title: Totally implantable venous access devices: retrospective analysis of different insertion techniques and predictors of complications in 796 devices implanted in a single institution.
abstract: BACKGROUND
  The aim of this study was to assess the efficacy and safety of totally implanted vascular devices (TIVAD) using different techniques of insertion.
  
  
  METHODS
  We performed a retrospective study using a prospective collected database of 796 consecutive oncological patients in which TIVADs were inserted. We focused on early and late complications following different insertion techniques (surgical cutdown, blind and ultrasound guided percutaneous) according to different techniques.
  
  
  RESULTS
  Ultrasound guided technique was used in 646 cases, cephalic vein cutdown in 102 patients and percutaneous blind technique in 48 patients. The overall complication rate on insertion was 7.2% (57 of 796 cases). Early complications were less frequent using the ultrasound guided technique: arterial puncture (p = 0.009), technical failure (p = 0.009), access site change after first attempt (p = 0.002); pneumothorax occurred in 4 cases, all using the blind percutaneus technique. Late complications occurred in 49 cases (6.1%) which required TIVAD removal in 43 cases and included: sepsis (29 cases), thrombosis (3 cases), dislocation (7 cases), skin dehiscence (3 cases), and severe pain (1 case).
  
  
  CONCLUSIONS
  Ultrasound guided technique is the safest option for TIVAD insertion, with the lowest rates of immediate complications.
authors.forename: Elisa
authors.initials: E
authors.lastname: Granziera
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy. marcoscarpa73@yahoo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Angelo
authors.initials: A
authors.lastname: Ciccarese
authors.forename: Bogdan
authors.initials: B
authors.lastname: Filip
authors.forename: Matteo
authors.initials: M
authors.lastname: Cagol
authors.forename: Valentina
authors.initials: V
authors.lastname: Manfredi
authors.forename: Rita
authors.initials: R
authors.lastname: Alfieri
authors.forename: Connie
authors.initials: C
authors.lastname: Celentano
authors.forename: Sandra
authors.initials: S
authors.lastname: Cappellato
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
authors.forename: Muzio
authors.initials: M
authors.lastname: Meroni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D062666:Vascular Access Devices; D016748:Venous Cutdown