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Impact of insertion site on complications in central venous access devices

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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.

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Abbreviations

CVAD:

Central venous access device

SQP:

Subcutaneous port

SCV:

Subclavian vein

IJ:

Internal jugular

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Funding

This research was supported by the American Syrian Lebanese Associated Charities (ALSAC/St. Jude Children’ Research Hospital).

Author information

Authors and Affiliations

  1. Department of Surgery, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Sara A. Mansfield, Andrew J. Murphy, Lindsay Talbot, Abdelhafeez Abdelhafeez, Andrew M. Davidoff & Regan F. Williams

  2. Division of Pediatric Surgery, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA

    Jessica Staszak, Andrew J. Murphy, Lindsay Talbot, Abdelhafeez Abdelhafeez, Andrew M. Davidoff & Regan F. Williams

  3. Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Hasmukh Prajapati, Robert Gold & Vinod Maller

  4. Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA

    Hasmukh Prajapati, Robert Gold, Vinod Maller & Kimberly Proctor

Authors
  1. Sara A. Mansfield
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  2. Jessica Staszak
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Contributions

Study conception and design: Sara Mansfield, Jessica Staszak, Andrew Davidoff, Regan Williams Data acquisition: Sara Mansfield, Jessica Staszak Analysis and data interpretation: Sara A. Mansfield MD MS, Jessica Staszak MD, Andrew J. Murphy MD, Lindsay Talbot MD, Abdelhafeez Abdelhafeez MD, Hasmukh Prajapati MD, Robert Gold MD, Vinod Maller MD, Kimberly Proctor BS MSN, Andrew M. Davidoff MD, Regan F. Williams MD Drafting of the manuscript: Sara Mansfield Critical revision: Sara A. Mansfield MD MS, Jessica Staszak MD, Andrew J. Murphy MD, Lindsay Talbot MD, Abdelhafeez Abdelhafeez MD, Hasmukh Prajapati MD, Robert Gold MD, Vinod Maller MD, Kimberly Proctor BS MSN, Andrew M. Davidoff MD, Regan F. Williams MD.

Corresponding author

Correspondence to Sara A. Mansfield.

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Mansfield, S.A., Staszak, J., Murphy, A.J. et al. Impact of insertion site on complications in central venous access devices. Pediatr Surg Int 39, 118 (2023). https://doi.org/10.1007/s00383-023-05399-w

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