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Totally implantable venous access ports: A prospective randomized study comparing subclavian and internal jugular
Liling Han1, Jun Zhang1, Xiaobing Deng1
1Department of Surgical Oncology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P, .R, China; Chongqing Key Laboratory of Pediatrics.
Insights
For children needing long-term IV therapy, subclavian vein implantation of totally implantable venous access ports (TIVAPs) resulted in fewer occlusions and higher satisfaction than internal jugular vein placement.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Oncology Support
Background:
- Totally implantable venous access ports (TIVAPs) are crucial for children requiring long-term intermittent intravenous therapy.
- Choosing the optimal insertion site is vital for TIVAP efficacy and patient well-being.
Purpose of the Study:
- To compare the outcomes of TIVAP implantation in children using either the internal jugular vein or the subclavian vein.
- To evaluate complications and patient satisfaction between the two surgical approaches.
Main Methods:
- A randomized controlled trial involving 415 children undergoing TIVAP implantation.
- Patients were assigned to either the internal jugular vein or subclavian vein group.
- Data collected included operative details, complications, and satisfaction surveys.
Main Results:
- TIVAP implantation was successful in all participants.
- The subclavian vein group had a significantly lower incidence of venous access occlusion (1.5%) compared to the internal jugular vein group (5%).
- Children and guardians reported significantly higher satisfaction scores with TIVAPs placed in the subclavian vein (9.6) versus the internal jugular vein (8.3).
Conclusions:
- The subclavian vein is recommended as the preferred site for TIVAP implantation in pediatric patients.
- This approach offers improved outcomes regarding complication rates and patient satisfaction.
Background And Objectives:
Totally implantable venous access ports (TIVAPs) are essential in children who require long-term intermittent intravenous therapy.
Methods:
Patients who needed to undergo TIVAP implantation were randomly assigned to the internal jugular vein group or the subclavian vein group. The medical histories, operative details and major complications from the time of port implantation to 48 h after port removal were collected. During the use of TIVAPs, satisfaction surveys were regularly conducted for the children and guardians and compared in the two groups.
Results:
A total of 216 patients in the subclavian vein group and 199 patients in the internal jugular vein group were included. TIVAPs were successfully implanted in all children. The incidence of postoperative venous access occlusion in the subclavian vein group and internal jugular vein group was 1.5% and 5%, respectively, and the difference was statistically significant (P < 0.05). The average satisfaction score of the children and guardians in the subclavian vein group was 9.6 ± 0.3, and that in the internal jugular vein group was 8.3 ± 0.8. There was a significant difference between the 2 groups (P < 0.05).
Conclusions:
Subclavian vein should be the first choice for TIVAP implantation in children.
The Level Of Evidence Rating:
Treatment study level I.
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