CVC insertion site and associated complication rates
Abstract:
Purpose: There is still debate over the safest route for the placement of long-term central venous access devices. The aim of this study was to review a large, single-institution experience to determine the impact of access location on peri-operative complications.
Methods: The records of patients undergoing subcutaneous port (SQP) and tunneled catheter insertion over a seven-year period were reviewed. Vein cannulated (subclavian (SCV) versus internal jugular (IJ) vein), and 30-day complications were assessed. Surgical complications included pneumothorax, hemothorax, infections, arrhythmia or malpositioning requiring intervention.
Results: A total of 1,309 patients were included (618 SQP, 691 tunneled catheters). The location for insertion was SCV (909, 69.4%) and IJ (400, 30.6%). There were 69 complications (5.2%) (41, 4.5% SCV, 28, 7.0% IJV) including: malpositioning/malfunctioning (SCV 13, 1.4% and IJV 14, 3.0%), pneumothorax (SCV 4, 0.4% and IJV 1, 0.3%), hemothorax (SCV 0 and IJV 1, 0.3%), arrhythmia (SCV 1, 0.1%, and IJV 0), and infection within 30 days of placement (SCV 20, 2.2% and IJ 11, 2.8%). The complication rates were not significantly different based on site (p = 0.080).
Conclusion: There was no significant difference in complication rates when using the subclavian versus the internal jugular vein as the site for long-term central venous access.
Level of evidence: III, retrospective comparative study.
Reference:
Mansfield SA, Staszak J, Murphy AJ, Talbot L, Abdelhafeez A, Prajapati H, Gold R, Maller V, Proctor K, Davidoff AM, Williams RF. Impact of insertion site on complications in central venous access devices. Pediatr Surg Int. 2023 Feb 11;39(1):118. doi: 10.1007/s00383-023-05399-w. PMID: 36773111.