Research Project Essay

Steven K. Zegar, RPA

A Comparative Review of Port-A-Cath Placement Techniques

PURPOSE: The present study is designed to evaluate and compare subcutaneous ports placed by subclavian and internal jugular approach. The evaluation will compare cost, approach, technique, access, complications and incidence of revision. No specific brand of port will be used; this is to study the procedural aspect and not the port itself. Patients who have already undergone radiation treatments to the upper extremities and chest will also be excluded.

JUSTIFICATION: This study will try to determine what method is in the patients’ best interest when having a chemotherapy port placed. If there is a newer, safer and less costly method of conducting a procedure and the method has been proven; why are patients not given the option as a viable alternative?

HYPOTHESES: Chemotherapy ports have been placed in for years using the subclavian and internal jugular approach. This study will provide necessary data to conclude which approach would be in the patients’ best interest when comparing cost, technique, access, complications and incidence of revision. Most complications that occur from the implantation of a chemotherapy port can be directly related to the type of surgical technique that was used.

BACKGROUND

There is a fair amount of data available from analyses of the complications and costs of central venous access ports for chemotherapy. Studies evaluating vessel used, guidance used, complication rates and cost are available and will be presented. All studies to be presented can be found in the National Library of Medicine and can be accessed through the PubMed website; each study presented will have an index number for easy reference. Reference studies will be evaluated and only the data that is pertinent to the author’s research design will be considered and patients with disqualifying factors will be eliminated.

There is no one study that exists that articulates all the aspects of the author’s design, but there is valuable and pertinent data to be extrapolated to support certain aspects of the popular theories that coincide with the author’s design. For instance, one study explores the idea of using ultrasound guidance for the insertion of subclavian venous access ports. (PMID 15720903) It is the popular belief in the interventional radiology field that subclavian access is a poor first choice for any line and ultrasound guided access is standard practice.

The conclusion of the study states that an ultrasound-guided approach should be the standard technique for central venous cannulation in portacath placement. Without using ultrasound guidance to canuelate the subclavian vein the incidence of pneumothorax increases by 1.9% and the possibility exists of arterial puncture which may present a complication when achieving hemostasis, which in turn raises the possibility of hematoma and pseudo aneurysm. Post procedure complications due to having a catheter itself in the subclavian will be discussed later.

Another study out of Germany supports the widely accepted practice within the interventional society of transjugular implantation of venous port catheter systems. (PMID14610706) This study was a prospective analysis of success and complication rates of chest port implantation via the internal jugular vein. In 50 consecutive patients (25 men, 25 women; mean age 61 +/- 14 years) the internal jugular was punctured under ultrasound guidance. The results were 100% successful implantation rate. The mean duration of placement was 90 +/- 65 catheter days.

No complications occurred during implantation. Post procedure complications included one dysfunctional port, two local infections that occurred within the early post-interventional period, and one port system was explanted prematurely due to pain. In conclusion the ultrasound guided puncture of the internal jugular vein enables a safe

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