A novel “shrug technique” for totally implantable venous access devices via the external jugular vein: A consecutive series of 254 patients

Background: The external jugular vein (EJV) approach for totally implantable venous access devices (TIVADs) is safe. However, the success rate is unsatisfactory because of the difficulty in catheterization due to the acute angle between the EJV and the subclavian vein (SCV). A novel “shrug technique” to overcome this difficulty was developed, and its efficacy was assessed in a consecutive case series. Methods: TIVAD placement was performed via the EJV cut-down approach. “Shrug technique,” a simple way to straighten the EJV–SVC angle by shrugging the patient's shoulder, was applied to facilitate the passage of the guidewire and sheath-introducer when there was acute angulation between the EJV and SCV. Results: A total of 254 patients underwent TIVAD implantation by the EJV cut-down approach. The “shrug technique” was applied in 51 cases (20%), and catheterization was successful in all cases. Thus, TIVAD implantation was successfully completed in all 254 cases (100%) in a single operative setting. The median operating time was 38 [IQR 30–45] min. Eleven complications (4%) were observed, but none of them were EJV-specific. Conclusion: The “shrug technique” is simple but very useful to achieve a higher success rate and safer insertion of TIVADs from the EJV. J. Surg. Oncol. 2017;115:291–295.