Eliminating the "Pitfalls" of chronic indwelling central venous access device placement in cancer patients by utilizing a venous cutdown approach and by selectively and appropriately utilizing intraoperative venography

Stephen P Povoski

doi:10.1186/1477-7800-4-16

Abstract

There are several very obvious and simple solutions for eliminating the "Pitfalls" and for minimizing the risk of occurrence of any perioperative complications associated with placement of chronic indwelling central venous access devices in cancer patients. The first is the utilization of a venous cutdown approach, such as the cephalic vein or the external jugular vein, which essentially eliminates potentially life-threatening perioperative complications, such as pneumothorax and injury to the great vessels (with or without associated hemothorax). The second is the selective and appropriate utilization of intraoperative venography for defining the central venous anatomy and for providing a venous roadmap in those particularly challenging cases in which difficulties are encountered during chronic indwelling central venous access device placement.

Highlights

International Seminars in Surgical Oncology 2007, 4:16 http://www.issoonline.com/content/4/1/16 falls" and would have minimized the risk of occurrence of any potential perioperative complications
The use of these venous cutdown approaches completely eliminates the chance of inadvertent cannulation of the arterial system, as was obviously an ongoing concern expressed by Wyles et al in their recent case report [2]. These cutdown approaches essentially eliminate the risk of potentially life-threatening perioperative complications, such as pneumothorax and injury to the great vessels [3,4]. Such potentially life-threatening perioperative complications are well-known to be associated with the percutaneous venipuncture approach to the subclavian vein or internal jugular vein using the modified Seldinger technique [1]
The venous cutdown approach represents an easy, safe, and highly useful avenue for selectively and appropriately performing intraoperative venography during challenging central venous access cases [7]. Such a venous cutdown approach allows for performing intraoperative venography with the injection of contrast at the point of entry into the most peripheral venous conduit

Summary

Introduction

International Seminars in Surgical Oncology 2007, 4:16 http://www.issoonline.com/content/4/1/16 falls" and would have minimized the risk of occurrence of any potential perioperative complications. It appears that the authors did recognize the immediate difficulties that they were faced with in this particular challenging case in which placement of the chronic indwelling central venous access device was accomplished by way of a percutaneous subclavian vein approach.

Results

Conclusion