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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Chang YL, Sae-Lim C, Lin SL, Lai HW, Huang HI, Lai YC, Chen ST, Chen DR. Scarless totally implantable venous access port (TIVAP) implantation: Surgical technique, preliminary results, learning curve, and patients-reported outcome in 125 breast cancer patients. Surg Oncol 2024; 53:102048. [PMID: 38412756 DOI: 10.1016/j.suronc.2024.102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Minimal-access (endoscopic or robotic-assisted) breast surgery has been increasingly performed and shown better cosmetic results. However, location of totally implantable venous access port (TIVAP) for systemic treatment at anterior chest may compromise its aesthetic benefits. Therefore, we proposed a new scarless technique for TIVAP implantation, and reported the preliminary results, learning curve, and patients-surveyed outcome. METHODS Surgical technique of the new "scarless" TIVAP implantation was proposed. Patients receiving this procedure in a single institution were included. The preliminary results of the scarless TIVAP implantation, learning curve, and patient-reported outcome were analyzed and reported. RESULTS A total of 125 breast cancer patients received scarless TIVAP procedures were enrolled. The primary success rate of the scarless TIVAP implantation was 100%. Mean operative time was 46 ± 14 min. Mean amount of blood loss was 8.5 ± 3.2 ml. The cumulative sum plot showed operation time significantly decreased after 24th cases. In the initial learning phase, the mean operative time was 55 ± 17 min, and decreased to 43 ± 12 min in the later mature phase (P = 0.003). There were 5 (4%) complications detected, which included 1 (0.8%) seroma formation, 2 (1.6%) revisions, and 2 (1.6%) unplanned explantations. From patients-evaluated questionnaires, more than 90% of responders were satisfied with aesthetic results, experience during surgery, and application of scarless TIVAP for systemic therapy. CONCLUSIONS The scarless TIVAP implantation is a safe & reliable procedure with high patients-reported aesthetic satisfaction, and could be an alternative TIVAP procedure for patients requiring chemotherapy and desiring a less noticeable scar.
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Affiliation(s)
- Yi-Lin Chang
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
| | - Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Hung-Wen Lai
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Hsin-I Huang
- Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan.
| | - Yuan-Chieh Lai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Shou-Tung Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Dar-Ren Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
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Graf S, Feldmann H, Hunold LS, Steinkraus KC, Nasir N, Michalski CW, Dörr-Harim C, Hüttner FJ. Use of virtual reality in port implantation to reduce perioperative anxiety and pain: protocol for a randomised controlled pilot trial at a single German university hospital (VIP-trial; DRKS00028508). BMJ Open 2023; 13:e074738. [PMID: 37709332 PMCID: PMC10503368 DOI: 10.1136/bmjopen-2023-074738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Intravenous access port implantation is commonly performed under local anaesthesia, which offers advantages such as increased patient satisfaction and resource savings compared with general anaesthesia. However, patients may experience increased perioperative stress and anxiety in the operating room setting without general anaesthesia. Virtual reality (VR) distraction or hypnosis during surgery under local anaesthesia may help patients to auditorily and visually separate from their real environment and engage with a virtual environment through hypnorelaxing guidance. Previous studies suggested that VR hypnosedation may reduce the use of sedatives or general anaesthesia, and may offer additional benefits such as reducing postoperative pain and nausea, and promoting faster patient discharge. METHODS AND ANALYSIS The VIP trial is a randomised controlled pilot trial comparing the usage of VR during port implantation with the current standard of care (local anaesthesia and analgosedation if needed). A total of 120 adult patients are included after screening for eligibility and obtaining informed consent. Patients are randomised preoperatively in a 1:1 ratio to the trial groups. The main outcomes are change of perioperative anxiety and pain. Further outcomes include patient satisfaction and tolerability, perioperative analgesia and sedation, occurrence of postoperative nausea, vomiting and VR sickness symptoms, surgeon's satisfaction, procedure duration, postoperative complications until postoperative day 30 and patient willingness to hypothetically undergo port implantation again under the same conditions. ETHICS AND DISSEMINATION The VIP trial has been approved by the Ethics Committee of the Medical Faculty of Ulm University (reference number 03/22). If the intervention demonstrates that VR can effectively reduce perioperative anxiety and pain, it may become a novel standard of care to minimise the need for analgosedation or general anaesthesia in port implantation procedures and improve patient outcomes. The results will be submitted to a peer-reviewed journal in the field and will be presented at applicable conferences to ensure rigorous evaluation and access for the academic community. TRIAL REGISTRATION NUMBER German Clinical Trials Register: DRKS00028508; registration date 15 March 2022; Universal Trial Number: U1111-1275-4995.
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Affiliation(s)
- Sandra Graf
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Hannah Feldmann
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Lisa S Hunold
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Kira C Steinkraus
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
| | - Nadir Nasir
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
| | - Christoph W Michalski
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
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Yao MQ, Jiang YY. Catheter misplacement from an implantable central venous access port into the internal thoracic vein: a case description. Quant Imaging Med Surg 2023; 13:6338-6342. [PMID: 37711839 PMCID: PMC10498269 DOI: 10.21037/qims-23-338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/26/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Min-Quan Yao
- Department of Gastrointestinal Surgery, Tongxiang First People’s Hospital, Jiaxing, China
| | - Yan-Yan Jiang
- Department of Clinical Laboratory, Tongxiang First People’s Hospital, Jiaxing, China
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Menekli T, Yaprak B, Doğan R. The Effect of Virtual Reality Distraction Intervention on Pain, Anxiety, and Vital Signs of Oncology Patients Undergoing Port Catheter Implantation: A Randomized Controlled Study. Pain Manag Nurs 2022; 23:585-590. [PMID: 35367144 DOI: 10.1016/j.pmn.2022.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the port catheters have many beneficial effects on the patient's quality of life, it was reported in the literature that patients experience pain in the incision area after the implantation or anxiety before, during or, after the implantation.Distraction is a simple and effective method in the management of pain and anxiety. AIMS To determine the effect of virtual reality (VR) distraction intervention on pain, anxiety, and vital signs of oncology patients undergoing port catheter implantation. DESIGN Randomized controlled study METHODS: The study was carried out with 139 participants (69 intervention, 70 control) between September 2019 and January 2020. Data were collected before, during, and after the implantation by using a patient identification form, State Anxiety Inventory (SAI), a table for vital signs, and a visual analog scale for pain severity. In the intervention group, a virtual reality device, movies, and relaxing music were provided and patients were instructed to use it during the implantation and when they felt pain after the implantation. There wasn't any blinding for patients or researchers throughout the study. RESULTS There was an increase in pain scores of both groups after the implantation; however, pain scores in the intervention group were lower and there was a statistically significant difference between the groups after the implantation. In the intervention group, there was a decrease in anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, and an increase in SpO2. VR use has a great effect on pain scores (Cohen's d = 3.023) and a great effect on SAI scores (Cohen's d = 8.770). CONCLUSIONS VR distraction intervention was found an effective way to reduce pain, anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate and increase the SpO2 of the patients undergoing port catheter implantation.
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Affiliation(s)
- Tuğba Menekli
- Department of Internal Medicine Nursing, Malatya Turgut Özal University, Malatya, Turkey.
| | - Bülent Yaprak
- Internal Medicine Department, Malatya Turgut Özal University, Malatya, Turkey
| | - Runida Doğan
- Department of Surgical Nursing, Inonu University, Malatya, Turkey
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Civetta G, Lombardi L, Lanotte A, Delvecchio AM, Colonnata M, Todisco A, Cristallo R, Marcone A, Somma M, Vitale E, Giammarinaro MP, Bruno G, Caldarola GG. Needle Insertion Difficulty Algorithm (NIDA): A novel pilot study to predict Huber needle insertion difficulty in totally implanted devices. J Vasc Access 2021; 24:492-496. [PMID: 34405754 DOI: 10.1177/11297298211040343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Safeguarding of venous assets in cancer patients provides for positioning vascular devices. In totally implanted central venous access devices, hereinafter referred as TIVADs, it's necessary introducing Huber needle, into subcutaneous port, to use it. This procedure is not easy for all implanted devices. The procedural difficulty is to be attributed both to the type of the implanted port and to the skill of the clinician. The degree of patient satisfaction is variable and related with the clinician performing the maneuver. It follows a professional dissatisfaction of the clinician and a hesitation of the patient. Moreover, the incorrect positioning of the Huber needle into the port, could lead to the infusion of antiblastic drugs into the subcutaneous tissue with the consequent tissue damage due to extravasation of the drugs. Evaluation of different characteristics of TIVADs, allowed grouping them, in different types, setting up the S.P.I.A. method (Subcutaneous Port Investigator Assessment). Collected data from medical records concerning: primary pathology, port's permanence and using, Huber needle insertion failed events, if a vascular access expert/specialist clinician has been called, weight gain or loss were recruited. These data made it possible to determine the types of implanted ports that were most difficult to insert the Huber needle, creating the N.I.D.A. (Needle Inserting Difficulty Algorithm) as a prognostic index of Huber needle inserting into the port. In particular, the type of implanted port, that is, if it was a brachial or thoracic implant (p < 0.001), the SPIA type, if type 1, 2, or 3 (p < 0.001) and the experience of the clinician (p < 0.001) were considered as predictors of a successful first attempt and then can perform the NIDA. The relevant aspects in the success of the procedure are therefore the type of port (thoracic or brachial), the SPIA type, and the experience of the clinician in the successful insertion of the Huber needle into the port at the first attempt.
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Affiliation(s)
- Giuseppe Civetta
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy.,Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Lucia Lombardi
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Antonio Lanotte
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Anna Maria Delvecchio
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Melania Colonnata
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Angela Todisco
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Rosa Cristallo
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Andrea Marcone
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Michele Somma
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
| | - Elsa Vitale
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Giammarinaro
- Department for the Promotion of Health, Maternal and Childhood, Internal and Specialized Medicine of Excellence, School of Medicine and Surgery, University of Palermo, Palermo, Italy
| | - Giovanni Bruno
- Department for the Promotion of Health, Maternal and Childhood, Internal and Specialized Medicine of Excellence, School of Medicine and Surgery, University of Palermo, Palermo, Italy
| | - Gennaro Gadaleta Caldarola
- Medical Oncology Unit, Oncohematology Department, Monsignor Dimiccoli Hospital Barletta, ASL BT, Barletta, Italy
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Long-Term Results of a Standard Algorithm for Intravenous Port Implantation. J Pers Med 2021; 11:jpm11050344. [PMID: 33923312 PMCID: PMC8146737 DOI: 10.3390/jpm11050344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 01/15/2023] Open
Abstract
Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.
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Complications and pitfalls of central venous port catheters: experience with 782 patients with cancer. Ir J Med Sci 2020; 189:1371-1377. [PMID: 32193794 DOI: 10.1007/s11845-020-02207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The clinical use of port catheters has become widespread because they provide a safe and easy vascular route. Such widespread use of vascular port catheters has revealed early and late complications. AIM This study was evaluated the early and late noninfectious complications and present precautions and pitfalls to handle these complications. METHODS The retrospective observational study comprised 801 vascular port catheters inserted into 782 adult patients for various reasons between 2010 and 2018. Patient demographic, indications for port catheter implantation, port catheter types, and insertion sides were noted. Port catheter implantation related early and late complications were recorded. RESULTS The subclavian vein was selected as a target vein in almost all of the interventions (98.9%). Similarly, right-sided veins were used in about 90% of patients. The most common problem was technical issues related to the interventions. If venous cannulation was challenging, ultrasonography and fluoroscopy guidance roadmap technique were used. Most serious complication was pneumothorax in 7 patients. In the late period, the most common problem was thrombotic occlusion of the catheter. In two-thirds of these patients, thrombolytic therapy for thrombosed port catheters may rescue some catheters and avoid secondary port catheter insertions. CONCLUSIONS Despite these benefits, port catheters are associated with various complications. However, most of these complications can be effectively prevented by proper techniques and easily applied precautions.
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An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.594025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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