Comparison of Two Different Central Venous Access Device Insertion Techniques: No Evil in Details

Aim:Central venous access devices (CVADs) have been used for prolonged infusion chemotherapy and have facilitated the problem of vascular access. The aims of this study were to analyse the results and complications of two CVAD implantation techniques.Methods:We performed a retrospective study of 118 implantable venous access devices inserted via the subclavian vein using two different surgical techniques between January 2015 and June 2017 in İstanbul Haseki Training and Research Hospital, Clinic of General Surgery. While the devices were placed under fluoroscopic guidance in group 1, they were placed without fluoroscopy in group 2. All procedures were performed under sedation and local anesthesia. All devices were placed at the anterior chest wall over the pectoralis fascia. Outcome and complications were followed and recorded elaborately.Results:A total of 118 venous access devices were implanted. During follow-up, a total of eight complications were observed. Pneumothorax was observed in five, wound infection in two and catheter fracture was observed in one patient. There was no statistically significant difference in complications between the two groups.Conclusion:CVADs increase quality of life of patients with oncologic diseases during chemotherapy. Common periprocedural complications of CVADs are pneumothorax, wound infection and catheter occlusion. In critical patients, the use of fluoroscopy may be helpful in reducing complications. However, since fluoroscopy increases costs and requires experience, CVAD insertion under fluoroscopy guidance may not always be possible. There is also a risk of radiation exposure when using fluoroscopy. In regard to comparison of the two techniques, fluoroscopy guidance did not alter the results and its superiority over the other technique was not observed. Although image-guided insertion of subcutaneous chest ports has advantages over unguided insertion, the latter can be used in a selected group of patients in experienced hands.