Single-incision technique for tunneled central venous access

To describe the authors' experience in using a single-incision technique for placing implantable chest ports and tunneled dialysis catheters.

Implantable chest ports and tunneled dialysis catheters were placed in 130 consecutive unselected patients aged 18 to 81 years over a 6-month period. A micropuncture needle bent into a C shape was used to access the internal jugular vein (IJV) from an infraclavicular access under real-time ultrasonographic (US) guidance. A microwire and sheath were then passed into the superior vena cava; this was followed by placement of the tunneled catheter either through a peel-away sheath (implantable chest port) or de novo over the wire (tunneled dialysis catheter). Technical success of procedure performance, total US and procedure times, and adverse procedural outcomes were documented for each case. Follow-up for infections and catheter outcomes was performed, with an average follow-up of 2 months.

One hundred thirty of the 131 placements were successful. Fifty-eight implantable chest ports and 72 tunneled dialysis catheters were placed. Four implantable chest ports and 16 tunneled dialysis catheters were placed via the left IJV; the remainder were placed via the right IJV. There were no procedure-related complications. The average US and total procedure times were the same as those for a conventional technique. The lack of a second incision in the lower neck improved the cosmetic result.

The single-incision technique for tunneled central venous access is feasible and safe. Total US and procedure times are within the range of those with a conventional technique. Cosmetically, this technique is superior to the conventional technique.