Complications of Central Venous Totally Implantable Access Port:Internal Jugular Versus Subclavian Access
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allowspatients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax(n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complicationsexcept infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complicationfree probability is significantly higher in group 1 (p = 0.040). Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
Abstract
Background: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allowspatients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax(n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complicationsexcept infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complicationfree probability is significantly higher in group 1 (p = 0.040). Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
참고문헌 (17)
- Ruesch S, "Complications of central venous catheters: internal jugular versus subclavian access-a systematic review", Crit Care Med, 30, pp.454~460 (2002)
- Galloway M, "Insertion and placement of central catheters in the oncology patient", Semin Oncol Nurs, 26, pp.102~112 (2010)
- Broviac JW, "A silicone rubber atrial catheter for prolonged parenteral alimentation", Surg Gynecol Obstet, 136, pp.602~606 (1973)
- Seiler CM, "Surgical technique for totally implantable access ports (TIAP) needs improvement:a multivariate analysis of 400 patients", J Surg Oncol, 93, pp.24~29 (2006)
- Frykholm P, "Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine", Acta Anaesthesiol Scand, 58, pp.508~524 (2014)
- Silberzweig JE, "Society of Interventional Radiology Technology Assessment Committee: Reporting standards for central venous access", J Vasc Interv Radiol, 14(9 Pt 2), pp.S443~S452 (2003)
- Biffi R, "Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial", Ann Oncol, 20, pp.935~940 (2009)
- Wu CF, "A single-center study of vascular access sites for intravenous ports", Surg Today, 44, pp.723~731 (2014)
- 신병석, "피하매몰 중심정맥포트 설치술: 천자위치와 시술방법에 따른 비교", 대한영상의학회지, 49(3), pp.165~171 (2003), 대한영상의학회
- Araújo C, "A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients", Eur J Surg Oncol, 34, pp.222~226 (2008)
- Silas AM, "Complication rates and outcomes of 536 implanted subcutaneous chest ports: do rates differ based on the primary operator’s level of training?", Acad Radiol, 17, pp.464~467 (2010)
- 금동윤, "Safety of a Totally Implantable Central Venous Port System with Percutaneous Subclavian Vein Access", The Korean Journal of Thoracic and Cardiovascular Surgery, 46(3), pp.202~207 (2013), 대한흉부외과학회
- Schwarz RE, "Subcutaneously implanted central venous access devices in cancer patients:a prospective analysis", Cancer, 79, pp.1635~1640 (1997)
- Ge X, "Central venous access sites for the prevention of venous thrombosis, stenosis and infection", Cochrane Database Syst Rev, 3, pp.CD004084~ (2012)
- Mirza B, "Pinch-off syndrome:case report and collective review of the literature", Am Surg, 70, pp.635~644 (2004)
- Aitken DR, "The “pinch-off sign”: a warning of impending problems with permanent subclavian catheters", Am J Surg, 148, pp.633~636 (1984)
- McGee DC, "Preventing complications of central venous catheterization", N Engl J Med, 348, pp.1123~1133 (2003)