Annals of Oncology Advance Access published online on January 29, 2009
Annals of Oncology, doi:10.1093/annonc/mdn701
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Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial
1 Division of Abdomino-Pelvic Surgery
2 Division of Interventional Radiology
3 Division of General and Laparoscopic Surgery
4 Division of Epidemiology and Biostatistics
5 Department of Medicine, European Institute of Oncology, via Ripamonti 435, I-20141 Milan, Italy
* Correspondence to: Dr R. Biffi, Division of Abdomino-Pelvic Surgery, European Institute of Oncology, via Ripamonti 435, I-20141 Milan, Italy. Tel: +39-02-57489609; Fax: +39-02-94379215; E-mail: roberto.biffi{at}ieo.it
Background: Central venous access is extensively used in oncology, though practical information from randomized trials on the most convenient insertion modality and site is unavailable.
Methods: Four hundred and three patients eligible for receiving i.v. chemotherapy for solid tumors were randomly assigned to implantation of a single type of port (Bard PortTM, Bard Inc., Salt Lake City, UT), through a percutaneous landmark access to the internal jugular, a ultrasound (US)-guided access to the subclavian or a surgical cut-down access through the cephalic vein at the deltoid–pectoralis groove. Early and late complications were prospectively recorded until removal of the device, patient's death or ending of the study.
Results: Four hundred and one patients (99.9%) were assessable: 132 with the internal jugular, 136 with the subclavian and 133 with the cephalic vein access. The median follow-up was 356.5 days (range 0–1087). No differences were found for early complication rate in the three groups {internal jugular: 0% [95% confidence interval (CI) 0.0% to 2.7%], subclavian: 0% (95% CI 0.0% to 2.7%), cephalic: 1.5% (95% CI 0.1% to 5.3%)}. US-guided subclavian insertion site had significantly lower failures (e.g. failed attempts to place the catheter in agreement with the original arm of randomization, P = 0.001). Infections occurred in one, three and one patients (internal jugular, subclavian and cephalic access, respectively, P = 0.464), whereas venous thrombosis was observed in 15, 8 and 11 patients (P = 0.272).
Conclusions: Central venous insertion modality and sites had no impact on either early or late complication rates, but US-guided subclavian insertion showed the lowest proportion of failures.
central venous ports, cephalic vein, chemotherapy, jugular vein, randomized trial, subclavian vein, surgical venous cut-down
Received for publication June 3, 2008. Revision received October 6, 2008. Accepted for publication October 8, 2008.