***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE To compare percutaneous nonangiographic insertion of a venous access device with a st and ard surgical cutdown insertion technique . DESIGN Prospect i ve , controlled , r and omized study . SETTING Operating room and anesthesia induction room of a university hospital . PATIENTS 100 consecutive oncology patients scheduled for intravenous chemotherapy . INTERVENTIONS Patients were r and omized to two groups : ( 1 ) The percutaneous group received implantation through the internal jugular vein by experienced anesthesiologists , whereas ( 2 ) the surgical group received venous cutdown insertion through the cephalic or subclavian vein by surgeons ( n = 50 for each group ) . MEASUREMENTS Duration of procedure , long-term device function , complications such as hematoma formation , infection , hemothorax , pneumothorax , and patients ' satisfaction with the placement procedure at two months of follow-up were all measured and recorded . MAIN RESULTS The percutaneous technique was found to have several advantages , including reduced time for insertion and greater patient satisfaction with procedure . The percutaneously implanted devices also had fewer insertion-associated complications . CONCLUSION The simplified , percutaneous , nonangiographic technique is as effective as the traditional venous cutdown technique and can be safely done by surgeons as well as by experienced physicians who are not surgeons BACKGROUND Central venous access is extensively used in oncology , though practical information from r and omized 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 r and omly assigned to implantation of a single type of port ( Bard Port , Bard Inc. , Salt Lake City , UT ) , through a percutaneous l and mark 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 prospect ively 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 r and omization , 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 Background The insertion of central venous access devices , such as totally implantable venous access ports ( TIVAPs ) , is routine in patients who need a safe and permanent venous access . The number of port implantations is increasing due to the development of innovative adjuvant and neo-adjuvant therapies . Currently , two different strategies are being routinely used : surgical cut-down of the cephalic vein ( vena section ) and direct puncture of the subclavian vein . The aim of this trial is to identify the strategy for the implantation of TIVAPs with the lowest risk of pneumothorax and haemothorax . Methods / Design The PORTAS-3 trial is design ed as a multicentre , r and omised controlled trial to compare two implantation strategies . A total of 1,154 patients will be r and omised after giving written informed consent . Patients must be over 18 years of age and scheduled for primary implantation of a TIVAP on the design ated side . The primary endpoint will be the frequency of pneumothorax and haemothorax after insertion of a TIVAP  by one of two different strategies . The experimental intervention is as follows : open strategy , defined as surgical cut-down of the cephalic vein , supported by a rescue technique if necessary , and in the case of failure , direct puncture of the subclavian vein . The control intervention is as follows : direct puncture of the subclavian vein using the Seldinger technique guided by sonography , fluoroscopy or l and mark technique . The trial duration is approximately 36 months , with a recruitment period of 18 months and a follow-up period of 30 days . Discussion The PORTAS-3 trial will compare two different TIVAP implantation strategies with regard to their individual risk of postoperative pneumothorax and haemothorax . Since TIVAP implantation is one of the most common procedures in general surgery , the results will be of interest for a large community of surgeons as well as oncologists and general practitioners . The pragmatic trial design ensures that the results will be generalizable to a wide range of patients .Trial registration The trial protocol was registered on 28 August 2014 with the German Clinical Trials Register ( DRKS00004900 ) . The World Health Organization ’s Universal Trial Number is U1111 - 1142 - 4420 The aim of this r and omized controlled study was to compare the primary success rate between venous cutdown and the Seldinger technique for placement of the totally implantable venous access port ( TIVAP ) Permanent central venous access devices ( PCVAD ) are used widely in the management of chronically ill patients , particularly in neoplastic diseases . The st and ard approach consists of positioning the catheter in the superior vena cava ( SVC ) either using subclavian or internal jugular vein puncture , or cephalic or external jugular vein cut-down , with the port implanted in a subcutaneous pouch of the thoracic region . Alternative insertion sites could be used in selected cases . In our experience , consisting of 158 PCVAD , 12 cases required a different insertion site : six cases of an SVC catheter and port on the forearm using a basilic vein cut-down , and six cases of an inferior vena cava ( IVC ) catheter and port in the abdominal region using a great saphenous vein cut-down . Comparing st and ard to alternative approaches , we observed a total morbidity rate of 8.9 % and 8.3 % , respectively ( P = NS ) , while the explant rate was 5.4 % vs 8.3 % ( P=0.1 ) . Our data show non-significant differences in morbidity and explant rates between the two groups of patients . Alternative insertion sites for the PCVAD implant seem to be a valid possibility in the management of chronically ill patients BACKGROUND This prospect i ve r and omized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein . METHODS A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008 . Patients were r and omly allocated to the subclavian or jugular vein group . The endpoint was complications that led to catheter revision or catheter removal . RESULTS Six patients were excluded , 43 had the catheter implanted in the subclavian and 34 in the jugular vein . Subclavian catheters were used for up to 12.6 months , while jugular catheters were kept in place for up to 14.8 months ( P = 0.38 ) . No statistical differences were found between the groups concerning age , sex , leukocyte count , platelet count , type of admission ( in or outpatient ) , or previous chemotherapy regimens . When analyzed individually , long-term complications did not present statistically significant differences either . Infection occurred in 20 and 11 % ( P = 0.44 ) , while catheter embolism took place in 23 and 8 % ( P = 0.11 ) of patients with subclavian and jugular catheters , respectively . A statistical difference was seen in the total number of complications , which occurred in 48 and 23 % ( P = 0.02 ) of patients in the subclavian and in the jugular groups , respectively . CONCLUSIONS Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein Totally implantable venous access ports are valuable instruments for long-term intravenous treatment of patients with cancer , but implantation and use of these devices may be associated with complications . The aim of our study was to compare two implantation techniques in order to establish which one is better for the patient and the surgeon as regards morbidity , surgical time , tolerability , and costs . A prospect i ve study was conducted on a series of 99 patients undergoing implantation of totally implantable venous access ports with surgical cut-down or percutaneous access from January 2000 to June 2004 at the Department of Surgical Sciences , Organ Transplantation and Advanced Technologies . Our experience shows that there are no statistically significant differences between these two techniques in terms of associated morbidity , technical failure , operative time and patient acceptance PURPOSE To examine the safety , efficacy , costs , and impact on quality of life of venous access ports implanted at the outset of a course of intravenous cancer chemotherapy . PATIENTS AND METHODS Adults beginning a course of intravenous chemotherapy at two university-affiliated hospitals were r and omly allocated to have venous access using a surgically implanted venous access port ( Port-a-Cath ; Pharmacia , Canada Inc , Montreal , Québec , Canada ) or using st and ard peripheral venous access . All accesses were documented by number , route , purpose , and procedure duration . Outcome measurements included port complications , access strategy failure , access-related anxiety and pain , quality of life ( Functional Living Index-Cancer [ FLI-C ] ) , and costs . RESULTS Port complication rates were low ( 0.23/1,000 days ) . Failure occurred in two ( 3.4 % ) of 59 port subjects and 16 ( 26.7 % ) of 60 controls ( P = . 0004 ) at a median period of 26 days after r and omization ( 95 % confidence interval , 8 to 92 ) . Peripheral accesses in port subjects took less time , had less access-related anxiety and pain , and were less costly to perform than in controls . Allocation had no effect on FLI-C scores . Peripheral access failure correlated with allocation to the control group ( P = .007 ) , higher pain scores with intravenous ( IV ) starts ( P = .003 ) , and anxiety with IV starts ( P = .01 ) . Venous accessing overall in port patients was four times more costly than that in controls ( $ 2,178/patient v $ 530/patient , respectively ) . CONCLUSION Ports were safe and effective but had no detectable impact on functional quality of life , despite less access-related anxiety , pain , and discomfort . Because only approximately one quarter of control patients ultimately required central venous access , economic considerations suggest that port-use policies should be based upon defined criteria of need Objective : Comparison of two different insertion techniques for implantation of totally implantable access ports  ( TIAP ) . Background : TIAP are introduced through different open and closed cannulation strategies and by various medical experts . The aim of this expertise-based r and omized trial was to compare venous cutdown approach with puncture of subclavian vein . Methods : One hundred and ten patients scheduled for primary implantation of a TIAP  were r and omly assigned to either open insertion technique performed by surgeons or puncture of the subclavian vein under fluoroscopic guidance by radiologists at an outpatient single university center . The primary endpoint was the primary success rate of the cannulation strategy . A logistic regression model was used for analysis adjusting for age , Karnofsky index , body mass index and surgeons ' , and the radiologists ' experience . Results : Percutaneus cannulation was not superior to surgical venous cutdown in the intention-to-treat analysis ( odds ratio , 0.37 ; 95 % CI , 0.07 ; 2.15 ) and the as-treated analysis ( odds ratio , 0.16 ; 95 % CI , 0 ; 1.28 ) . The procedure was shorter with surgery ( median , 21 minutes ; 95 % CI , 14 ; 30 ) than with radiology ( median , 45 minutes ; 95 % CI , 43 ; 50 ) ( P < 0.001 ) , and the dose of radiation was lower with surgery ( median , 37 cGy/cm2 ; 95 % CI , 26 ; 49 ) than with radiology ( 200 cGy/cm2 ; 95 % CI , 200 ; 300 ) ( P < 0.001 ) . Conclusion : Central venous cannulation for insertion of TIAPs can be performed safely and effectively with both approaches . The open direct surgical access requires further strategies for successful placement of a TIAP , and percutaneous Seldinger technique requires more time and a higher dose of radiation and is associated with risk of pneumothorax 
    Output:
    
Moderate- quality evidence showed that the Seldinger technique has a higher primary implantation success rate compared with the venous cutdown technique .
Moderate- quality evidence showed no difference in the overall complication rate between the Seldinger and venous cutdown techniques .
However , when the Seldinger technique with subclavian vein access was compared with the venous cutdown group , there was a higher reported incidence of catheter complications .
The rates of pneumothorax and infection did not differ between the Seldinger and venous cutdown group .