title: Evaluation of three different techniques for insertion of totally implantable venous access device: A randomized clinical trial.
abstract: BACKGROUND
  Although totally implantable venous access devices (TIVAD) are increasingly being used in oncology patients, more robust evidence about the best technique is lacking, especially regarding to ultrasound (US) guided puncture.
  
  
  METHODS
  One hundred ten patients with indication of intravenous chemotherapy were randomly assigned to TIVAD implant through US-guided internal jugular vein (USG) puncture (39) or internal jugular vein blindly (IJB) (36) or subclavian vein blindly (SCB) (35). Procedure data and complications were prospectively recorded within 30 days of the procedure.
  
  
  RESULTS
  All patients completed the follow up. Immediate complication rate was 5.1%, 13.9%, and 0% in the USG, IJB, and SCB groups, respectively (P = 0.05). First attempt success rate was 79.5% in the USG, 52.8% in the IJB and 47.2% in the SCB group (P = 0.012). Technique failure was observed in 2.6%, 22.2%, and 8.6% of the population in the USG, IJB, and SCB, respectively (P = 0.021). Early complication rate was 5.1% in USG group, 2.8% in the IJB, and 0% in the SCB (P = 0.401).
  
  
  CONCLUSIONS
  The findings of our study suggest superiority of the USG approach in terms of first puncture success rate and technique failure, without increasing the procedure duration. Long-term follow-up results should help to further clarify the current debates.
authors.affiliation: Department of General Surgery of Hospital de Cl, í, nicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Tagliari
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Fernanda Luiza
authors.initials: FL
authors.lastname: Staub
authors.affiliation: Department of General Surgery of Hospital de Cl, í, nicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: José Ricardo
authors.initials: JR
authors.lastname: Guimarães
authors.affiliation: Department of General Surgery of Hospital de Cl, í, nicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Alceu
authors.initials: A
authors.lastname: Migliavacca
authors.affiliation: Department of General Surgery of Hospital de Cl, í, nicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Diego da Fonseca
authors.initials: Dda F
authors.lastname: Mossmann
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011379:Prognosis
keywords: central venous ports; chemotherapy; internal jugular vein; randomized trial; subclavian vein; ultrasound