Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception.
OBJECTIVE
To determine the safest and most tolerable method for totally implantable access ports (TIAPs) particularly in regard to patient's pain perception and catheter-related complications.


METHODS
From January 2007 to October 2008 a subcutaneous TIAP (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18-85 years old; mean age of 56 ± 6 years) by experienced interventional radiologists. 94 TIAP were implanted through the subclavian vein (subclavian group) and 44 TIAP were implanted through the internal jugular vein (jugular group). Intrainterventional pain perception (visual analogue scale from 1 to 10), postinterventional catheter tip migration and radiation dose were documented for each method and implantation side and differences were compared with Wilcoxon t-test. For ordinal variables, comparison of two groups was performed with the Fisher's exact test.


RESULTS
No severe periinterventional complication occurred. Inadvertent arterial punctures without serious consequences were reported in one case for the jugular group versus four cases in the subclavian group. Significantly (p<0.05) lower pain perception, radiation dose and tip migration rate were observed in the jugular group. Catheter occlusions occurred in 4% (n=4) of the subclavian group versus 2% (n=1) of the jugular group. The corresponding values for vein thrombosis and catheter dislocation were 3% (n=3) and 1% (n=1) in the subclavian group, while none of those complications occurred in the jugular group.


CONCLUSIONS
Both techniques, the TIAP implantation via fluoroscopy-guided subclavian vein puncture and via ultrasound-guided jugular vein puncture, are feasible and safe. Regarding intrainterventional pain perception, radiation dose, postinterventional catheter tip position and port function the jugular vein puncture under ultrasound guidance seems to be advantageous.
Plumhans
Cédric
C
Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Aachen, Germany. plumhans@rad.rwth-aachen.de
Mahnken
Andreas H
AH
Ocklenburg
Christina
C
Keil
Sebastian
S
Behrendt
Florian F
FF
Günther
Rolf W
RW
Schoth
Felix
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000453:epidemiology; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011677:Punctures; D011829:Radiation Dosage; D015641:Radiography, Interventional; D018709:Statistics, Nonparametric; D013350:Subclavian Vein; D014283:Triiodobenzoic Acids / Q000008:administration & dosage; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol