Port first vs. Tip first: does difference in portacath insertion techniques reduce complication rates.

Area of Science:

• Vascular Surgery
• Medical Device Technology
• Patient Safety

Background:

• Accurate central venous access device (CVAD) placement is crucial for preventing complications like infection, thrombosis, and migration.
• Two common insertion techniques for intravenous jugular (IVJ) ports are fixation of port first (PF) and tip first (TF).

Purpose of the Study:

• To audit and compare complication rates and catheter tip placement accuracy between the PF and TF IVJ port insertion techniques.
• To evaluate the impact of insertion technique on the incidence of infection, thrombosis, and device migration.

Main Methods:

• A retrospective audit of 227 patients undergoing IVJ port insertions at Cairns Hospital from 2019 to 2021.
• Data were extracted from the Australia Vascular Audit database, focusing on accurate catheter tip placement, line infections, and thrombosis rates.
• Comparison of outcomes between the port first (PF) and tip first (TF) insertion groups.

Main Results:

• The PF group demonstrated a higher rate of accurate catheter tip placement (81.6%) compared to the TF group (69.8%).
• Line-related thrombosis rates were significantly lower in the PF group (1%) versus the TF group (6.2%).
• Infection rates were comparable between the two techniques (PF: 5.1%, TF: 6.2%).

Conclusions:

• The port first (PF) technique for IVJ port device placement is associated with statistically significant improvements in accuracy and reduced thrombosis rates.
• Further multicenter studies with larger populations are recommended to validate these findings and compare practitioner results.