Randomised comparison of complications from three different permanent central venous access systems

We present a prospective randomised trial comparing complications from three different permanent central venous access systems (PCVAS).

The PCVAS trial groups were I, polyurethane ChemoSite (AutoSuture); II, polyurethane Port-a-Cath (Pharmacia-Upjohn); and III, silicone Port-a-Cath. The PCVAS were inserted under local anaesthesia by direct puncture of the subclavian vein, using the Seldinger technique. Every complication and ist evolution was recorded and analysed. The follow-up period was closed five years after the last PCVAS was implanted, and interrupted when for any reason the device was removed.

Over a period of 45 months, we included 228 patients (96 men, 132 women, average age 58 yr). Patients were followed from six days to 103 mo (median 14.7 mo). We observed 10 pneumothorax (4.3%), seven of them requiring drainage. Out of 10 infected ports (4.3%), eight were removed. We observed 46 complications (20.1%) related to the device (rupture, displacement, disconnection, and occlusion of the catheter). Most of the thirteen ruptures (5.7%) occurred in the space between the clavicle and the first rib. Catheters of group I ruptured more often than those of groups II and III (p <0.05). Polyurethane catheters ruptured more often than silicone catheters (p <0.01).

The polyurethane catheters that ruptured more often had a larger diameter and a thicker wall than the other polyurethane catheters, and were probably subjected to greater shearing between the clavicle and the first rib. Silicone catheters, although thicker and of larger diameter than the two other catheters, seemed more resistant to shearing.