- Permanent parenteral nutrition
- Intravenous chemotherapy (in the absence of access to peripheral veins)
- Permanent infusion therapy
-
Indications
-
Contraindications
- Systemic infections with the risk of implant infection
- Thrombosis of the subclavian vein
- Contralateral pneumothorax
- Local skin eczema/fungal infection
- History of local radiation with radiation-induced keloid formation
- Severe coagulation disorder (highly pathological plasma coagulation, platelets < 30 G/l)
-
Preoperative Diagnostics
- Clinical examination (swelling of the arm, collateral circulation in the shoulder area as an indication of subclavian vein thrombosis, history of ipsilateral axillary dissection and radiation, ipsilateral arm lymphedema with positive Stemmer's sign)
- Preoperative duplex sonography of the subclavian vein in cases of previous punctures/catheter placements in the neck vessels
- Laboratory tests in case of pathological standardized bleeding history: blood count, Quick test, PTT, platelet count
-
Special Preparation
- Placement of a peripheral venous access (contralateral arm) and initiation of an intravenous infusion
- Shaving of the chin, lateral neck triangle, and thorax up to the nipple line
- Sterile washing of the lateral neck triangle from the midline to the nipple
-
Informed consent
- Risk of pneumothorax in approximately 2% with subclavian vein puncture involving lung injury → placement of a chest drain
- Vascular injury, both venous and arterial, necessitating surgical revision
- Local bleeding and bleeding with vascular injury
- Brachial plexus lesion with persistent numbness and paresis
- Wound infection with potential infection of the port system → surgical removal
- Port dislocation and dysfunction (kinking, inability to puncture, etc.)
- Air embolism during placement with potential subsequent cerebral hypoperfusion and consequent neurological deficits
- Stroke in case of arterial malposition
Anesthesia
The procedure is performed under local anesthesia, e.g., 10 ml of 1% Mepivacaine. If available, an
The procedure is performed under local anesthesia, e.g., 10 ml of 1% Mepivacaine. If available, an
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