Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures

Abstract

Background: Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method.

Methods: Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis.

Results: A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43-1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15-3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14-8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22-3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22-1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01-2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16-89.76, p = .41) between the two implantation paths.

Conclusions: There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.

Keywords: Totally implantable venous access port; complications; internal jugular vein; meta-analysis; subclavian vein.