Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies

BMC Cancer

Research Article

Zongming Jiang¹  Jin Guo²  Weian Zeng²  Jingxiu Huang²  Wenqian Lin²  Handong Ouyang²  Shaoyong Wu²  Li Deng³  Zhimei Huang⁴ 

[1] Department of Anesthesiology, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China;Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, 510060, Guangzhou, Guangdong, People’s Republic of China;Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China;Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China;

关键词: Internal jugular vein;    Subclavian vein;    Totally implantable venous access device;    Meta-analysis;   

DOI  :  10.1186/s12885-016-2791-2

 received in 2016-05-26, accepted in 2016-09-16,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundA totally implantable venous access device (TIVAD) provides reliable, long-term vascular access and improves patients’ quality of life. The wide use of TIVADs is associated with important complications. A meta-analysis was undertaken to compare the internal jugular vein (IJV) with the subclavian vein (SCV) as the percutaneous access site for TIVAD to determine whether IJV has any advantages.MethodsAll randomized controlled trials (RCTs) and cohort studies assessing the two access sites, IJV and SCV, were retrieved from PubMed, Web of Science, Embase, and OVID EMB Reviews from their inception to December 2015. Random-effects models were used in all analyses. The endpoints evaluated included TIVAD-related infections, catheter-related thrombotic complications, and major mechanical complications.ResultsTwelve studies including 3905 patients published between 2008 and 2015, were included. Our meta-analysis showed that incidences of TIVAD-related infections (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.48–1.04, P = 0.081) and catheter-related thrombotic complications (OR 0.76, 95 % CI 0.38–1.51, P = 0.433) were not significantly different between the two groups. However, compared with SCV, IJV was associated with reduced risks of total major mechanical complications (OR 0.38, 95 % CI 0.24–0.61, P < 0.001). More specifically, catheter dislocation (OR 0.43, 95 % CI 0.22–0.84, P = 0.013) and malfunction (OR 0.42, 95 % CI 0.28–0.62, P < 0.001) were more prevalent in the SCV than in the IJV group; however, the risk of catheter fracture (OR 0.47, 95 % CI 0.21–1.05, P = 0.065) were not significantly different between the two groups. Sensitivity analyses using fixed-effects models showed a decreased risk of catheter fracture in the IJV group.ConclusionThe IJV seems to be a safer alternative to the SCV with lower risks of total major mechanical complications, catheter dislocation, and malfunction. However, a large-scale and well-designed RCT comparing the complications of each access site is warranted before the IJV site can be unequivocally recommended as a first choice for percutaneous implantation of a TIVAD.

【 授权许可】

CC BY   
© The Author(s). 2016