Insertion of Totally Implantable Central Venous Access Devices by Surgeons

Abstract

PurposeThe aim of this study is to evaluate the results for the insertion of totally implantable central venous access devices (TICVADs) by surgeons.MethodsTotal 397 patients, in whom TICVADs had been inserted for intravenous chemotherapy between September 2008 and June 2014, were pooled. This procedure was performed under local anesthesia in an operation room. The insertion site for the TICVAD was mainly in the right-side subclavian vein. In the case of breast cancer patients, the subclavian vein opposite the surgical site was used for insertion.ResultsThe 397 patients included 73 males and 324 females. Primary malignant tumors were mainly colorectal and breast cancer. The mean operation time was 54 minutes (18-276 minutes). Operation-related complications occurred in 33 cases (8.3%). Early complications developed in 15 cases with catheter malposition and puncture failure. Late complications, which developed after 24 hours, included inflammation in 6 cases, skin necrosis in 6 cases, hematoma in 3 cases, port malfunction in 1 case, port migration in 1 case, and intractable pain at the port site in 1 case.Conclusion Insertion of a TICVAD under local anesthesia by a surgeon is a relatively safe procedure. Meticulous undermining of the skin and carefully managing the TICVAD could minimize complications.

Ultrasound‐guided totally implantable venous access device through the right innominate vein in older patients is safe and reliable

“…At present, IJV and SCV are the two main approaches for TIVAD. 3,4 The IJV approach has a higher puncture point, and the catheter is connected to the port on the anterior upper chest wall after a 180 bend back. In addition, the IJV approach has a long tube insertion path.…”

“…At present, ultrasound (US)‐guided percutaneous puncture of the internal jugular vein (IJV) and subclavian vein (SCV) are the two main approaches for TIVAD . Complications include hemothorax, pneumothorax, catheter displacement and catheter rupture, which delay the treatment of the disease and reduce the effective utilization rate of the transfusion port …”

“…2 At present, ultrasound (US)-guided percutaneous puncture of the internal jugular vein (IJV) and subclavian vein (SCV) are the two main approaches for TIVAD. 3,4 Complications include hemothorax, pneumothorax, catheter displacement and catheter rupture, which delay the treatment of the disease and reduce the effective utilization rate of the transfusion port. 5 Recently, US-guided innominate vein (INV) access central venous catheterization is reported to be an appropriate option of high puncture success rate and low puncture complications, and this technique has some advantages over IJV approaches.…”

An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein

“…According to the large case series, the rate of catheter mispositioning following TIVAP insertion varies between 0.2% and 3.1% [2,[7][8][9][10][11][12][13][14][15][16][17] (Table 1). [16] 2018 3000 0.2% 9.6% Kim et al [17] 2019 843 0.3% 4%…”

Spontaneous migration of an implanted central venous access device into the ipsilateral jugular vein

“…Spontaneous migration of these devices has an estimated incidence of 0.1%-1.8%, typically presenting with neck or shoulder pain, venous phlebitis or thrombosis. [2][3][4] Proposed mechanisms for migration include forced flushing, vigorous upper extremity movements, and abrupt changes in intrathoracic pressure secondary to vomiting or coughing. 5 Our patient's overhead weight-lifting was a plausible explanation for his catheter migration, and we suggested that he modify his exercise routine accordingly.…”