Clinical Application And Comparison Of Ultrasound-guided Insertion Of Implantable Venous Access Port Through Different Injection Sites

Objective:This study aims to explore the feasibility,safety and clinical practicability of IVAP through different injection sites,and to investigate the effect of propofol sedation on pain and anxiety during IVAP.Methods:A total of 240 patients with tumor were enrolled to receive IVAP inserts via middle internal jugular vein(n=80),lower internal jugular vein(n=80)or subclavian vein(n=80)from Jan 2018 to Jun 2018.Some patients received propofol sedation before IVAP.The main endpoint of this study included the success rate of puncture,catheter tip arrival rate,IVAP-related complication rates and changes in anxiety score and pain score before and after IVAP.Results:In this study,the first puncture success rate of the middle jugular vein group,the lower jugular vein group and the subclavian vein group was 93.8%,100% and 87.5%,respectively.The catheter tip arrival rate of the middle jugular vein group,the lower jugular vein group and the subclavian vein group was 96.3%,100.0% and 91.3%,respectively.The intraoperative complications included 6 cases of pneumothorax and1 case of inadvertent arterial puncture,and the overall incidence of complications was2.9%.The incidence of postoperative complications in the middle jugular vein group,the lower jugular vein group and the subclavian vein group was 7.5%(6/80),5.0%(4/80);18.6%(15/80),respectively.The postoperative complications mainly included catheter ectopic,fibrin sheath,infection and thrombosis.A total of 73 patients received propofol sedation during IVAP,while the remaining 167 patients received only lidocaine anesthesia.The NRS score of pain before and after IVAP was 0.4±0.7、0.2±0.4(P<0.05)in the propofol sedation group,and 0.4±0.6、0.5±0.8 in the lidocaine anesthesia group.Before and after IVAP,S-AI of propofol sedation group was 40.1±4.5、37.1±4.6(P<0.05),and lidocaine anesthesia group was 39.9±5.1、40.0±4.7,respectively Conclusions:The study suggested the lower jugular vein group showed advantage over middle jugular vein group and subclavian vein group.Propofol sedation before IVAP could significantly reduce pain and anxiety,which is worthy of further clinical application.