Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

Abstract

Purpose Modern oncological treatment algorithms require a central venous device in form of a totally implantable venous access port (TIVAP). While most commonly used techniques are surgical cutdown of the cephalic vein or percutaneous puncture of the subclavian vein, there are a relevant number of patients in which an additional strategy is needed. The aim of the current study is to present a surgical technique for TIVAP implantation via an open Seldinger approach of the internal jugular vein and to characterize risk factors, associated with primary failure as well as short- (< 30 days) and long-term (> 30 days) complications. Methods A total of 500 patients were included and followed up for 12 months. Demographic and intraoperative data and short- as well as long-term complications were extracted. Primary endpoint was TIVAP removal due to complication. Logistic regression analysis was used to analyze associated risk factors. Results Surgery was primarily successful in all cases, while success was defined as functional (positive aspiration and infusion test) TIVAP which was implanted via open Seldinger approach of the jugular vein at the intended site. TIVAP removal due to complications during the 1st year occurred in 28 cases (5.6%) while a total of 4 (0.8%) intraoperative complications were noted. Rates for short- and long-term complications were 0.8% and 6.6%, respectively. Conclusion While the presented technique requires relatively long procedure times, it is a safe and reliable method for TIVAP implantation. Our results might help to further introduce the presented technique as a secondary approach in modern TIVAP surgery.

Application of Chain Nursing Process in the Nursing of Elderly Inpatients with Implantable Venous Infusion Port

“…[ 1 , 2 ]. Compared with peripheral venous catheterization and indwelling needle intravenous infusion, the incidence of local redness, drug extravasation and other adverse reactions is reduced, and the safety is high, and there is less damage to the lining of patients' blood vessels [ 3 , 4 ].And has that advantage of convenient operation, reduced puncture frequency, convenient maintenance and the like. Therefore, for patients who need long-term infusion and infusion of chemotherapy drugs, the implantable venous port is an ideal infusion method.…”

Comment on: Simple implantation is safe for patients with totally implantable venous access ports

“…We are gratified to note the interest from Di Carlo et al in our work and their comment related to our recent publication "Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein-a retrospective risk stratification of 500 consecutive patients" [1]. Di Carlo et al have raised some important points in their letter to the editor and are happy to further discus them as well as to clear up all remaining misunderstandings.…”

Forty years after the first totally implantable venous access device (TIVAD) implant: the pure surgical cut-down technique only avoids immediate complications that can be fatal

“…Recently, another mixed technique has been reported [54]. In this manuscript, the authors report the complete surgical preparation of the internal jugular vein, and then after clamping, the catheter is inserted using the Seldinger technique through the venous wall.…”

“…In this innovative procedure, however, there are 2 important complications to keep in mind: puncture of the carotid artery, which requires suturing, and the possibility of PNX. The focus of this manuscript is on immediate complications, but after preparation of the internal jugular vein, surgical insertion of the catheter may avoid these complications [54].…”