Implant of subcutaneous central venous access devices in outpatient surgery
نویسندگان
چکیده
Today, an increasing number of subcutaneous central venous access devices are implanted on a ambulatory basis either by percutaneous vein puncture or venous cut down. The aim of the present study was to prospectively evaluate which is the most suitable implant technique for ambulatory surgery by comparing subclavian vein puncture using a Seldinger technique with cephalic vein cut-down in terms of operative morbidity, patient acceptance and health costs. Analysis of a personal series of 189 subcutaneous central venous access device insertions did not show any significant difference between the two methods, with an overall morbidity of 9.6 and 6.5% (P=ns), respectively, a greater cost of $120 for percutaneous subclavian vein puncture and a slightly more painful experience during dilatation for catheter positioning during the Seldinger manoeuvre. Furthermore, subclavian vein puncture carries the risk of major complications, such as pneumothorax, major vessel injury or nerve palsy. In conclusion, we think that venous cut-down is the ideal technique for ambulatory surgery, limiting the Seldinger technique to cases where proper catheter insertion through the cephalic vein is impossible. © 1998 Elsevier Science B.V. All rights reserved.
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