[Long-term central venous access. Experience with 173 cases]

Utility of long term central venous accesses.

Personal experience in 173 long term central venous accesses (a.v.c.) performed from January 1990 to December 1997 in 172 patients mostly affected by neoplastic disease is reported. The device used was totally implantable in 102 cases (59%): 82 Port (80.3%), 20 Chrono-infusors (20.7%); in 71 cases (41%) an external tunnellized catheter (c.v.c.). Percutaneous way with Seldinger procedure was performed in 168 cases (97.3%), left subclavian vein was preferred in 118 cases (68.2%).

The overall complications in this series were about 7.4%: early 4% (5 accidental arterial punctures, 2 pneumothoraxes), late 3.4% (1 subcutaneous pocket infection, 3 cutaneous necrosis, 1 venous catheter dislocation and 1 migration). No significative differences in terms of complications were reported between totally implantable devices and external tunnellized catheter.

The reasons of a low rate of complications in our series are to be found in the perfect aseptic condition of the operating room, the positioning of the a.v.c. under constant fluoroscopic control and a good management during the postoperative care of the a.v.c. The indications and the economic aspect for each kind of device used (c.v.c. or totally implantable a.v.c.) are then discussed and the conclusion drawn that for short term therapy, up to six months, (hematologic patients of this series) the external tunnellized catheter should be advisable, while for long term therapy administration (solid tumors and parenteral nutrition) totally implanted device should be recommended.