total of 39 complications occurred (7.28%), including 27 infections (5%). There was no statistically significant difference in overall complication rates, including infection rates, among operator groups (P = .925).
  
  
  CONCLUSIONS
  Our results confirm that well-trained physician extenders and trainees can safely perform chest port placement and that these providers, under appropriate supervision, can help provide improved access to chest port placement for patients and referring clinicians.
authors.affiliation: Department of Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Anne.M.Silas@Hitchcock.org
authors.forename: Anne M
authors.initials: AM
authors.lastname: Silas
authors.forename: Kiley D
authors.initials: KD
authors.lastname: Perrich
authors.forename: Eric K
authors.initials: EK
authors.lastname: Hoffer
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: McNulty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011361:Professional Competence / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome