Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
GOMEZ FERNANDEZ, M. et al. Retrospective analysis of complications associated with implantable intravascular devices. Rev. Soc. Esp. Dolor [online]. 2009, vol.16, n.5, pp.279-283. ISSN 1134-8046.
Objectives: To present our series of patients with a permanent subcutaneous reservoir and describe the system chosen, the technique used, and complications. Material and methods: Between January 1, 2005 and December 31, 2006, 66 devices were placed in patients from the Medical Oncology and Hematology Services. The reservoir was placed in the operating room, under strict aseptic conditions. The subclavian vein was canalized through the infraclavicular route, following Seldinger's technique. After the vein was canalized, an incision was made approximately 5 cm from the puncture point to allow a tunneler to guide the catheter to the area where the titanium reservoir would be placed. Subsequently, the subcutaneous cellular tissue of the infraclavicular area was dissected to create a bed where a small deposit was placed with a silicone membrane to allow injections, perfusions and blood extraction. The deposit was fixed and the incisions were closed by anatomical planes. A protocol was designed for data collection and follow-up, which included the following: affiliation, diagnosis, indication, catheter type, route of venous access, antibiotic prophylaxis, early and late complications, eventual catheter withdrawal and reason, days of use without complications. Patient follow-up was performed retrospectively until the end of the study (June 2007). The statistical analysis was performed with the SPSS 11.0 statistical package. Results: The indication was chemotherapy administration and the main disease was breast carcinoma. The type of catheter used was Celsite ST201. The most frequently chosen route of access was the right subclavian vein (60.6%). Early complications (less than 1 month after placement) occurred in two patients (3%) and consisted of catheter malfunction and pneumothorax, which were resolved with conservative measures. Late complications occurred in 12 patients (18.2%). The mean number of days of use without complications was 309.5 (±353.32). The mean number of complications per 1000 days of use was 0.6, 95% CI (0.3-1). No significant differences were found between the occurrence of infection and administration of antibiotic prophylaxis. However, the incidence of complications was significantly higher in devices implanted through the left subclavian vein. Conclusions: The complications rate in our series was similar to that in other published series. Importantly, the incidence of complications was significantly higher in reservoirs implanted through the left subclavian vein.
Palabras clave : Central venous catheterization; Complications; Infection.