External Jugular Vein Cutdown Research Articles

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest

Delayed Diagnosis and Treatment of an Occult Hemothorax Following Complicated Central Line Insertion Leads to Cardiac Arrest

External Jugular Venous Cutdown versus Percutaneous Technique for Chemoport Insertion in Children: A Comparative Study.

Aims:We aimed to compare the external jugular vein (EJV) cutdown technique with the percutaneous technique for difficulties in insertion, maintenance, and other complications of chemoport placement in children.Materials and Methods:A retrospective study was carried out in children who underwent chemoport insertion between January 2007 and December 2019 either by EJV cutdown or percutaneous technique in the department of pediatric surgery at a tertiary center. All children aged <18 years undergoing chemoport insertion by EJV cutdown or percutaneous technique were included in the study. Data collected included the indication, procedure time, early and late complications, and the time to removal of chemoport.Results:There was no significant difference between the EJV group and the percutaneous group in terms of the time taken for chemoport placement (40.9 ± 7.6 min vs. 37.6 ± 18.9 min; P = 0.14), failure to cannulate (one vs. six; P = 0.05), and the mean chemoport indwelling days (816.8 ± 729.2 days vs. 854.5 ± 705.1 days; P = 0.73). The chemoport placement by EJV cutdown method was found to have significantly fewer overall complications (4 vs. 14; P = 0.01) and a lesser rate of premature chemoport removal (4 vs. 12; P = 0.04) compared to the percutaneous group.Conclusions:Chemoport placement by the EJV cutdown was found to have fewer port-related complications and a lesser rate of premature chemoport removal compared to the percutaneous technique. The time taken for port placement and the mean chemoport-indwelling days were similar in both techniques.

External Jugular Cutdown Technique for Totally Implantable Venous Access Devices: a Single-Centre Study.

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 3years 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 32min. 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.

A Prospective, Comparative Evaluation on Totally Implantable Venous Access Devices by External Jugular Vein versus Cephalic Vein Cutdown

The request for totally implantable venous access devices (TIVADs) has rapidly grown up through the last decades. TIVADs are implanted by direct vein puncture or by surgical approach with vein cutdown. The authors present a comparative prospective study evaluating external jugular vein (EJV) and cephalic vein cutdown techniques. Two hundred and fifteen patients were consecutively submitted to TIVAD implantation to perform chemotherapy. Patients were divided in two groups, depending on the implantation technique. Group A patients (106) underwent implantation via EJV cutdown and group B (109) patients underwent implantation by cephalic vein cutdown. The following variables were investigated: operating time, need for conversion to other approaches, complications, and intraoperative and postoperative pain. In Group A patients, the success rate of the procedure was 100 per cent, whereas in 11 patients (10.1%) of Group B, a modification of the initial approach was needed. Mean operative time was 23.9 ± 9.2 minutes in Group A and 35.4 ± 11.9 in Group B, and this was statistically significant (P < 0.05). Complication rates at 30 days were similar. Considering intraoperative pain, a difference was found between the two groups because the mean value of pain in Group A was lower than that in Group B (4.13 ± 0.3 vs 5.22 ± 1.24), even if not significant. External jugular vein cutdown approach is quick and safe and allows a very high success rate with very low risk of complications. For these reasons, this approach could be considered as a first choice in TIVAD placement.

IP267 External Jugular Vein Cutdown Approach vs Percutaneous Approach for Totally Implantable Venous Access Device Placement: A Safe, Fast, and Cheap Method

IP267 External Jugular Vein Cutdown Approach vs Percutaneous Approach for Totally Implantable Venous Access Device Placement: A Safe, Fast, and Cheap Method

English

The jugular vein cutdown for a totally implantable central venous port (TICVP) has 2 disadvantages: 2 separate incisions are needed and the risk for multiple vein occlusions. We sought to evaluate the feasibility of a cephalic vein (CV) cutdown in children. We prospectively followed patients who underwent a venous cutdown for implantation of a TICVP between Jan. 1, 2002, and Dec. 31, 2006. For patients younger than 8 months, an external jugular vein cutdown was initially tried without attempting a CV cutdown. For patients older than 8 months, a CV cutdown was tried initially. We recorded information on age, weight, outcome of the CV cutdown and complications. During the study period, 143 patients underwent a venous cutdown for implantation of a TICVP: 25 younger and 118 older than 8 months. The CV cutdown was successful in 73 of 118 trials. The 25th percentile and median body weight for 73 successful cases were 15.4 kg and 28.3 kg, respectively. There was a significant difference in the success rate using the criterion of 15 kg as the cutoff. The overall complication rate was 8.2%. The CV cutdown was an acceptable procedure for TICVP in children. It could be preferentially considered for patients weighing more than 15 kg who require TICVP.

Conversion From Cephalic Vein to External Jugular Vein

Totally implantable access ports (Port-A) can be inserted using 2 techniques: cut-down and percutaneous. The cut-down method is safer than the percutaneous method. However, the cut-down method has a higher failure rate. We report an alternative method to decrease the failure rate of the cut-down method. In all, 758 cases of Port-A implantation with cephalic vein cut-down were tried, and 56 cases failed. Of the 56 cases, 29 cases were converted to the percutaneous subclavian method (group A), and 27 cases were converted to the external jugular vein cut-down method (group B). The patient's characteristics, causes of failure of cephalic vein cut-down, operating time, and complications were compared. The failure rate of cephalic vein cut-down was 7.4%. The causes of failure of cephalic vein cut-down are described. There were 4 complications in group A, including one pneumothorax (1/29), one fracture of the catheter (1/29), one embolization of the catheter (1/29), and one hematoma formation in the port site (1/29); 2 complications occurred in group B, including one embolization of the catheter (1/27) and one hematoma in the port site (1/27). The total complications were 17.7%. Conversion to external jugular vein cut-down is safely and easily applied in cases of cephalic vein cut-down failure. This method did not take more time than the percutaneous subclavian method. However, placement of the port should be made more carefully to prevent angulation of the catheter. We provide an alternative method to deal with failure of cephalic vein cut-down.

Use of a Totally Implantable Access Port Through the External Jugular Vein When the Cephalic Vein Approach is Not Feasible

We report our experience of using a totally implantable access port (TIAP) through the external jugular vein (EJV) when the cephalic vein (CV) approach is not feasible. We reviewed 197 cases involving TIAP implantation through the EJV in a single medical center between January 1995 and January 2009. All the ports were implanted after the CV approach was found unfeasible. Patient characteristics, operating time, and early and late complications were recorded. The mean patient age was 50 years (range: 33-75). The mean operating time was 54.5 ± 7.5 minutes. Early complications within the first 30 postoperative days included port hematoma (2%) and catheter migration (2%). The late postoperative complications included catheter occlusion (2.5%), venous thrombosis (2%), and port infection (1.5%). There were no complications associated with TIAP disconnection. The EJV approach is an easy and safe alternative method for TIAP implantation when the CV approach is not feasible. This method can avoid conversion to percutaneous puncture of the subclavian vein, which could result in life-threatening complications such as pneumothorax and hemothorax. In patients with breast cancer or those who are contraindicated for TIAP implantation on the opposite side, the EJV cutdown approach provides an alternative route with comfortable and satisfactory results as complications with this approach are rare.

Modification of approach for totally implantable venous access device decreases rate of complications

The aim of this study was to analyze the potential utilization of external jugular vein (EJV) cutdown approach for totally implantable venous access device (TIVAD) placement. This is a prospective, non-randomized, observational, uni-institutional study. All patients (n = 451) were first subjected to attempted subclavian vein (SV) percutaneous approach. If SV percutaneous approach was unsuccessful after multiple puncture in group A and maximum two puncture in group B, an ipsilateral EJV cutdown approach was attempted. Four hundred four patients (89.6%) underwent TIVAD placement via SV percutaneous approach. Of those 47 patients in which SV percutaneous approach was not successful, 8 patients in group A and 39 patients in group B, TIVAD was placed via ipsilateral EJV cutdown approach. The average of operative time was 17.9 +/- 8.5 min in group A and 18 +/- 7.3 min in group B (P > 0.05). The early complications of group A were significantly higher than that of group B (P = 0.02). TIVAD placement by the SV percutaneous approach is safe and fast, and its success rate is very high. By avoiding the immediate complications associated with the percutaneous approach, the EJV cutdown has to be considered a valid, safe, and suitable alternative when the SV percutaneous approach unsuccessful after two needle puncture.

Cutdowns for Totally Implantable Access Ports to Central Veins

For insertion of totally implantable access ports, with the catheter end in the superior vena cava, the percutaneous (Seldinger) technique is commonly used. Of cutdowns, the cephalic vein cutdown is the most popular one (success rate about 80%), followed by the external jugular vein cutdown. Our preliminary experience suggests that internal jugular vein and basilic vein cutdowns have the anatomic features to prove both of them superior to the cephalic vein cutdown.

External Jugular Vein Cutdown Approach, as a Useful Alternative, Supports the Choice of the Cephalic Vein for Totally Implantable Access Device Placement

Cephalic vein (CV) cut down for totally implantable venous access device (TIVAD) placement has been accepted as an alternative to the percutaneous subclavian vein approach. The aim of this retrospective study was to validate the external jugular vein (EJV) cut-down approach when the CV is not feasible. Patients receiving a TIVAD from January 1995 to December 2003 were included in this study. Age, sex, surgical technique, disease, device used, length of the procedure, and morbidity were considered. A total of 427 TIVADs were placed in 425 patients: 253 men (59.5%) and 172 women (40.5%) aged 31 to 79 years. Of 425 patients, 5 were excluded; 420 underwent a CV cut down on the first attempt, and 391 (93.1%) procedures were successful. Among the final 29 patients, 20 (68.96%) underwent a TIVAD placement through the ipsilateral EJV cut-down approach. In the remaining nine patients (31.04%), TIVAD placement was performed through the ipsilateral internal jugular vein in four cases, via the ipsilateral axillary vein in three cases, and through the ipsilateral coracobrachial vein in the other cases. No immediate postoperative complications were detected in any of the patients. TIVAD placement by the CV cut-down approach is safe and fast, and its success rate is very high. By avoiding the immediate complications associated with the percutaneous approach, the EJV cut down has to be considered a valid, safe, and suitable alternative when the CV is not feasible.

Central venous access through the external jugular vein in children submitted to bone marrow transplantation

Establishment of long-term central venous access is a sine qua non step for bone marrow transplantation in children. Most frequently, long-term central venous access has been obtained via blind percutaneous cannulation of subclavian and internal jugular veins or via internal jugular vein cutdown. In order to avoid some potential minor and major complications associated with the subclavian or internal jugular approaches, the authors describe an easy, simple and safe method for central venous access through an external jugular vein cutdown that should be of interest to readers involved in the field of bone marrow transplantation. It should be also considered for children as well as adults needing central venous access via an external catheter - or totally implantable port - for reasons other than bone marrow transplantation, such as total parenteral nutrition and administration of chemotherapeutic agents.

External jugular vein cutdown approach for chronic indwelling central venous access in cancer patients: A potentially useful alternative.

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Julie Eddins, S. Povoski; External jugular vein cutdown approach for chronic indwelling central venous access in cancer patients: A potentially useful alternative.. Journal of the Association for Vascular Access 1 September 2004; 9 (3): 166. doi: https://doi.org/10.2309/1552-8855-9.3.166a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest Search

External jugular vein cutdown approach for chronic indwelling central venous access in cancer patients: A potentially useful alternative

BackgroundCephalic vein (CV) cutdown approach for chronic indwelling central venous access device (CICVAD) placement has previously been shown to be technically feasible in 82% of cancer patients. No data are available as to the potential utilization of external jugular vein (EJV) cutdown approach in cancer patients when CV cutdown approach is not technically feasible.Patients and methodsOne hundred and twenty consecutive cancer patients were taken to the operating room with the intention of placing a CICVAD. All patients were first subjected to attempted CV cutdown approach. If CV cutdown approach was unsuccessful and there were no contraindications to establishing central venous access in the ipsilateral neck region, an ipsilateral EJV cutdown approach was attempted.ResultsNinety-five cancer patients (79%) underwent CICVAD placement via CV cutdown. Of those 25 patients in which CV cutdown was not technically feasible, 7 had a contraindication to establishing central venous access in the ipsilateral neck region and a CICVAD was placed via the ipsilateral subclavian vein percutaneous approach. Of those remaining 18 patients in which CV cutdown approach was not technically feasible, 17 (94%) underwent CICVAD placement via ipsilateral EJV cutdown approach. Combined success of the CV and EJV cutdown approaches, excluding those 7 patients with a contraindication to central venous access in the ipsilateral neck region, was greater than 99%.ConclusionsVenous cutdown approaches for CICVAD placement are viable alternatives to subclavian vein percutaneous approach in cancer patients. EJV cutdown approach appears to be a highly successful and safe alternative route when CV cutdown approach is not technically feasible and may be considered a potentially useful primary route for CICVAD placement in cancer patients.