Educational Exhibit Abstract No. 409 - A “how-to” demonstration highlighting the single-incision insertion technique of chest port placement

Abstract

Learning Objectives To provide a “how-to” demonstration highlighting the single-incision insertion technique of chest port placement. Background Oncology patients who require frequent intravenous infusions have come to rely on long term venous access ports (1). The most widely used technique for implantable chest ports involve the creation of a venotomy in the anterior neck, a subcutaneous tunnel and a separate anterior chest skin incision through which the subcutaneous pocket is created as the port reservoir (2). A modified technique has been described in which the internal jugular vein access and the pocket for the port reservoir are established through a single chest wall incision (3). Clinical Findings/Procedure Details This technique will be demonstrated with accompanying images. The distal third of a 21-g micropuncture needle is manually bent into a smooth curve of approximately 35 degrees. A puncture site is chosen 2 cm inferior to the midpoint of the clavicle. Under ultrasound guidance, the needle is advanced subcutaneously in a cephalad direction and then made to turn horizontally toward the internal jugular vein. After puncturing the IJ, a wire is advanced under fluoroscopy to the junction of the SVC and right atrium. After placing an introducer sheath, the port catheter is inserted over the wire and advanced to the SVC. The proximal portion of the catheter is then attached to the port, which is placed within a subcutaneous pocket. Conclusion and/or Teaching Points The single incision insertion approach is technically feasible, lowers the risk of infection and bleeding and is aesthetically more pleasing. This technique can be applied in the insertion of most tunneled catheters.