Surgical technique: placement of a totally implantable venous access port (TIVAP) through a cephalic vein cutdown in pediatric patients

Abstract

The placement of totally implantable venous access ports (TIVAPs) is a critical step in the overall care of pediatric oncohematologic patients. These devices constitute a significant technical challenge and are not free of complications during their placement and use. There is extensive literature concerning placement techniques, including venous cut-down (mainly from the external jugular vein) and venous access through ultrasound-guided puncture (Seldinger technique), usually performed in jugular or subclavian veins. Considering that in chronic patients, especially oncology patients, the preservation of quality central venous accesses is essential, alternatives for peripherally inserted central venous catheters have been proposed. The cephalic vein is a peripheral accessory vein located at the deltopectoral groove and characterized by well-defined surgical landmarks. Although scarce and focused on adult populations, the preceding literature concerning using the cephalic vein for TIVAP placement shows promising results. In this manuscript, I present my experience using this technique in pediatric populations, detailing the necessary preoperative preparation to perform the procedure safely, the technical aspects of its implantation, and the most relevant postoperative considerations. Critical knowledge gaps concerning this technique that warrant further study, such as the role of ultrasound as a predictor of success for cephalic vein cut-down TIVAP placement in pediatric populations, are also discussed.