Key result
Limiting subclavian vein percutaneous attempts to a maximum of two punctures before switching to an external jugular vein cutdown significantly reduced early complications (P=0.02).
Why the study?
Does limiting subclavian vein punctures to a maximum of two before switching to external jugular vein cutdown decrease complications during TIVAD placement?
Observational (n=451)
No
Does limiting subclavian vein punctures to a maximum of two before switching to external jugular vein cutdown decrease complications during TIVAD placement?
p-value: p=0.02
Limiting subclavian vein percutaneous puncture attempts to a maximum of two before switching to an external jugular vein cutdown significantly reduces early complications during TIVAD placement.
May reduce early TIVAD complications; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: The aim of this study was to analyze the potential utilization of external jugular vein (EJV) cutdown approach for totally implantable venous access device (TIVAD) placement. METHODS: This is a prospective, non-randomized, observational, uni-institutional study. All patients (n = 451) were first subjected to attempted subclavian vein (SV) percutaneous approach. If SV percutaneous approach was unsuccessful after multiple puncture in group A and maximum two puncture in group B, an ipsilateral EJV cutdown approach was attempted. RESULTS: Four hundred four patients (89.6%) underwent TIVAD placement via SV percutaneous approach. Of those 47 patients in which SV percutaneous approach was not successful, 8 patients in group A and 39 patients in group B, TIVAD was placed via ipsilateral EJV cutdown approach. The average of operative time was 17.9 +/- 8.5 min in group A and 18 +/- 7.3 min in group B (P > 0.05). The early complications of group A were significantly higher than that of group B (P = 0.02). CONCLUSIONS: TIVAD placement by the SV percutaneous approach is safe and fast, and its success rate is very high. By avoiding the immediate complications associated with the percutaneous approach, the EJV cutdown has to be considered a valid, safe, and suitable alternative when the SV percutaneous approach unsuccessful after two needle puncture.
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Karanlık et al. (2009) conducted an observational in Patients requiring totally implantable venous access device (TIVAD) placement (n=451). Limiting subclavian vein percutaneous attempts to a maximum of two punctures before external jugular vein cutdown vs. Multiple subclavian vein percutaneous attempts before external jugular vein cutdown was evaluated on Early complications (p=0.02). Limiting subclavian vein percutaneous attempts to a maximum of two punctures before switching to an external jugular vein cutdown significantly reduced early complications (P=0.02).
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