Infraclavicular Fossa as an Alternate Site for Placement of Intrathecal Infusion Pumps

Abstract

Intrathecal infusion using an implantable pump is a common method of delivering medication for spasticity or chronic pain. The classic site for placement of the pump is in the abdominal wall. In some patients, there are confounding factors that make placement of an abdominal pump impractical. The purpose of this study was to report the implantation of Synchromed II pumps (Medtronic, Inc, Minneapolis, Minnesota) in the infraclavicular fossa. Four patients, aged 13 to 33 years, underwent infraclavicular placement of a Synchromed II infusion pump. In one patient, severe scoliosis and hip joint contractures precluded placement of the pump in the traditional position. Another patient had several ostomies on the abdominal wall, leaving no place for the pump. In a third, a combination of scoliosis and ostomy rendered the abdomen inappropriate for pump placement. In 3 patients, a 20-mL pump was placed in the infraclavicular fossa. In the fourth, a 40-mL pump was placed in the left infraclavicular fossa. All patients tolerated the operation well. There were no postoperative reports of local pain or discomfort. One patient died from unrelated respiratory compromise several months after pump placement. At last follow-up (average of 11 months), the pumps were functioning well, and there were no wound-related complications. Selected pre- and postoperative photographs are presented. The infraclavicular fossa is a viable alternative to the abdomen as the site for placement of a drug infusion pump.