Background: Central venous access systems are frequently used for delivery of medications; however, few studies have compared surgical and postoperative complications of right versus left access via the subclavian vein (SCV). The aim of this study was to compare the surgical and postoperative complications associated with Port-A-Cath system insertion via the right and left SCV. Methods: The medical records of patients who received Port-A-Cath insertion via the SCV for parenteral chemotherapy between August 2004 and July 2008 were reviewed. The incidence of surgical and postoperative complications was compared between patients who received right- versus left-SCV Port-A-Cath insertion. Results: A total of 1,848 patients were included in the study. Right-SCV catheterization was attempted in 1,029 (55.7%) patients and was successful in 866 (84.2%). Left-SCV catheterization was attempted in 819 (44.3%) patients and was successful in 651 (79.5%). The mean length of postoperative follow-up was 417.3 ± 401.3 and 396.7 ± 379.9 days for the right- and left-SCV groups, respectively. The incidence of SCV puncture failure was significantly lower in the right-SCV group (12.3%) compared with the left-SCV group (16.8%, p = 0.006). The incidence of catheter knotting at the ipsilateral brachiocephalic vein was also significantly lower in the right-SCV group (0.0%) compared with the left-SCV group (0.5%, p = 0.038), as was the incidence of catheter occlusion (1.0% for right SCV vs. 3.5% for left SCV, p = 0.001). Conclusion: These findings suggest that the right-SCV approach is superior to the left-SCV approach for Port-A-Cath insertion.

Keywords:
Postoperative complications, Left/right subclavian vein, Port-A-Cath, Surgical complications
1.
Poorter RL, Lauw FN, Bemelman WA, Bakker PJ, Taat CW, Veenhof CH: Complications of an implantable venous access device (Port-a-Cath) during intermittent continuous infusion of chemotherapy. Eur J Cancer 1996;32A:2262–2266.
2.
Shen-Gunther J, Mannel RS, Walker JL, Gold MA, Johnson GA: Outpatient implantation of a central venous access system in gynecologic oncology patients. J Reprod Med 2003;48:875–881.
3.
Ku YH, Kuo PH, Tsai YF, Huang WT, Lin MH, Tsao CJ: Port-A-Cath implantation using percutaneous puncture without guidance. Ann Surg Oncol 2009;16:729–734.
4.
Nocito A, Wildi S, Rufibach K, Clavien PA, Weber M: Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access ports. Br J Surg 2009;96:1129–1134.
5.
Vandoni RE, Guerra A, Sanna P, Bogen M, Cavalli F, Gertsch P: Randomised comparison of complications from three different permanent central venous access systems. Swiss Med Wkly 2009;139:313–316.
6.
Lin CH, Wu HS, Chan DC, Hsieh CB, Huang MH, Yu JC: The mechanisms of failure of totally implantable central venous access system: analysis of 73 cases with fracture of catheter. Eur J Surg Oncol 2010;36:100–103.
7.
Unal AE, Bayar S, Arat M, Ilhan O: Malpositioning of Hickman catheters, left versus right sided attempts. Transfus Apher Sci 2003;28:9–12.
8.
Yerdel MA, Karayalcin K, Anadol E: Malpositioning of subclavian vein catheters in left and right sided attempts: a prospective study. Neth J Surg 1991;43:178–180.
9.
Yerdel MA, Karayalcin K, Aras N, Bozatli L, Yildirim E, Anadol E: Mechanical complications of subclavian vein catheterization. A prospective study. Int Surg 1991;76:18–22.
10.
Macdonald S, Watt AJ, McNally D, Edwards RD, Moss JG: Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches. J Vasc Interv Radiol 2000;11:225–231.
11.
Czepizak CA, O’Callaghan JM, Venus B: Evaluation of formulas for optimal positioning of central venous catheters. Chest 1995;107:1662–1664.
12.
Nazarian GK, Bjarnason H, Dietz CA Jr, Bernadas CA, Hunter DW: Changes in tunneled catheter tip position when a patient is upright. J Vasc Interv Radiol 1997;8:437–441.
13.
Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM: Complications and failures of subclavian-vein catheterization. N Engl J Med 1994;331:1735–1738.
14.
Johnson JR: Complications and failures of subclavian-vein catheterization. N Engl J Med 1995;332:1580–1581.
15.
Jung CW, Bahk JH, Kim MW, Lee KH, Ko H: Head position for facilitating the superior vena caval placement of catheters during right subclavian approach in children. Crit Care Med 2002;30:297–299.
16.
Petersen J, Delaney JH, Brakstad MT, Rowbotham RK, Bagley CM Jr: Silicone venous access devices positioned with their tips high in the superior vena cava are more likely to malfunction. Am J Surg 1999;178:38–41.
17.
Luciani A, Clement O, Halimi P, Goudot D, Portier F, Bassot V, Luciani JA, Avan P, Frija G, Bonfils P: Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001;220:655–660.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.