Ultrasound guided placement of internal jugular catheters for chemotherapy delivery may be just as fast as subclavian placement and might reduce complications, researchers said here at the American College of Surgeons (ACS) annual meeting.

A research team led by Charity Wip, MD, MPH, Surgical Resident, McLaren Regional Medical Center, Flint, Michigan, United States, conducted a prospective assessment of the technique in all 479 consecutive cancer patients requiring a long-term port.

Long-term central venous catheters are being used with increasing frequency, particularly for patients who require antibiotics or chemotherapy.

The traditional placement subclavian method uses external landmarks on the body to guide incision for port placement. This method is associated with complication rates as high as 20%, Dr. Wip said.

Internal jugular placement has several advantages over subclavian placement, because of the ease of arterial puncture control with direct pressure, low incidence of pneumothorax, ease of hematoma diagnosis after vascular injury, and lower incidence of broken catheter tips, she said.

In her study subjects, she said, most catheters were placed via the right internal jugular (72%) or the left internal jugular (23%).

A 7.5 megahertz portable sonographic probe was used to identify the internal jugular vein and the location was marked with a pen on the skin, which guided cannulation and catheter placement.

The subclavian vein was used in a total of 5% of patients due to aberrant anatomy, thrombosis of the internal jugular vein or a previous radical neck procedure.

All patients in the study had successful central venous port placement; 45 patients (9.4%) required surgical insertion into the internal jugular because the guide wire could not be advanced into the vein through the skin, she said.

The rate of complications in this study was 2.2%, while published studies have reported rates of 2.3% to 6.6%. There were two arterial injuries, five pheumothorax (none requiring chest tube insertion) and three hematomas.

Average port placement times were 21 minutes for percutaneous insertion and 59 minutes for surgical insertion.

"We found it to be a safe and efficient method when placing implantable ports for chemotherapy in cancer patients," the authors concluded.