INTRODUCTION During the last decade, the use of totally implantable devices for prolonged venous access (Subcutaneous Infusion Ports - SIPs) has been widely adopted for the administration of chemotherapy, total parenter- al nutrition (TPN), antibiotics, analgesics, and blood products. With the expanding use of SIPs, however. new and more frequent complications are being en- countercd. We describe the results of a prospcctive study performed to assess the safety and the efficien- cy of these devices. The Journal of Vascular Access 2000; 1: 28-32 ONCOLOGY Complications of blind placement technique in 980 subcutaneous infusion ports L. ALDRIGHETTI, M. PAGANELLI, M. ARRU, R. CATERINI, M. CATENA, M. RONZONI 1 , G. FERLA Department of Surgery, Scientific Institute San Raffaele Hospital, Milan - Italy 1 Department of Oncology Scientific Institute San Raffaele Hospital, Milan - Italy ABSTRACT: Purpose: Subcutaneous Infusion Ports (SIPs) for prolonged venous access are useful tools for drug administration in a wide range of chronic diseases. An extensive use of these devices has to be balanced against the potential complications worsening the length and the quality of life of frequently compromised patients. The aim of the present study is the prospective evaluation of early and late complications of the technique for the blind placement of totally implantable devices for prolonged venous access. Methods: Between April l, 1991 and September 30, 1999, 980 SIPs were implanted in 967 patients. Thirteen pa- tients received 2 SIPs. The surgical procedure, the catheter through peel-away technique after infraclavicular ap- proach to the right or left subclavian vein, was performed without intraoperative fluoroscopy (blind placement technique) in the operating room under local anaesthesia. A postoperative chest radiography to rule out any pro- cedure-related complications and to check the position of the catheter tip was obtained in all cases. For the pur- pose of the study, intraoperative complications as well as all SIP-related complications were recorded during the follow-up period and classified as major and minor complications. Results: The study population consisted of 524 males/443 females, with a mean age of 56.3 ± 11.4 years (range 19-85 years). Primary diagnosis was malignancy in 916 patients (94.7%), acquired immunodeficiency syndrome (AIDS) in 44 patients (4.5%), and short gut syndrome secondary to subtotal small bowel resection in 2 cases (0.2%), others in 5 cases (0.5%). Perioperative complications were recorded in 12.9% of the 980 insertion pro- cedures, including 77 cases of arterial puncture (7.8%) of the subclavian artery, 1 case of hemoptysis (without clinical and radiological evidence of pneumothorax) (0.1%), 23 cases of pneumothorax (2.3%), 20 of which (86.9%) required chest drainage, 10 cases of unsuccessful progression of the J-wire after the venepuncture (1%), 16 cases of catheter malposition (1.6%). As for the follow-up, 919 patients (95.0%) who had received 942 SIPs turned out to be suitable for long-term analysis, while 48 patients (5.0%) were excluded due to missing data. Seventy-seven SIPs (8.2%) were removed during the follow-up period, 13 of which received a second SIP. Long-term complications were recorded in 9.5% of the 942 SIPs, including mechanical complications (2.9%), in- fections (4.4%) and venous thrombosis (1.2%). Minor and major complication rates were 7.3% and 2.2% re- spectively. The overall incidence of SIP-related complications was 22.1%, including 44 major complications (4.5%) and 173 minor complications (17.6%). Conclusions: Given the low rate of major complications, SIPs should be considered safe and effective devices, representing the first choice approach for prolonged venous access. Blind placement technique performed by full-trained operators yields adequate success rate to be suggested as a routine procedure. KEY WORDS: Subcutaneous infusion ports, Devices for prolonged venous access, Complications, Technique 1129-7298/028-05$02.50/0 ©by Wichtig Editore, 2000