By John Child

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G. g. bleeding, pneumothorax, thrombosis), as well as the risk of infection and the feasibility of adequate nursing care of the catheter exit site. Such venous approaches were made possible in the 1970s by the development of specific tools, like the Seldinger Jwire and the peel-away introducer-dilator, formerly not available.

These ports have several advantages over external central venous catheters, including less frequent maintenance, less risk of infection and thrombosis, and greater acceptance by patients. Before insertion of a totally implantable access port, indications for its need, how it will be used, and the overall physical condition of the patient should be considered. A minor surgical procedure is required to insert the port, although no special training is needed. The surgery should be performed in an operating room or interventional radiology unit using maximum sterile barrier precautions and sterile technique.

When the superior central venous routes are not available, the most common technique used to obtain central venous access to the inferior vena cava is the inguinal approach using the saphenous vein or the gonadal vein. Keywords Cephalic vein • External jugular vein • Internal jugular vein • Axillary vein • Saphenous vein • Gonadal vein • Inferior vein cava I. it 43 I. Di Carlo, R. ), Totally Implantable Venous Access Devices, © Springer-Verlag Italia 2012 I. Di Carlo, A. 1 Introduction The first placement of a totally implantable venous access device (TIVAD) was performed in 1982 at the MD Anderson Cancer Centre in Houston by John Niederhuber, using the cephalic vein and a surgical technique [1].

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British management thought: a critical analysis by John Child

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