Ultrasound-Guided Central Venous Port Implantation in the Upper Arm

Abstract

The number of cancer patients has recently been increasing worldwide due to progressive ageing of the society. Moreover, rapid developments in outpatient cancer chemotherapy have exponentially increased the needs for an implantable central venous port. Between 2006 and 2011, we implanted over 600 central venous ports in the upper arm or upper chest subclavian regions of advanced cancer patients who required chemotherapy. Here we introduce a relatively new practical method for central venous port implantation in the upper arm. It is notable that the choice of the upper arm and the use of ultrasound guidance enable not only surgeons but also other physicians, such as medical oncologists, to safely execute this procedure. In addition, this technique can be applied to peripherally inserted central catheters.We have also confirmed its equivalent safety and some of its advantages over subclavian implantation in our cohort of patients. First,due to anatomical reasons, pneumothorax does not occur with upper arm implantation. Second, unlike subclavian implantation, there is no landmark method for the upper arm, which forces an operator to apply an ultrasound-guided puncture and consequently eliminates the risk of arterial puncture. Finally, even if arterial puncture occurs by chance, one can easily stop bleeding by pressing one's hand on the puncture site, similar to the procedure used after an arterial blood gas test. Therefore, this procedure can be performed safely by any trained physician and is not limited to surgeons only. This may also contribute to releasing busy surgeons from routine central venous port implantation procedures, which will increase as noted above. It is also useful for in-home care or palliative medicine as with a venous line for total parenteral nutrition or opioids and so on.Furthermore, making the central venous port implantation procedure more common would reduce the medical costs by shifting the in-hospital cares to the outpatient cares (continuous infusional chemotherapy) and in-home cares (palliative medicine). We propose that upper arm central venous port implantation can benefit medical staff members and advanced cancer patients who have to continuously receive chemotherapy with respect to safety and comfort compared with subclavian implantation.