External Jugular Cutdown Technique for Totally Implantable Venous Access Devices: a Single-Centre Study
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ORIGINAL ARTICLE
External Jugular Cutdown Technique for Totally Implantable Venous Access Devices: a Single-Centre Study Nikhil Mehta 1
&
Sanjay M Desai 1 & Vinod Dhakad 1 & Dhruv Patel 1 & Elroy Saldanha 1
Received: 2 March 2020 / Accepted: 7 May 2020 # Indian Association of Surgical Oncology 2020
Abstract Chemotherapy drugs are the integral part of cancer treatment. Their administration is optimized by central venous access devices. We present our prospective study of chemoport implantation by external jugular vein cutdown technique. We studied 100 patients who underwent chemoport insertion over a span of 3 years for various solid and haematological malignancies via external jugular vein cutdown method. Outcomes such as type of disease, anaesthesia, choice of venous access, catheter tip position, length of the procedure, time to start chemotherapy and morbidity data were analysed. The Hundred /100 intravenous devices were implanted in 66% females and 33% males. Most common indication was breast cancer (64% of patients). A total of 80% of patients underwent procedure under local anaesthesia. Chemoports were inserted on the right side in 84 and left side in the remaining 16. The average surgical time was 32 min. The overall success rate was 97% with no intraoperative complications. Three postoperative complications were encountered due to displacement of catheter or wound infection. External jugular vein cutdown approach is a safe, reliable method for venous access device implantation. This approach has a high success rate and has minimal complications and can be easily learnt. Keywords TIVAD . External jugular vein . Chemoport . Cutdown
Introduction Totally implantable venous access devices (TIVADs) are a simple and safe method for achieving venous access—for delivering chemotherapeutic drugs, fluids and total parenteral nutrition in cancer patients. TIVADs can be placed either by percutaneous approach or venous cutdown approach. Commonly practiced technique is percutaneous approach via subclavian or internal jugular vein using Seldinger technique [1, 2]. This can be done either blindly or under ultrasound guidance. A less commonly explored technique is venous cutdown technique either through cephalic vein or external jugular vein. However, percutaneous technique has been associated with complications in 12% of patients—such as pneumothorax, hemothorax, vascular, or brachial plexus inju-
* Nikhil Mehta [email protected] 1
Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore 453555, India
ries, catheter pinch off and catheter migration [3, 4]. Although cutdown techniques are not associated with these complications, their failure rate can be as high as 30% [4, 5]. External jugular vein (EJV) cutdown technique has a high amount of success rate with minimal complications. We, therefore conducted a prospective study of chemoport insertion via external jugular vein using the cutdown technique.
Materials and Methods This prospective study was conducted at our
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