Is it possible to insert a vascular access port (VAP) in the arm?

From the Guidelines

Yes, it is possible to insert a vascular access port (VAP) in the arm, specifically in the upper arm, as an alternative to the traditional chest placement. This procedure involves surgically implanting a small device under the skin of the upper arm that connects to a major vein, such as the brachial vein, which is associated with easy vascular access and a lower risk of complications at insertion 1. The use of arm ports may be preferable in patients with tracheostomy, head and neck tumors, and anatomic deformities in the chest that may make access and nursing care more difficult 1.

Benefits and Considerations

The benefits of arm ports include:

• Elimination of the need for repeated needle sticks
• Ability to remain in place for months or years
• Potential for improved patient satisfaction and reduced anxiety related to vascular access 1 However, arm ports may have slightly higher complication rates, including infection, thrombosis, or mechanical issues, compared to chest ports 1. The risk of thrombogenic complications is higher in arm ports than in chest ports, with a reported incidence of 11.4% versus 4.8%, respectively 1.

Procedure and Recovery

The procedure is typically performed under local anesthesia by an interventional radiologist or surgeon and takes about 30-60 minutes. Recovery from port placement is generally quick, with most patients resuming normal activities within a day or two, though they should avoid heavy lifting with the affected arm for about a week. The choice of vein for access is important, with the basilic vein being the preferred option due to its superficial location and larger size, while the cephalic vein has a higher incidence of thrombosis and the brachial vein carries a greater risk of injury to the brachial artery and median nerve 1.

Key Points to Consider

• Arm ports are a viable alternative to traditional chest ports
• The procedure is relatively quick and recovery is generally fast
• Complication rates may be slightly higher compared to chest ports
• Patient involvement in the decision-making process can lead to greater patient satisfaction and reduced complications 1

From the Research

Vascular Access Port (VAP) Insertion in the Arm

• It is possible to insert a vascular access port (VAP) in the arm, as demonstrated by several studies 2, 3, 4, 5, 6.
• The studies show that arm port implantation is a safe and effective method for patients requiring central venous access, with comparable outcomes to chest port implantation 2, 3, 4.
• The advantages of arm port implantation include lower risk of pneumothorax, less risk of arterial puncture, and easier accessibility 3.
• However, arm port implantation is associated with a higher procedure conversion rate and lower incidence of intra-operative complications compared to chest port implantation 4.
• The complications associated with arm port implantation include venous thrombosis, infection, and mechanical difficulties, but these are relatively rare 2, 5, 6.

Comparison of Arm Port and Chest Port Implantation

• A systematic review and meta-analysis found that arm port implantation was associated with a higher procedure conversion rate, but lower incidence of intra-operative complications compared to chest port implantation 4.
• Another study found that arm port implantation had a lower risk of postprocedural complications compared to subclavian port implantation 3.
• However, a retrospective comparative analysis found that arm port implantation was associated with a higher rate of adverse events, including phlebitis and system occlusions, compared to subclavian port implantation 6.

Safety and Efficacy of Arm Port Implantation

• The studies demonstrate that arm port implantation is a relatively safe and effective method for patients requiring central venous access 2, 3, 5.
• The safety and efficacy of arm port implantation are comparable to those of chest port implantation, with similar outcomes and complication rates 2, 4.
• However, further experience and prospective analysis are needed to improve the placement technique and maintenance of arm ports 6.