Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2023; 11(1): 116-126
Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.116
Impact of central venous port implantation method and access choice on outcomes
Ayhan Erdemir, Huseyin Kemal Rasa
Ayhan Erdemir, Department of General Surgery, Anadolu Medical Center, Kocaeli 41400, Turkey
Huseyin Kemal Rasa, Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
Author contributions: Erdemir A contributed to the formal analysis of the data, investigation, writing of the original draft, and project administration; Erdemir A and Rasa HK contributed to the conceptualization of the study and methodology; Rasa HK contributed to the review and editing of the manuscript for important intellectual content; and all authors read and approved the final manuscript.
Institutional review board statement: The study was conducted following the Declaration of Helsinki (as revised in 2013) and was approved by the Anadolu Medical Center Hospital review board and ethics committee (ASM-EK-22/187).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets analyzed during the current study are available in the hospital’s “electronic patient records” and from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huseyin Kemal Rasa, MD, Attending Doctor, Department of General Surgery, Anadolu Medical Center Hospital, Cumhuriyet Mahallesi 2255 Sokak No. 3 Gebze, Kocaeli 41400, Turkey. kemrasa@gmail.com
Received: September 23, 2022
Peer-review started: September 23, 2022
First decision: November 11, 2022
Revised: November 24, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 6, 2023
Abstract
BACKGROUND

Although the number of patients who need central venous ports for permanent vascular access is increasing, there is still no “gold standard” for the implantation technique.

AIM

To identify the implantation technique that should be favored.

METHODS

Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated. Patients were assigned into two groups according to the access method. The first group comprised patients whose jugular veins were used, and the second group comprised patients whose subclavian veins were used. Groups were evaluated regarding age, sex, application side, primary diagnosis, active follow-up period in the hospital, chemotherapy agents administered, number of complications, and the Clavien-Dindo severity score. The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test. The χ2 test was used to analyze the variables.

RESULTS

There was no statistically significant difference between the groups regarding age, sex, side, number of chemotherapy drugs, and duration of port usage (P > 0.05). Only 2 patients in group 1 had complications, whereas in group 2 we observed 19 patients with complications (P < 0.05). No port occlusion was found in group 1, but the catheters of 4 patients were occluded in group 2. One port was infected in group 1 compared to three infected ports in group 2. Two port ruptures, two pneumothorax, one revision due to a mechanical problem, one tachyarrhythmia during implantation, and four suture line problems were also recorded in group 2 patients. We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.

CONCLUSION

Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.

Keywords: Permanent vascular access, Central venous ports, Central venous port implantation methods, Jugular vein route, Subclavian vein approach, Impact of implantation method on outcomes

Core Tip: A total of 200 consecutive patients who had undergone central venous port implantation were assigned to two groups according to the access method: Jugular or subclavian veins. Our results firmly showed that the port occlusion rate was higher in the subclavian group. The jugular vein approach was also safer regarding port infections, fractures and pneumothorax risk. Contrary to the literature, our study also advocates a longer 2-mo interval for port care and washing. Our results set forth that the jugular vein route is safer than the subclavian vein for central venous port implantation.