Upper arm central venous port implantation: a 6-year single institutional retrospective analysis and pictorial essay of procedures for insertion

• Published in: PloS one Vol. 9; no. 3; p. e91335
• Main Authors: Shiono, Masatoshi, Takahashi, Shin, Kakudo, Yuichi, Takahashi, Masanobu, Shimodaira, Hideki, Kato, Shunsuke, Ishioka, Chikashi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.03.2014; Public Library of Science (PLoS)
• Subjects: Aging; Analysis; Arm - blood supply; Bleeding; Breast cancer; Cancer; Cannulation; Catheterization, Central Venous - adverse effects; Catheters; Catheters, Indwelling - adverse effects; Chemotherapy; Consultation; Data processing; Feasibility studies; Female; Head & neck cancer; Hospitals; Humans; Implantation; Male; Medical instruments; Medical schools; Medicine; Middle Aged; Neck; Oncology; Patients; Phlebotomy; Physicians; Pneumothorax; Ports; Preoperative Care; Retrospective Studies; Risk; Scars; Statistical analysis; Surgeons; Thrombosis; Tomography, X-Ray Computed; Ultrasonics; Ultrasound; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0091335

The requirement of central venous (CV) port implantation is increasing with the increase in the number of cancer patients and advancement in chemotherapy. In our division, medical oncologists have implanted all CV ports to save time and consultation costs to other departments. Recently, upper arm implantation has become the first choice as a safe and comfortable method in our unit. Here we report our experience and discuss the procedure and its potential advantages. All CV port implantations (n = 599) performed in our unit from January 2006 to December 2011 were analyzed. Procedural success and complication rates between subclavian and upper arm groups were compared. Both groups had similar patient characteristics. Upper arm CV port and subclavian implantations were equivalently successful and safe. Although we only retrospectively analyzed data from a single center, the upper arm group had a significantly lower overall postprocedural complication rate than the subclavian group. No pneumothorax risk, less risk of arterial puncture by ultrasound, feasibility of stopping potential arterial bleeding, and prevention of accidental arterial cannulation by targeting the characteristic solitary basilic vein were the identified advantages of upper arm CV port implantation. In addition to the aforementioned advantages, there is no risk of "pinch-off syndrome," possibly less patient fear of manipulation, no scars on the neck and chest, easier accessibility, and compatibility with the "peripherally inserted central catheter" technique. Upper arm implantation may benefit clinicians and patients with respect to safety and comfort. We also introduce our methods for upper arm CV port implantation with the videos.