Totally implantable central venous access devices in patients with cancer. Experience at a private oncology center]

Background: Use of totally implantable central venous access ports in cancer patients is a common practice for chemotherapy, not excluding early and late morbidity. We undertook this study to report the experience using these devices in a private cancer center. Methods: We conducted a consecutive series of 156 cases of patients using these devices placed by the same surgical team to enhance chemotherapy. Patients were evaluated during a 44-month period. Prevalence of early and late complications and days-risk for patient-infection was determined. Results: In 140 cases (89.8%) patients underwent placement of totally implantable devices by surgical cutdown through the external jugular vein. One case (0.6%) was done through the internal jugular vein and another one (0.6%) through the cephalic vein (0.6%). In the remaining 13 cases (8.4%), devices were placed by percutaneous puncture of the subclavian vein. In one case it was impossible to place it by any of the two access ways (0.6%). Prevalence of early complications was 3.22% and late complications 1.93%. The average days-risk for the development of infection was 473.8/per patient. One case had fracture of the catheter during follow-up. No mortality was reported. Discussion: Overall complication rate was 5.15%, similar to that reported by reference centers, without infection during follow-up. Access through the external jugular vein facilitates correct positioning of the catheter and has fewer complications. Conclusions: The combination of a trained surgical team and careful monitoring reduces morbidity and prevents infections. Access through the external jugular vein is recommended for its accessibility and low morbidity.