Cephalic vein cut-down verses percutaneous access: a retrospective study of complications of implantable venous access devices

Background Central venous access devices play an integral role in providing long-term venous access. Percutaneous and cut-down techniques have been used with varying complications. Methods Between January 1998 and July of 2001, 358 venous access devices were placed at Albert Einstein Medical Center in Philadelphia, Pennsylvania. A retrospective study was performed to compare complications and operative times for 2 methods of catheter insertion. Results Overall complication rate was 14%. In lines successfully placed percutaneously, the complication rate was 15% (25 of 163) compared with 11% (16 of 148) in the successful cephalic cut-down group, P = .11. Complications including—pneumothorax, late catheter transection, and bradycardia—only occurred in percutaneously placed lines. Mean operative times were similar for both groups. Comments Use of the cut-down approach for long-term venous access may result in improved patient safety. The cut-down technique should be considered a safe initial approach for placement of venous access devices.