Internal vs. external jugular vein access for pediatric totally implantable venous ports: a systematic review and meta-analysis.

Abstract

Background: Totally implantable venous access ports (TIVAPs) are vital for long-term intravenous therapy in children, especially in oncology. Internal jugular vein (IJV) access is commonly used but may require general anesthesia and poses anatomical challenges. External jugular vein (EJV) access is more superficial and may offer procedural advantages. This study hypothesizes that the EJV is the most appropriate venous access site for TIVAP placement in pediatric oncology patients due to its anatomical advantages and potential for fewer complications compared to the IJV.

Methods: A systematic review was conducted across PubMed, Scopus, Web of Science, Embase, and EBSCO through January 2025, following PRISMA guidelines. Studies comparing TIVAP insertion via IJV and EJV in patients under 18 years were included. Quality was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale. Meta-analysis was performed with RevMan 5.4.

Results: Three studies with three hundred fifteen pediatric patients (160 EJV, 155 IJV) were included. EJV access was associated with significantly shorter operative time (MD: - 24.80 min, 95% CI - 36 to - 13.16; p < 0.0001). Complication rates, including hematoma, pneumothorax, thrombosis, and catheter issues, showed no significant differences between groups.

Conclusion: EJV access offers reduced operative time without increasing complication risk compared to IJV access for TIVAP placement in children. It may be preferred when minimizing anesthesia exposure is important.