The "L-shaped tunneling technique": a modified technique facilitating a more discreet implantable port positioning.

Abstract

Venous port catheters, also known as "totally implantable venous access devices" (TIVADs), are now the standard of care in patients requiring long-term intermittent intravenous drug administration. We describe a modification of the implantation technique that we use in our department in order to improve the cosmetic result of a TIVAD. After ultrasound-guided venous access in the internal jugular vein (IJV) or another appropriate vein has been obtained, we create a port pocket in the deltopectoral groove, in the upper-lateral chest wall, in a "far-lateral-oblique" orientation, respecting the individual patient's relaxed skin tension lines. Then we create a subcutaneous tunnel using a straight metal tunneler in two steps: first tunneling cranially and perpendicular to the port incision for a small distance, and then, after turning the tunneler at a right angle continuing in a straight line until we exit at the venous access site. This configuration not only prevents catheter kinking, to ensure uninhibited flow, but also allows us to place the port pocket in a more discreet position, in order to offer a better cosmetic result to our patients. Adoption of a "far-lateral-oblique" port implantation site along with the "L-shaped tunneling technique" will offer doctors who are implanting TIVADs a useful alternative for a better cosmetic result.