Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial

Ann Oncol. 2009 May;20(5):935-40. doi: 10.1093/annonc/mdn701. Epub 2009 Jan 29.


Background: Central venous access is extensively used in oncology, though practical information from randomized trials on the most convenient insertion modality and site is unavailable.

Methods: Four hundred and three patients eligible for receiving i.v. chemotherapy for solid tumors were randomly assigned to implantation of a single type of port (Bard Port, Bard Inc., Salt Lake City, UT), through a percutaneous landmark access to the internal jugular, a ultrasound (US)-guided access to the subclavian or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Early and late complications were prospectively recorded until removal of the device, patient's death or ending of the study.

Results: Four hundred and one patients (99.9%) were assessable: 132 with the internal jugular, 136 with the subclavian and 133 with the cephalic vein access. The median follow-up was 356.5 days (range 0-1087). No differences were found for early complication rate in the three groups {internal jugular: 0% [95% confidence interval (CI) 0.0% to 2.7%], subclavian: 0% (95% CI 0.0% to 2.7%), cephalic: 1.5% (95% CI 0.1% to 5.3%)}. US-guided subclavian insertion site had significantly lower failures (e.g. failed attempts to place the catheter in agreement with the original arm of randomization, P = 0.001). Infections occurred in one, three and one patients (internal jugular, subclavian and cephalic access, respectively, P = 0.464), whereas venous thrombosis was observed in 15, 8 and 11 patients (P = 0.272).

Conclusions: Central venous insertion modality and sites had no impact on either early or late complication rates, but US-guided subclavian insertion showed the lowest proportion of failures.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antineoplastic Agents / administration & dosage*
  • Brachiocephalic Veins*
  • Catheter-Related Infections / etiology
  • Catheter-Related Infections / prevention & control
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / instrumentation
  • Catheterization, Central Venous / methods*
  • Catheters, Indwelling / adverse effects*
  • Equipment Failure
  • Female
  • Hemorrhage / etiology
  • Hemorrhage / prevention & control
  • Humans
  • Jugular Veins*
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Pneumothorax / etiology
  • Pneumothorax / prevention & control
  • Prospective Studies
  • Subclavian Vein* / diagnostic imaging
  • Time Factors
  • Treatment Failure
  • Ultrasonography, Interventional
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control


  • Antineoplastic Agents