Department of Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Acad Radiol. 2010 Apr;17(4):464-7. doi: 10.1016/j.acra.2009.10.019. Epub 2010 Jan 12.
Totally implanted subcutaneous central venous access devices (chest ports) are an attractive option for patients in need of intermittent, recurrent venous access. In our department, these are placed by different operator types including interventional radiology (IR) attending physicians, dedicated IR nurse practitioners (NP), and IR fellows/radiology residents. The purpose of our study is to assess the rate of complications of subcutaneous chest port placement among the different operator types.
A retrospective review of all subcutaneous central venous access devices implanted in our department between October 8, 2004, and October 19, 2007, was undertaken. Total numbers of port days, overall complication rates for all operators, as well as complication rates for the various operator types were calculated and were compared using the chi square test.
A total of 558 patients had totally implanted subcutaneous central venous access devices placed during the period of study. Of these, 536 had documented follow-up and comprise the study population. A total of 89 were placed by attending physician alone, 133 by an NP, and 314 by an IR fellow or resident, with supervision by an attending physician. Mean duration of port usage was 341 days with 182,522 total port days. A total of 39 complications occurred (7.28%), including 27 infections (5%). There was no statistically significant difference in overall complication rates, including infection rates, among operator groups (P = .925).
Our results confirm that well-trained physician extenders and trainees can safely perform chest port placement and that these providers, under appropriate supervision, can help provide improved access to chest port placement for patients and referring clinicians.
对于需要间歇性、反复性静脉通路的患者，完全植入皮下的中心静脉通路装置（胸端口）是一种有吸引力的选择。在我们的科室中，不同类型的操作者（包括介入放射科主治医生、专门的介入放射科护士从业者、介入放射科研究员/放射科住院医师）都可以进行此类操作。我们的研究目的是评估不同操作者类型进行皮下胸端口放置的并发症发生率。
对我们科室在 2004 年 10 月 8 日至 2007 年 10 月 19 日期间植入的所有皮下中央静脉通路装置进行回顾性分析。计算所有操作者的总置管天数、总体并发症发生率，以及不同操作者类型的并发症发生率，并使用卡方检验进行比较。
在研究期间，共有 558 例患者接受了完全植入的皮下中央静脉通路装置。其中，536 例有记录的随访资料，构成了研究人群。共有 89 例由主治医生单独进行操作，133 例由护士从业者进行操作，314 例由介入放射科研究员/住院医师进行操作，由主治医生进行监督。平均置管使用时间为 341 天，总置管天数为 182522 天。共发生 39 例并发症（7.28%），包括 27 例感染（5%）。在总体并发症发生率（包括感染率）方面，操作者组之间无统计学显著差异（P=0.925）。
我们的结果证实，经过良好培训的医师助手和学员可以安全地进行胸端口放置，并且在适当的监督下，这些提供者可以帮助为患者和转诊临床医生提供更好的胸端口放置途径。
