Cephalic vein cut down technique for chemoport implantantion and ease of chemoport access - A cohort study

Cephalic vein cut down technique for chemoport implantantion and ease of chemoport access - A cohort study: Jency Mathews, Seethal Abraham, Rani Philip



Archives of International Surgery 2018 8(3):113-118



Background: Multiple techniques have been established for the insertion of totally implantable chemotherapy ports. Cephalic vein cut down technique is considered a safe technique with reasonable success. The surgical team implanting the chemoports and the nursing team handling them have a learning curve. This prospective observational cohort study aimed to document the techniques used for the implantation, the success and failure of cephalic vein cut down technique, the intraoperative and delayed complications of chemoport implantation, and the ease and difficulties of the nursing personnel in subsequent handling of the chemoports.

Patients and Methods: All consecutive patients undergoing surgical implantation of chemoports between September 2015 and December 2017 were included in this study. Chemoport implantation was first attempted in the cephalic vein by cut down technique followed by closed Seldinger method in the subclavian or internal jugular vein. Surgical details were recorded and further access of the chemoport by the nursing personnel was monitored. Any difficulty in access or use of the chemoports was noted and help sought. All data were collected prospectively and analysed.

Results: Thirty chemoport implantations and 280 chemoport cannulations were performed during the study period. Cephalic vein cut down technique was performed in 28 (96%) patients. Cephalic vein implantation of chemoport was successful in 14 (50%) patients. Obliterated vein, small luminal diameter and adverse anatomy were reasons for failure. Patients who had not previously received chemotherapy had a cephalic vein success rate higher than those who had, with an odds ratio of 2.4. Chemoport access by nursing personnel was easy in 92% patients. No blood return was seen in 7%.

Conclusion: Cephalic vein cut down technique was successful in 50% patients. It was less successful in patients who have previously been treated with chemotherapy. No blood return on access was the commonest cause for concern while handling chemoports. An algorithm for the preference of veins to be used and an institutional protocol for chemoport access and use increase safety and efficiency.