Complicaciones por accesos venosos centrales en pacientes adultos / Complications due to central venous access in adult patients

Los accesos venosos centrales son técnicas de uso regular en el ámbito hospitalario, es por ello que la investigación tiene como Objetivo: Establecer la incidencia de complicaciones asociadas a la colocación de accesos venosos centrales en pacientes atendidos en el Hospital Militar Universitario "Dr. Carlos Arvelo". Métodos: estudio prospectivo, de selección intencional de pacientes en el ámbito hospitalario que presenten complicaciones asociadas a la canalización de accesos venosos centrales; a los cuales se les aplicó un cuestionario donde se registraron, además de datos demográficos y clínicos, los resultados del funcionamiento del acceso venoso central. Al séptimo día se retiró o se recambió el acceso venoso central y se tomó muestra para cultivo y antibiograma de la punta de catéter. Los datos fueron tabulados, analizados en gráficos y tablas. Resultados: Uno de los principales hallazgos fueron las complicaciones infecciosas en un 65.93 % y producto de complicaciones mecánicas un 34.05 % del grupo de estudio. Las complicaciones infecciosas fueron atribuibles en su mayoría a Staphylococcus aureus (27,39 %), Pseudomona sp (21,91 %), Stenotrophomonas maltophilia (16,44%), Burkholderia cepacia (10,95 %) y Klebsiella pneumonia (5,48 %). En cuanto al porcentaje de éxito de las intervenciones se encontró que el promedio de intentos fue de 5 con una desviación estándar de ± 3 intentos y una duración promedio menor a 30 minutos en 90 de los casos representando el 76,27 % y duración mayor de 30 minutos en 28 casos representando 23,7 %. Conclusiones: Los accesos venosos yugulares internos fueron los procedimientos más frecuentes seguido de los accesos subclavios, sin predilección de lateralidad alguna. Al revisar los hallazgos se puede evidenciar que la punción arterial se convierte en la complicación mecánica más frecuente produciendo hematomas y equimosis con un alto porcentaje de intentos superiores a 30 minutos o un número de intentos mayores a tres, así como las complicaciones infecciosas generadas por el Staphylococcus aureus y sin que dichas complicaciones se encontraran asociadas al tipo de abordaje estudiado, tiempo de intervención u otros factores de carácter demográfico(AU)

Central venous accesses are a technique of regular use in the hospital environment, that is why the objective of this research is: to establish the incidence of complications treated at the University Military Hospital "Dr. Carlos Arvelo". Methods: prospective study, of intentional selection of patients in the hospital setting who present complications associated to the cannulation of central venous accesses; to whom a questionnaire was applied where, in addition to demographic and clinical data, the results of the central venous access operation were registered. On the seventh day, the central venous access was removed or replaced and a sample was taken for culture and antibiogram of the catheter tip. Data were tabulated, analyzed in graphs and tables. Results: One of the main findings was infectious complications in 65.93 % and mechanical complications in 34.05 % of the study group. Infectious complications were mostly attributable to Staphylococcus aureus (27.39 %), Pseudomona sp (21.91 %), Stenotrophomonas maltophilia (16.44 %), Burkholderia cepacia (10.95 %) and Klebsiella pneumonia (5.48 %). Regarding the percentage of success of the interventions, it was found that the average number of attempts was 5 with a standard deviation of ± 3 attempts and an average duration of less than 30 minutes in 90 of the cases representing 76.27 % and duration greater than 30 minutes in 28 cases representing 23.7 %. Conclusions: Internal jugular venous accesses were the most frequent procedures followed by subclavian accesses, with no predilection for laterality. When reviewing the findings, it can be evidenced that arterial puncture becomes the most frequent mechanical complication producing hematomas and ecchymosis with a high percentage of attempts longer than 30 minutes or a number of attempts longer than three, as well as infectious complications generated by Staphylococcus aureus and without these complications being associated to the type of approach studied, time of intervention or other demographic factors(AU)

Risk factors for failure of subclavian vein catheterization: a retrospective observational study.

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze risk factors for failure of subclavian vein catheterization. METHODS: A retrospective analysis of 1562 patients who underwent subclavian vein puncture performed by the same experienced operator at Peking University Cancer Hospital from January 1, 2016 to January 1, 2019 was conducted. The success or failure of subclavian vein catheterization was registered in all cases. Various patient characteristics, including age, gender, body mass index (BMI), preoperative hemoglobin, preoperative hematocrit, preoperative mean corpuscular hemoglobin concentration (MCHC), preoperative albumin, preoperative serum creatinine, puncture needles from different manufacturers and previous history of subclavian vein catheterization were assessed via univariate and multivariate analyses. RESULTS: For the included patients, landmark-guided subclavian vein puncture was successful in 1476 cases and unsuccessful in 86 cases (success rate of 94.5%). Successful subclavian vein catheterization was achieved via right and left subclavian vein puncture in 1392 and 84 cases, respectively. In univariate analyses, age and preoperative hemoglobin were associated with failure of subclavian vein catheterization. In a multivariate analysis, aged more than 60 years was a risk factor while the central venous access with Certofix® was associated with an increased rate of success (p-values of 0.001 and 0.015, respectively). CONCLUSIONS: This study has demonstrated that patient aged more than 60 years was a risk factor for failure of subclavian vein catheterization while the central venous access with Certofix® was associated with an increased rate of success.

Accesos vasculares centrales. Complicaciones en pacientes pediátricos

La necesidad de un rápido y eficaz tratamiento por vía intravenosa a pacientes críticamente enfermos y con imposibilidad de tratamiento por otras vías ha hecho imperioso el acceso a través de las vías venosas centrales (CVC), se ha asociado con eventos adversos que prolongan la estancia hospitalaria, aumentan los costos hospitalarios, pueden agregar morbilidad e incluso mortalidad al paciente. Objetivo: analizar complicaciones de los pacientes con acceso vascular central hospitalizados en los servicios de Urgencias, Terapia Intensiva Pediátrica, Cirugía General y Cuidados Intensivos Neonatales del Hospital de Niños "J.M. de los Ríos", en el período marzo-agosto 2016. Método: Estudio retrospectivo, longitudinal y descriptivo con seguimiento de la evolución según registros de la historia clínica de cada paciente. Se registraron características demográficas, diagnóstico, criterios de indicación, características de los catéteres y su localización, complicaciones infecciosas y no infecciosas, duración y tipo de manipulación del CVC. Resultados: Se estudiaron 54 pacientes en total con CVC determinando que no existe diferencia importante en cuanto al sexo, 52 % masculino frente a 48,1 % femenino. La localización más frecuente fue a nivel de la vena yugular interna derecha en 56 % de casos. En un 41 % no se cumplieron con los criterios de colocación. Se identificó un 37 % de complicaciones de las cuales 22 % fueron de causa no infecciosa destacando la obstrucción como causa más frecuente y un 15 % de etiología infecciosa siendo la bacteriemia la principal causa en un 56 %. Conclusiones: se obtuvo con mayor frecuencia aislamiento de K. pneumoniae y P. aeruginosa. La permanencia de la mayoría de CVC fue mayor de 7 días. No se cumplen con los bundles de inserción ni de mantenimiento. Al analizar los diferentes factores de riesgo para complicación infecciosa, se obtuvo que la duración del catéter incrementa el riesgo de infección.

The need for rapid and effective intravenous treatment of critically ill patients who are unable to treat by other means has made access through the central venous pathways (CVC) imperative, has been associated with adverse events that prolong hospital stay, increase hospital costs, can add morbidity and even mortality to the patient. Objective: To analyze complications of patients with central vascular access hospitalized in the Emergency Services, Pediatric Intensive Care, General Surgery and Neonatal Intensive Care of Children's Hospital "J.M. de Los Rios, in the period March-August 2016. Method: Retrospective, longitudinal and descriptive study with follow-up of the evolution according to records of the clinical history of each patient. Patient demographics, diagnosis, indication criteria, catheter characteristics and location, infectious and noninfectious complications, duration and type of CVC manipulation were recorded. Results: A total of 54 patients with CVC were studied, determining that there is no significant difference in sex, 52 % male versus 48.1 % female. The most frequent localization was at the level of the right internal jugular vein in 56 % of cases. In 41 %, the placement criteria were not met. 37 % of complications were identified, of which 22 % were of non-infectious cause, the most frequent cause being obstruction and 15 % of infectious etiology, with bacteremia being the main cause in 56 %. Conclusions: Among the isolated microorganisms K. pneumoniae and P. aeruginosa were most frequently found. The permanence of the majority of CVC was greater than 7 days. Insertion and maintenance bundles are not met. When analyzing the different risk factors for infectious complication, it was obtained that the duration of the catheter increases the risk of infection.

Biofilm fúngico asociado a dispositivo intravascular de larga permanencia: Complicaciones y dificultades terapéuticas / Fungal biofilm associated with long-term central venous access device: Complications and therapeutic difficulties

Las infecciones fúngicas asociadas a biofilms en dispositivos biomédicos son refractarias al tratamiento antifúngico y habitualmente se requiere del retiro oportuno del dispositivo, así como la administración de antifúngicos sistémicos. Presentamos el caso de una paciente mujer de 36 años que recibe terapia para el dolor administrada por dispositivo intravascular de larga permanencia, catéter Port-A-Cath, y que desarrolló candidemia y endocarditis por Candida parapsilosis asociada al catéter; el cual tuvo que ser retirado mediante toracotomía por persistencia de la infección a pesar de la terapia antifúngica sistémica. Se evidenció extenso biofilm rodeando al catéter, con aislamiento de Candida parapsilosis y se completaron seis semanas de tratamiento antifúngico con evolución clínica favorable

Fungal infections associated with biofilms in biomedical devices are refractory to antifungal treatment and usually require the timely removal of the device, as well as the administration of systemic antifungals. We present the case of a 36-year- old female patient who received pain therapy administered by a Port-A-Cath long-term central venous access device. She developed catheter-related candidemi a and endocarditis caused by Candida parapsilosis. The catheter had to be removed by thoracotomy due to persistent infection despite the systemic antifungal therapy. An extensive biofilm surrounding the catheter was observed and Candida parapsilosis was isolated. Six weeks of antifungal treatment with a favorable clinical evolution were completed

The impact of technology on treatment of iatrogenic cervicothoracic vascular traumas: a study of two cases three decades apart and a review of the literature.

Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.

Cateterización de la vena yugular interna guiada por ecografía: estudio comparativo con la técnica convencional por reparos anatómicos

RESUMEN Introducción: los catéteres venosos centrales son sondas intravasculares que se insertan en los grandes vasos venosos del tórax y abdomen. La técnica comúnmente realizada es la guiada por reparos anatómicos basada en la presunción de la ubicación de los vasos del cuello al identificar estructuras anatómicas externas. El uso de la ultrasonografía ha sido promovido como un método para reducir el riesgo de complicaciones durante la cateterización venosa central. Objetivos: comparar la eficacia de la técnica de inserción de catéteres venosos yugulares internos guiado por ecografía con la realizada por reparos anatómicos. Metodología: estudio experimental realizado en varones y mujeres, mayores de 18 años, en quienes estaba indicada la colocación de acceso venoso central yugular interno en forma programada, internados en las Cátedras de Clínica Médica, Unidad de Cuidados Intermedios y Unidad de Cuidados Intensivos del Hospital de Clínicas y en la Unidad de Cuidados Intensivos del Sanatorio Británico (Asunción). En cada caso fueron medidas las siguientes variables: tasa de éxito de colocación, número de intentos, tiempo de realización y complicaciones (hematomas, punción arterial y neumotórax). Resultados: 149 pacientes fueron considerados en este estudio, realizándose 90 vías venosas yugulares con guía ecográfica y 59 por la técnica habitual por reparos anatómicos. El tiempo de realización y el número de punciones en el grupo con guía ecográfica fue menor (p<0,001). No hubo diferencias estadísticamente significativas en éxito del procedimiento entre ambos grupos pero el realizado con guía ecográfica tuvo menor proporción de complicaciones: hematomas (p<0,01) y punción arterial (p 0,01). No se registró neumotórax en ninguno de los dos grupos. Conclusiones: la colocación de vía venosa central bajo guía ecográfica es superior sobre la técnica por reparos anatómicos considerando la menor proporción de complicaciones, la reducción en el número de intentos y menor tiempo de realización. Aunque el éxito del procedimiento sea similar, las implicancias para llegar a dicho objetivo bajo la técnica a ciegas se traducen en un incremento directo en las otras variables ya citadas en detrimento del paciente. Por lo tanto, siempre que esté disponible tanto el equipamiento necesario como el operador capacitado ésta será la técnica de elección.

ABSTRACT Introduction: The central venous catheters are intravascular tubes that are inserted in the major vessels of the thorax and abdomen. The commonly performed technique is the external anatomical landmarks technique based on the presumption of the location of the neck vessels when identifying external anatomical structures. The use of ultrasound has been promoted as a method to reduce the risk of complications during the central venous catheterization. Objectives: To compare the effectiveness of the ultrasound-guided insertion technique of internal venous catheters versus the surface anatomy landmark technique. Methodology: This experimental study was carried out in adult men and women in whom the insertion of an internal jugular central venous access was indicated and programmed. They were hospitalized in the Services of Medical Clinic, Intermediate Care Unit and Intensive Care Unit of the Hospital de Clínicas and the Intensive Care Unit of the Sanatorio Británico (Asunción). The following variables were measured: the rate of successful insertions, the number of attempts, the duration of catheterization (from puncture of EJV to external fixation of the catheter) and the complications (hematomas, arterial puncture and pneumothorax). Results: One hundred forty nine patients were included in this study, 90 ultrasound-guided jugular vein catheterizations were made and 59 using the external anatomical landmarks technique. The time of performance and the number of punctures were lower in the ultrasound-guided group (p<0.001). There were no statistically significant differences between the groups regarding the success rates but the ultrasound-guided group had less proportion of complications: hematomas (p<0.01) and arterial puncture (p<0.01). Pneumothorax was not registered in any groups. Conclusions: The ultrasound-guided central venous catheterization is superior to the one made using the surface anatomy landmark technique considering the lower proportion of complications, the reduction of the number of attempts and the shorter duration. Although the success of both procedures was similar, the implications for reaching the aim using the surface anatomy landmark technique turned into a direct increase of the above mentioned variables at the expense of the patient. Therefore, whenever both the necessary equipment and a trained operator are available, the ultrasound-guided technique will be the technique of choice.

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country.

BACKGROUND: The US National Healthcare Safety Network has provided a definition of mucosal barrier injury-associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its influence in pediatric oncology centers in low- to middle-income countries. OBJECTIVES: To determine the influence of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI versus non-MBI LCBI cases. METHODS: We retrospectively applied the National Healthcare Safety Network definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were reclassified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared. RESULTS: Of 55 CLABSI events, 44% (24 out of 55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72-3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P = .029) and had a significantly greater frequency of neutropenia (100% vs 39%; P = .001) and chemotherapy exposure (87% vs 58%; P = .020) and significantly longer median hospitalization (34 vs 23 days; P = .008). CONCLUSION: A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI-LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections.

The surgery of the long-term central venous accesses in oncology.

The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.

Accesos venosos centrales guiados por ultrasonido: ¿existe evidencia suficiente para justificar su uso de rutina? / Ultrasound guided central venous access: is there enough evidence to justify its routine use?

Tradicionalmente, el sitio de inserción de las vías venosas centrales se ha determinado mediante la palpación de referencias anatómicas con una relación conocida con la vena a canular. Existe evidencia que señala que esta técnica está asociada a complicaciones. El empleo de ultrasonido para guiar la cateterización de estructuras vasculares, ofrece ventajas teóricas y promete hacer de la instalación de accesos vasculares una técnica precisa y segura, reduciendo las complicaciones y disminuyendo el tiempo de inserción de los catéteres. En Estados Unidos y Gran Bretaña, se han dado recomendaciones con respecto a la utilización del ultrasonido como técnica de rutina. La respuesta a estas recomendaciones, ha sido inconsistente. En el futuro, es probable que la técnica guiada por ultrasonido se conviertan en un estándar de cuidado en la práctica clínica, por lo que los médicos involucrados en estos procedimientos deben familiarizarse con esta técnica.

Traditionally, the site of initial needle insertion during central venous catheters placement is determined by using palpable anatomic structures with known relationships to desired vein as landmarks. Evidence has shown that landmark-guided percutaneous venous catheters insertion is associated with significants complications. The ultrasound guided central venous access technique has been shown to ensure safe and timely catheter placement and to reduce many of the potential complications associated with anatomic landmark methods. In the United Kingdom and the United States, ultrasound guidance for internal jugular central venous catheterisation is recommended. Response to these recommendations has polarised opinions and implementation has been inconsistent. In the future, probably the ultrasound guided technique will become a standard of care in the clinical practice, clinicians must readily incorporate the ultrasound in clinical practice and enhance venous access performance.

Acesso venoso central em cães - uma revisão / Central venous access in dogs and cats - a review

O acesso venoso central é uma técnica de acesso vascular relativamente simples, pouco empregadaem Medicina Veterinária e que ocorre quando há o posicionamento intravascular de um dispositivoapropriado cuja extremidade atinge a veia cava cranial ou caudal, independentemente do local deinserção. Pode ser utilizado para diversos fi ns, tais como nutrição parenteral, hemodiálise, fl uidoterapia,coleta de material para análise e administração de medicamentos; e cada fi m requer um tipode cateter específi co. Embora seja uma técnica exequível, deve-se atentar aos riscos associados, comoa incidência de fl ebites, trombos e infecções associadas à permanência dos cateteres. Acredita-se que,com um maior conhecimento e domínio sobre esta técnica, esta possa ser mais rotineiramente empregadapelo clínico veterinário, maximizando seus benefícios e minimizando seus riscos

Central venous access is a simple technique of vascular access, rarely used in veterinary medicine.This occurs when there is an appropriate intravascular catheter placement into the cranial or caudalvena cava. It can be used for various purposes, such as parenteral nutrition, hemodialysis, fl uid andmedication administration, and each order requires a specifi c type of catheter. Although it is a feasibletechnique, must pay attention to the risks, as the incidence of phlebitis, thrombus and infectionsassociated with permanent catheters. It is believed that with greater knowledge and mastery of thistechnique, it can be more routinely used by the veterinary practitioner, maximizing benefi ts and minimizingtheir risks

Acesso venoso central em cães - uma revisão / Central venous access in dogs and cats - a review

O acesso venoso central é uma técnica de acesso vascular relativamente simples, pouco empregadaem Medicina Veterinária e que ocorre quando há o posicionamento intravascular de um dispositivoapropriado cuja extremidade atinge a veia cava cranial ou caudal, independentemente do local deinserção. Pode ser utilizado para diversos fi ns, tais como nutrição parenteral, hemodiálise, fl uidoterapia,coleta de material para análise e administração de medicamentos; e cada fi m requer um tipode cateter específi co. Embora seja uma técnica exequível, deve-se atentar aos riscos associados, comoa incidência de fl ebites, trombos e infecções associadas à permanência dos cateteres. Acredita-se que,com um maior conhecimento e domínio sobre esta técnica, esta possa ser mais rotineiramente empregadapelo clínico veterinário, maximizando seus benefícios e minimizando seus riscos(AU)

Central venous access is a simple technique of vascular access, rarely used in veterinary medicine.This occurs when there is an appropriate intravascular catheter placement into the cranial or caudalvena cava. It can be used for various purposes, such as parenteral nutrition, hemodialysis, fl uid andmedication administration, and each order requires a specifi c type of catheter. Although it is a feasibletechnique, must pay attention to the risks, as the incidence of phlebitis, thrombus and infectionsassociated with permanent catheters. It is believed that with greater knowledge and mastery of thistechnique, it can be more routinely used by the veterinary practitioner, maximizing benefi ts and minimizingtheir risks(AU)

Cateteres venosos totalmente implantáveis em pacientes com neoplasia hematológica e não hematológica / Totally implantable venous catheters in patients with hematological and non hematological neoplasias

OBJETIVO: Analisar se a presença de neoplasia hematológica acarreta maior risco de complicações para inserção de cateteres totalmente implantáveis e se há diferença de tempo cirúrgico quando o procedimento é realizado por punção ou dissecção venosa. MÉTODO: Foram avaliados 68 pacientes com neoplasia internados no Hospital Santa Rita de Porto Alegre entre fevereiro de 1998 e dezembro de 1999, os quais necessitavam de acesso venoso central para tratamento quimioterápico, sendo 48 do sexo feminino e com idade média de 55,6 anos. Desses, 31 apresentavam neoplasia hematológica. RESULTADOS: Complicações pós-operatórias ocorreram em 13 pacientes (19 por cento), sendo elas: obstrução do sistema (7 por cento), hematoma (6 por cento) e infecção (6 por cento), não havendo diferença quanto ao tipo de neoplasia (p = 0,56). Foram realizadas dissecção e punção venosa em 30 e 38 pacientes, respectivamente, sem diferença em relação ao tempo de implantação do cateter (p = 0,42). CONCLUSÃO: Neoplasias hematológicas não aumentaram o risco de complicações quando do uso de cateteres totalmente implantáveis no presente estudo, além disso, ambas as técnicas cirúrgicas - dissecção ou punção - são exeqüíveis, haja visto o tempo cirúrgico semelhante entre elas, desde que sejam respeitados o valor sérico mínimo de plaquetas (50.000/mL) e a técnica cirúrgica apropriada, com hemostasia rigorosa e curativo compressivo.

BACKGROUND: We analyse whether hematological tumors increase the risk of complications of totally implantable catheters and if there are differences regarding procedure time when it is perfomed through venous dissection or venous puncture. METHODS: We studied 68 patients with neoplasia in Hospital Santa Rita from Porto Alegre, between February 1998 and December 1999, who had required central venous access for chemotherapy. Forty-eight patients were female and the mean age was 55.6 years. Thirty-one patients had hematological tumors. RESULTS: Postoperative complications were observed in 13 patients (7 percent with device obstruction, 6 percent with hematoma and 6 percent with infection), but there was no difference regarding the pattern of the neoplasia (p = 0.56). Venous dissection and venous puncture were performed in 30 and 38 patients, respectively, with no difference concerning surgical time (p = 0.42). CONCLUSIONS: Hematological tumors did not increase the risk of complications of totally implantable catheters; furthermore, both surgical techniques (venous dissection or venous puncture) are acceptable choices, with similar surgical times, since one respects minimal platelet count of 50 000/mL and careful hemostasis techniques and compressive dressings.