Comparison of Subclavian Vein and Internal Jugular Vein Approaches for Totally Implantable Access Ports in Cancer Patients and Analysis of Factors Associated with Catheter Malposition

doi:10.3877/cma.j.issn.2095-5782.2026.03.011

Abstract

Abstract:

Objective

To compare the efficacy, complications, and postoperative discomfort of totally implantable access ports (TIAP) implanted via the subclavian vein (SCV) versus the internal jugular vein (IJV) in cancer patients, and to analyze factors associated with catheter malposition.

Methods

A total of 724 cancer patients were prospectively enrolled and non-randomly assigned to the subclavian vein (SCV) group (n=224) or the internal jugular vein (IJV) group (n=500) according to the venous access approach. Blind puncture success rate, operative time, complications, and postoperative discomfort grade scores were compared between the two groups. Firth-corrected logistic regression was used to analyze factors associated with catheter malposition.

Results

The IJV group had a higher blind puncture success rate (P<0.001) but longer operative time (P<0.001) than the SCV group. The SCV group showed a higher incidence of catheter malposition (P<0.001) but better postoperative discomfort scores (P<0.05). Firth regression indicated that the IJV approach was associated with a lower risk of malposition (P=0.005); older age (P=0.027) and obesity (BMI≥28, P=0.038) were also associated factors.

Conclusion

The IJV approach offers a higher blind puncture success rate and lower malposition risk, while the SCV approach is associated with shorter operative time and milder patient-reported discomfort. Clinical selection should be individualized.

Key words: Totally implantable access port, Subclavian vein, Internal jugular vein, Postoperative complications, Associated factors

Ligang Wu, Hanqiang Zeng, Zhicheng Zhang, Quan Chen. Comparison of Subclavian Vein and Internal Jugular Vein Approaches for Totally Implantable Access Ports in Cancer Patients and Analysis of Factors Associated with Catheter Malposition[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 299-306.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2026.03.011

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Figures/Tables 9

分级	不适程度
0	无任何不适
1	极轻微不适
2	一点不适
3	一些不适
4	相当不舒服
5	极度不适

并发症类型	判定标准	诊断方式	观察周期
导管异位	导管尖端未位于上腔静脉下1/3段至上腔静脉与右心房交界处	术中超声或术后即刻胸片（本研究17例导管异位均为术后即刻胸片发现）	术后30 d
症状性静脉血栓	患肢/颈部肿胀、疼痛+超声确认血栓	彩色多普勒超声	术后30 d
导管堵塞	输液阻力大、无法回抽或需溶栓恢复通畅	临床+导管造影	术后30 d
港体外露/翻转	注射座暴露于皮外或发生翻转	临床检查	术后30 d
气胸/血胸	术后胸片提示气胸或血胸	胸片	术后30 d
误穿动脉	穿刺抽出鲜红色搏动性血液	术中观察	即刻
局部血肿	穿刺点周围肿胀、瘀斑，超声证实血肿	临床+超声	术后30 d
感染	切口、港座或隧道局部红肿、疼痛、化脓，发热，血象升高，微生物培养阳性	临床检查+微生物培养	术后30 d

基线资料	SCV组(n=224)	IJV组(n=500)	统计值	P值
年龄[岁，M(Q₁，Q₃)]	58.0(47.0, 67.0)	58.0(48.0, 66.0)	Z=0.41	0.682
性别[例(%)]			χ²=0.56	0.452
男性	121(54.0)	277(55.4)
女性	103(46.0)	223(44.6)
身体质量指数[kg/m²，M(Q₁，Q₃)]	23.5(21.2, 26.0)	23.8(21.5, 26.2)	Z=-1.01	0.312
糖尿病史[例(%)]	34(15.2)	78(15.6)	χ²=0.02	0.886
肿瘤类型[例(%)]			χ²=2.26	0.521
肺癌	78(34.8)	165(33.0)
乳腺癌	42(18.8)	95(19.0)
结直肠癌	56(25.0)	130(26.0)
其他	48(21.4)	110(22.0)
放疗史[例(%)]	34(15.2)	72(14.4)	χ²=0.08	0.782

指标	SCV组 (n=224)	IJV组 (n=500)	统计值	P值
术中指标
盲穿成功[例(%)]	189(84.4)	470(94.0)	χ²=18.21	<0.001
手术时间[min，M(Q₁，Q₃)]	28.0(24.0, 32.0)	33.0(29.0, 37.0)	Z=-9.15	<0.001
术后并发症[例(%)]
总体并发症	23(10.3)	31(6.2)	χ²=4.02	0.045
导管相关并发症
导管异位	12(5.4)	5(1.0)	χ²=15.20	<0.001
症状性静脉血栓	4(1.8)	6(1.2)	-	0.505
导管堵塞	3(1.3)	8(1.6)	χ²=0.08	0.777
港体相关并发症
港体外露	2(0.9)	1(0.2)	-	0.240
港体翻转	1(0.5)	0(0.0)	-	0.305
穿刺相关并发症
气胸	0(0.0)	0(0.0)	-	-
误穿动脉	4(1.8)	6(1.2)	χ²=0.39	0.534
局部血肿	4(1.8)	9(1.8)	χ²=0.00	0.995

变量	总病例数(724例)	导管异位组(17例)	非异位组(707例)	P 值
年龄[岁，M(Q₁，Q₃)]	58.0(47.0, 67.0)	65.0(56.5, 72.5)	58.0(47.0, 67.0)	0.008
性别[例(%)]				0.452
男性	398(55.0)	11(64.7)	387(54.7)
女性	326(45.0)	6(35.3)	320(45.3)
身高 (cm， $x ¯$ ±s)	166.0(160.0, 172.0)	164.0(158.0, 170.5)	166.0(160.0, 172.0)	0.191
BMI分类 [例(%)]				0.015
BMI<24 kg/m²	332(45.9)	4(23.5)	328(46.4)
24 kg/m²≤BMI<28 kg/m²	309(42.7)	8(47.1)	301(42.6)
BMI≥28 kg/m²	83(11.5)	5(29.4)	78(11.0)
静脉入路 [例(%)]				<0.001
SCV	224(30.9)	12(70.6)	212(30.0)
IJV	500(69.1)	5(29.4)	495(70.0)

变量	总病例数(724例)	导管异位组(17例)	非异位组(707例)	P 值
年龄[岁，M(Q₁，Q₃)]	58.0(47.0, 67.0)	65.0(56.5, 72.5)	58.0(47.0, 67.0)	0.008
性别[例(%)]				0.452
男性	398(55.0)	11(64.7)	387(54.7)
女性	326(45.0)	6(35.3)	320(45.3)
身高 (cm， $x ¯$ ±s)	166.0(160.0, 172.0)	164.0(158.0, 170.5)	166.0(160.0, 172.0)	0.191
BMI分类 [例(%)]				0.015
BMI<24 kg/m²	332(45.9)	4(23.5)	328(46.4)
24 kg/m²≤BMI<28 kg/m²	309(42.7)	8(47.1)	301(42.6)
BMI≥28 kg/m²	83(11.5)	5(29.4)	78(11.0)
静脉入路 [例(%)]				<0.001
SCV	224(30.9)	12(70.6)	212(30.0)
IJV	500(69.1)	5(29.4)	495(70.0)

变量	β值	标准误	Wald χ²	校正后 OR (95% CI)	P值
年龄(每增加1岁)	0.042	0.019	4.89	1.04(1.01~1.08)	0.027
BMI分类(参照：BMI<24 kg/m²)
24 kg/m²≤BMI<28 kg/m²	0.794	0.582	1.86	2.21(0.68~7.15)	0.173
BMI≥28 kg/m²	1.325	0.638	4.31	3.76(1.08~13.11)	0.038
静脉入路(参照：锁骨下静脉)
颈内静脉	-1.610	0.568	8.03	0.20(0.06~0.60)	0.005

术后时间	第1天			第3天			第7天
不适分级等级	SCV组(n=224)	IJV组(n=500)	P值	SCV组(n=224)	IJV组(n=500)	P值	SCV组(n=224)	IJV组(n=500)	P值
0	148(66.1)	75(15.0)	<0.001	75(33.5)	105(21.0)	<0.001	115(51.3)	180(36.0)	0.022
1	52(23.2)	150(30.0)		98(43.8)	145(29.0)		75(33.5)	190(38.0)
2	19(8.5)	215(43.0)		43(19.2)	185(37.0)		28(12.5)	105(21.0)
3	5(2.2)	50(10.0)		8(3.6)	55(11.0)		6(2.7)	20(4.0)
4	0(0.0)	10(2.0)		0(0.0)	10(2.0)		0(0.0)	5(1.0)
5	0(0.0)	0(0.0)		0(0.0)	0(0.0)		0(0.0)	0(0.0)

指标	曾医师	吴医师	统计值	P 值
手术数量[例(%)]	350(48.3)	374(51.7)	χ²=0.80	0.371
SCV[例(%)]	110(49.1)	114(50.9)	χ²=0.07	0.791
IJV[例(%)]	240(48.0)	260(52.0)	χ²=0.80	0.371
SCV盲穿成功[例(%)]	93(84.5)	96(84.2)	χ²=0.01	0.943
IJV盲穿成功[例(%)]	226(94.2)	244(93.8)	χ²=0.02	0.879
SCV导管异位[例(%)]	6(5.45)	6(5.26)	-	>0.99
IJV导管异位[例(%)]	2(0.83)	3(1.15)	-	>0.99
手术时间[min，M(Q₁，Q₃)]	30.0(26.0, 35.0)	31.0(27.0, 36.0)	Z=1.23	0.218

References 18

[1]	Niederhuber JE, Ensminger W, Gyves JW, et al. Totally implanted venous and arterial access system to replace external catheters in cancer treatment[J]. Surgery, 1982, 92(4): 706-712.
[2]	中国中西医结合学会外周血管疾病委员会中心静脉通路专家组. 静脉输液港植入与管理多学科专家共识(2023版)[J]. 中国普通外科杂志, 2023, 32(6): 799-814.
[3]	中心静脉通路上海协作组. 完全植入式输液港上海专家共识[J]. 介入放射学杂志, 2015, 24(12): 1029-1033.
[4]	张梦肃, 张杰, 金光鑫, 等. 上臂输液港并发导管相关血栓形成危险因素分析及机器学习预测模型构建[J]. 介入放射学杂志, 2025, 34(3): 253-260.
[5]	Chen YB, Bao HS, Hu TT, et al. Comparison of comfort and complications of implantable venous access port (IVAP) with ultrasound guided internal jugular vein (IJV) and axillary vein/subclavian vein (AxV/SCV) puncture in breast cancer patients: a randomized controlled study[J]. BMC Cancer, 2022, 22(1): 248.
[6]	Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale[J]. Pain, 1983, 16(1): 87-101.
[7]	Boonstra AM, Schiphorst Preuper HR, Reneman MF, et al. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain[J]. Int J Rehabil Res, 2008, 31(2): 165-169.
[8]	Shin HJ, Na HS, Koh WU, et al. Complications in internal jugular vs subclavian ultrasound-guided central venous catheterization: a comparative randomized trial[J]. Intensive Care Medicine, 2019, 45(7): 968-976.
[9]	Mu C, Zhu Z, Miao D, et al. Clinical efficacy and safety of a new single-incision axillary vein puncture technique for totally implantable venous access ports[J]. Sci Rep, 2025, 15(1): 7281.
[10]	Weiner MM, Geldard P, Mittnacht AJ. Ultrasound-guided vascular access: a comprehensive review[J]. J Cardiothorac Vasc Anesth, 2013, 27(2): 345-360.
[11]	O'Grady NP, Alexander M, Burns L A, et al. Guidelines for the prevention of intravascular catheter-related infections[J]. Am J Infect Control, 2011, 39(5): S1-S34.
[12]	中国抗癌协会肿瘤介入学专业委员会. 肿瘤患者完全植入式静脉输液港临床实践与质控指南(2024版)[J]. 四川大学学报(医学版), 2025, 56(2): 400-410.
[13]	Gu J, Wei G, Li L, et al. Catheter allotopia with totally implantable access port: a report of three cases and literature review[J]. Clin Case Rep, 2020, 8(5): 1-5.
[14]	Kartsouni V, Moschouris H, Bersimis F, et al. Complications of totally implantable central venous catheters (ports) inserted via the internal jugular vein under ultrasound and fluoroscopy guidance in adult oncology patients: a single-center experience[J]. Cureus, 2022, 14(7): e27485.
[15]	Ängeby E, Adrian M, Bozovic G, et al. Central venous catheter tip misplacement: a multicentre cohort study of 8556 thoracocervical central venous catheterisations[J]. Acta Anaesthesiologica Scandinavica, 2024, 68(4): 520-529.
[16]	Liu W, Han Q, Li L, et al. Catheter malposition analysis of totally implantable venous access port in breast cancer patients[J]. Front Surg, 2023, 9: 1061826.
[17]	Shinde PD, Jasapara A, Bansode K, et al. A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound-guided internal jugular vein cannulation in adult cardiac surgical patients[J]. Ann Card Anaesth, 2019, 22(2): 177-186.
[18]	Sharp R, Cummings M, Fielder A, et al. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study[J]. Int J Nurs Stud, 2015, 52(4): 677-685.

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