Port first vs. Tip first: does difference in portacath insertion techniques reduce complication rates

Abstract

Background: Accurate placement of central venous access devices is important to avoid complications such as infection, thrombosis and migration. This audit aims to determine if there is a difference in complication rates and accuracy of tip position between two different intravenous jugular (IVJ) port device insertion techniques: fixation of port first (PF) versus tip first (TF). Methods: Patients who underwent port device insertions from 2019 to 2021 at the Cairns Hospital were identified from the Australia Vascular Audit database. The primary outcome of accurate catheter tip placement (based on radiological criteria), secondary outcomes of line infection, thrombosis and other outcomes such as removal rates were gathered and compared between the 2 groups of port first (PF) versus tip first (TF) insertion. Results: Two-hundred and twenty-seven patients underwent port device insertions during the period of interest. 98 (43.2%) patients had a PF insertion technique and 129 (56.8%) had a TF insertion technique. In the PF group, 81.6% (P < 0.05) of lines were accurately placed compared to 69.8% (P < 0.05) in the TF group. The line related thrombosis rate was 1% (P < 0.05) in the PF group compared to 6.2% (P < 0.05) in the TF group. Rate of line infections in the PF group was 5.1% (P = 0.92) compared to 6.2% (P = 0.92) in the TF group. Conclusion: The port first technique for IVJ port device placement was associated with higher accuracy and lower thrombosis rates and this was statistically significant. Further studies should involve larger multicentre populations to compare results between practitioners