Central Venous Port Placement Research Articles

Learning curve of ultrasound-guided percutaneous central venous port placement in children

BackgroundAlthough percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon.MethodsData from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed.ResultsCumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator’s position from the patient’s right side to the patient’s head (p = 0.005).ConclusionsUltrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.

Impact of Educational Videos on Patient Understanding of Interventional Radiology Procedures

Under-awareness of Interventional Radiology (IR) care by the public has been reported. The aim of this study is to evaluate the impact of educational videos to facilitate better patient understanding during the informed consent process. Educational videos for six common IR procedures including chemoembolization, radioembolization, ablation, tunneled central venous catheter placement, port placement, and port removal were developed for educating patients in the pre-procedural setting. One hundred and eighty patients referred to a tertiary academic institution were randomly selected to participate, including 30 patients per procedure type. Anonymous seven question, five-point Likert-scale assessments were administered to the participants before and after engaging with the videos. The survey evaluated patients' perceived understanding of IR procedures and satisfaction with the videos as educational tools. One hundred and eighty patients completed the survey. Comparing post-video to pre-video ratings, there was an increase in patients' understanding of the involved anatomy (4.5 vs 3.3; p<0.01), understanding of procedure benefits (4.6 vs 3.7; p<0.01), understanding of procedural risks (4.5 vs 3.3; p<0.01), understanding of procedural alternatives (3.4 vs 2.7; p<0.01), and overall procedural understanding (4.7 vs 3.4; p<0.01). Additionally, patients had a positive impression of the videos with a mean overall satisfaction rating of the video-assisted explanation of 4.80. A patient-centric video-assisted informed consent for IR procedures enhances patients' understanding and results in high patient satisfaction.

Inversion of Central Venous Ports in Children Under Six Years Old: A Retrospective Analysis of 154 Oncology Patients.

Background Although some reports have evaluated the safety and efficacy of central venous port (CVP) placement in pediatric patients, the data about the inversion rate of the device and its risk factors are scarce. Therefore, this study aimed to evaluate the inversion rates of CVPs and their associated risk factors in pediatric patients. Methodology Between January 2010 and December 2021, 154 consecutive children (75 boys; median age, 28.5 months; range, 2-71 months) who underwent CVP placement at our center were included in this study. The primary outcome was the CVP inversion rate, and the secondary outcomes included technical success rate, intraoperative complications, and infectious complications. Intraoperative complications were evaluated according to the Society of Interventional Radiology guidelines. Patients under two years old were classified as the younger group and those aged ≥two years as the older group. Results The CVP inversion rate was 4.6% (n = 7/153), equivalent to 0.08 × 1,000 catheter-days. The inversion rate was significantly higher in the younger group (under two years old, 11.2%) than in the older group (≥two years old, 1.0%) according to the univariate analysis (p = 0.00576). The technical success rate was 99.4% (n = 153/154), and mild adverse events were observed during the procedure in three (1.9%) patients. Infectious complications were observed in 16 (10.5%) patients, equivalent to 0.19 × 1,000 catheter-days. Conclusions The CVP inversion rate was significantly higher in younger children (under two years old) than in older children (≥two years old).

The risk of pocket infection or bloodstream infection following central venous port placement for the patients with Cetuximab therapy.

Cetuximab is a molecular targeted drug that targets epithelial growth factor receptors. The skin toxicity of cetuximab arising from epithelial growth factor inhibition is well known. Some patients with cetuximab therapy decided to make central venous port during the long-term intravenous treatments. Therefore, the author hypothesized that cetuximab administration might increase the risk of central venous port-related infection due to damage to skin barrier function. The main aim of the present study was to investigate the relationship between cetuximab administration and central venous port-related infection. A total of 83 patients had a central venous port placed from 2016 through 2021. We analyzed, retrospectively, the relationship between cetuximab therapy and the incidence of central venous port-related infection involving central line-associated bloodstream infection and pocket infection. Additionally, the risk factors of central venous port-related infection were examined in the population undergoing cetuximab therapy. In total populations (83 cases), central line-associated bloodstream infection happened in five patients (6%) and pocket infection happened in six patients (7%) after central venous port placement. In the cetuximab therapy group (45 cases), there were four patients with central line-associated bloodstream infection (9%) and six with pocket infection (13%). The pocket infection happened more frequently in the cetuximab group than the other group with significant differences. Additionally, in the cetuximab group, the patients who had an interval of less than seven days between central venous port placement and cetuximab dosing, or central venous port placement preceded by cetuximab dosing had more pocket infection with significant differences. Skin complications after the central venous port placement were related to cetuximab administration and the timing of cetuximab therapy.

Postprocedural Patient Instructions for Central Venous Ports and Biliary Tubes: Assessment of Clinical Benefit and Impact on Quality of Life

BackgroundThis study aimed to demonstrate that despite their potentially significant impact on patient quality of life (QOL), many postprocedural practices for central venous port (CVP) placement, biliary tube (BT) placement, and BT change may not be evidence-based. MethodsA mixed-methods, institutional review board–approved, cross-sectional survey was conducted to assess impact of written postprocedural instructions on QOL in patients who underwent CVP placement and BT placement or change at a single center between April 2018 and May 2020, followed by a targeted literature search for evidence pertaining to the instructions patients noted were most detrimental to QOL. ResultsFifty seven of 840 (6.8%) of contacted CVP patients and 52/166 (31.3%) of contacted BT patients participated in the study. Four instructions (one from CVP and three from BT) were identified as having greater negative than positive responses based on a seven-point Likert scale of impact on QOL: the CVP instruction related to avoiding repetitious movements of the arm, while the BT instructions related to avoiding sleeping on the tube, submerging in water, and daily dressing changes. A Medline database literature search did not demonstrate substantial evidence supporting the implementation of these instructions postprocedurally. DiscussionInstructions regarding avoiding repetitious movements of the arm, sleeping on the BT, and changing the dressing daily have no evidence-based clinical benefit on outcomes and have a negative impact on patient QOL. Due to risk of antibiotic-resistant infection (e.g., Pseudomonas) from showering or swimming, BT submersion should be avoided.

Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version).

The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.

Safety of Early Bevacizumab Administration after Central Venous Port Placement for Patients with Colorectal Cancer.

Bevacizumab (BEV) requires an adequate withdrawal period to avoid BEV-related complications during major surgery. However, the safety of BEV administration immediately after surgical placement of the central venous (CV) port, a minor surgery, is still unclear. This study aimed to investigate whether BEV is safe when administered early after CV port placement. We retrospectively evaluated 184 patients with advanced colorectal cancer (CRC) treated with a BEV-containing regimen and divided them into two groups according to the interval between CV port implantation and chemotherapy initiation, with the early administration group being ≤7 days and late administration group being >7 days. Complications were then compared between the two groups. The early-administration group was significantly older and had a higher rate of colon cancer than the late-administration group. Overall, 24 (13%) patients developed CV port-related complications. Male sex was a risk factor for complications (odds ratio [OR], 3.154; 95% CI, 1.19-8.36). The two groups showed no significant difference in the frequency of complications (p = 0.84) or patient characteristics (after the inverse probability of treatment weighting, p = 0.537). In conclusion, the frequency of complications is not affected by the timing of BEV initiation after CV port implantation. Thus, early BEV administration after CV port placement is safe.

Survival and Complications After Placement of Central Venous Access Ports for Palliative Chemotherapy: A Single-Institution Retrospective Analysis.

Given the lack of empiric recommendations for vascular access for palliative chemotherapy, we aimed to analyze survival and complications after placement of central venous access ports for palliative chemotherapy. We performed a retrospective chart review of 135 patients undergoing port placement for palliative chemotherapy at a single institution from January 2015 - July 2020. The median age was 68 (range 47-91). Median overall survival was 7.7 months (95% CI, 6.5-8.9 months). The rate of port-related complications was 11.1% (15 of 135). Patients who developed port-related complications required corrective surgery in 73.3% (11 of 15) of cases. Results were similar among all patients, regardless of their primary diagnoses or central venous access sites. Increased awareness about the limited survival of patients after port placement for palliative chemotherapy, and their significant complication risk could be used to help patients and their providers make value-aligned decisions about vascular access.

Technical factors and outcomes in pediatric central venous port placement

Purpose While central venous port placement is common, there remains variation in placement technique and rates of technical complications. The aim of this study was to assess variability in techniques and identify predictors of complications for children undergoing port placement.Methods We retrospectively reviewed all 331 patients who underwent venous port placement at a single tertiary children's hospital from May 2018 to June 2020. The primary outcome was early revision or replacement (R/R) for complications occurring within 30 days. Secondary outcomes included radiation exposure and rate of intraoperative conversion to a secondary site.Results The median age was 7 years (Interquartile Range 3–13 years) and the most common diagnoses were leukemia (30.2%), solid tumors (27.8%), and brain tumors (16.9%). Initial approach for port placement was ultrasound-guided internal jugular (IJV) in 255 (147 by surgery and 108 by interventional radiology [IR]) and landmark subclavian vein (SCV) in 76 (all by surgery). Early R/R occurred in 5.1%, including 9.0% of patients with leukemia but 1.1% with solid tumors. Individual proceduralist volume ranged from 2 to 98 cases and was inversely correlated with early R/R (r = -0.12, p = 0.30). In univariate analysis, ports placed by IR had an increased rate of early R/R (9.3%, n = 10) compared to those placed by surgery (3.2%, n = 7, p = 0.036) but this was not significant in multivariable regression controlling for diagnosis and age (Hazard Ratio 2.04; p = 0.19). Mean fluoroscopy time was significantly longer for ports placed by IR (59.9 s) compared to those placed by surgery (15.1 s, p < 0.001). Initial SCV access was associated with an increased (14.5 vs 0.4%) rate of conversion to a secondary site.Conclusions Though venous port placement is a largely safe procedure in children, a substantial minority of patients, particularly those with leukemia, require early R/R. Proceduralist volume and training may influence early R/R, fluoroscopy exposure, and anatomic site preferences.

Financial Effect of Unbundling Moderate Sedation from Procedural Codes in Radiology

PurposeTo assess and quantify the financial effect of unbundling newly unbundled moderate sedation codes across major payors at an academic radiology practice. Materials and MethodsBilling and reimbursement data for 23 months of unbundled moderate sedation codes were analyzed for reimbursement rates and trends. This included 10,481 and 28,189 units billed and $443,257 and $226,444 total receipts for codes 99152 (initial 15 minutes of moderate sedation) and 99153 (each subsequent 15 minute increment of moderate sedation), respectively. Five index procedures—(i) central venous port placement, (ii) endovascular tumor embolization, (iii) tunneled central venous catheter placement, (iv) percutaneous gastrostomy placement, and (v) percutaneous nephrostomy placement—were identified, and moderate sedation reimbursements for Medicare and the dominant private payor were calculated and compared to pre-bundled reimbursements. Revenue variation models across different patient insurance mixes were then created using averages from 4 common practice settings among radiologists (independent practices, all hospitals, safety-net hospitals, and non-safety-net hospitals). ResultsDepartmental reimbursement for unbundled moderate sedation in FY2018 and FY2019 totaled $669,701.34, with high per-unit variability across payors, especially for code 99153. Across the 5 index procedures, moderate sedation reimbursement decreased 1.3% after unbundling and accounted for 3.9% of procedural revenue from Medicare and increased 11.9% and accounted for 5.5% of procedural revenue from the dominant private payor. Between different patient insurance mix models, estimated reimbursement from moderate sedation varied by as much as 29.9%. ConclusionsDepartmental reimbursement from billing the new unbundled moderate sedation codes was sizable and heterogeneous, highlighting the need for consistent and accurate reporting of moderate sedation. Total collections vary by case mix, patient insurance mix, and negotiated reimbursement rates.

Length of Stay Predicts Risk of Early Infection for Hospitalized Patients Undergoing Central Venous Port Placement

To compare early totally implantable central venous port catheter-related infection rates after inpatient vs outpatient placement and to determine whether the risk associated with inpatient placement is influenced by length of hospital stay. In this single-institution retrospective study, 5,301 patients (3,618 women; mean age 57 y) underwent port placement by interventional radiologists between October 2004 and January 2018. The 30-day infection rate was compared between inpatients and outpatients using survival analysis. Among inpatients, the effect of time from admission to port placement and from placement to discharge was analyzed using a survival regression tree. The 30-day infection rate was 3.6% (95% confidence interval [CI]= 1.9%-6.1%) among 386 inpatients and 1.0% (95% CI= 0.7%-1.3%) among 4,915 outpatients (hazard ratio [HR]= 3.6, 95% CI= 2.0-6.6, P < .001). Inpatient placement was a significant risk factor after accounting for covariates in multivariate analysis (HR= 2.2, 95% CI= 1.0-4.7, P= .05) and controlling for demographic differences by propensity score matching (HR= 2.8, 95% CI= 1.0-7.8, P= .04). Infection rate was 11% (95% CI= 4.7%-22%) among 65 inpatients in whom time from admission to placement was ≥ 7 days, 5.1% (95% CI= 1.9%-11%) among 129 inpatients in whom admission to placement was < 7 days and time to discharge was > 3 days, and 0% (95% CI= 0%-2.1%) among 192 inpatients in whom admission to placement was < 7 days and time to discharge was ≤ 3 days (P < .001). Inpatient port placement was associated with a higher risk of early infection. However, a clinical decision tree based on shorter length of stay before and after placement may identify a subset of hospitalized patients not at increased risk for infection.

Relation between Success Placement of Central Venous Port and Left Brachiocephalic Vein Stenosis

Relation between Success Placement of Central Venous Port and Left Brachiocephalic Vein Stenosis

Placement of Subcutaneous Central Venous Ports in Breast Cancer Patients: Does Side Matter?

BackgroundCentral venous ports placed for breast cancer treatment have traditionally been placed contralateral to the disease. This is done out of concern for the possibility of an increased risk of complications with ipsilateral port placement. There have been only a few small studies evaluating complication rates between ports placed ipsilateral versus contralateral to the breast cancer. We sought to determine if there was a difference in port complications or lymphedema rates by location. MethodsA single institution retrospective review was conducted of adult (aged >18 y) females undergoing central venous port placement for breast cancer treatment from 2012 to 2016. ResultsA total of 581 females were identified with a mean age of 52.9 ± 11.7 y. Ipsilateral ports were placed in 41 patients (7.1%). Ipsilateral ports were more likely to be placed via the internal jugular vein (56.1%), whereas contralateral ports were more likely to be placed in the subclavian vein (67.2%; P = 0.002). There was no difference between stage at diagnosis (P = 0.059), type of breast surgery (P = 0.999), axillary surgery (P = 0.087), or administration of radiation therapy (P = 0.684) between the groups. Ipsilateral ports were more likely to be on the right side, 73.2% versus 51.1% (P = 0.006). Port complications requiring intervention occurred in 3 patients (7.3%) with ipsilateral port and 33 patients (6.1%) with contralateral ports (P = 0.73). Lymphedema occurred in 8 patients (20%) with ipsilateral ports and 118 patients (21.9%) with contralateral ports (P = 0.639). On multivariable analysis, the type of axillary surgery (P = 0.003) was associated with upper extremity lymphedema, whereas port sidedness (P = 0.26) was not. ConclusionsThere was no difference in port complications or lymphedema rates between patients who had ports placed on the ipsilateral side compared with the contralateral side for breast cancer treatment.

Is Intraoperative Fluoroscopy Necessary for Central Venous Port System Placement in Children?

Central venous port (CVP) placement is traditionally performed under fluoroscopy guidance. However, efforts for radiation dose reduction in children have allowed the introduction of ultrasound guidance (USG) and anatomic landmarks as an alternative technique for CVP placement. The aim of this study is to determine whether intraoperative fluoroscopy (IF) is required to confirm the correct position of the catheter tip in children. A prospective, single-center study was performed between July and December 2017. Standard venous access site was the right internal jugular vein under USG. Estimated catheter length (ECL) was measured using anatomic landmarks. Ideal catheter length (ICL) was measured after placement under fluoroscopy guidance in the same patient. Age, sex, radiation dose, and complications were also analyzed. A t-test for paired samples and intraclass correlation coefficient were performed to analyze results. A total of 30 consecutive patients aged 7 ± 2 years underwent CVP placement. The mean ECL was 17.1 ± 1.8 cm, while the mean ICL was 17.7 ± 1.8 cm. The mean difference between measurements was 0.28 cm (95% confidence interval [CI], -0.29 to 0.86; p = 0.324). Intraclass correlation coefficient analysis showed an agreement of 0.95 (95% CI, 0.91-0.98) between measurements. Mean radiation exposure during the procedure was 1.060.78 mGym2 during 0.34 ± 0.6 minutes. There were no complications registered during CVP placement. The correlation between IF and USG and anatomically guided catheter tip placement is optimal. These results suggest that fluoroscopy and the radiation exposure it entails can be safely avoided in selected children.

Dilated Thoracic Duct Terminal and Chyle Withdrawal from a Central Venous Port in Innominate Vein Stenosis

Central vein stenosis is a rare complication that occurs after central venous port placement. We report a case of chyle withdrawal from a central venous port in a patient receiving chemotherapy for stage IV rectal cancer. Dilated thoracic duct terminal and innominate vein stenosis both were clearly shown in the angiography results, and innominate vein stenosis was resolved by performing percutaneous transluminal angioplasty.

Central venous access port placement by translumbar approach using angio-CT unit in patients with superior vena cava syndrome.

To evaluate the clinical results of central venous access port (CV port) placement by translumbar inferior vena cava cannulation using angio-CT unit for cancer patients with superior vena cava syndrome. A CV port was placed by translumbar inferior vena cava cannulation using an angio-CT unit, in 14 consecutive patients. All patients had occlusion or advanced stenosis of the superior vena cava due to cancer progression. The technical success rate of the percutaneous translumbar CV port placement was 100%. The only complication related to port placement was bleeding in the right iliopsoas muscle seen on CT in one patient, but it stopped with conservative treatment. The mean initial device service interval was 125days (range 6-448days). Complications in the chronic phase occurred in two patients, one with catheter-related infection and the other with catheter breakage, for a rate of 0.44/1000catheter days. In the patient with the broken catheter, the port chamber placement site was cut and replaced with a new catheter by guidewire exchange. CV port placement with translumbar inferior vena cava cannulation using an angio-CT unit for cancer patients with superior vena cava syndrome was safe and effective.

Is there any correlation between venipuncture sites and complications of central venous port placement in the chest wall?

BackgroundCentral venous (CV) port is an integral part of chemotherapy and parenteral treatment, for long-term venous access. It is still unclear whether there is a correlation between venipuncture sites, and complications and patency of the CV port placed in the chest wall. MethodsTwo-hundred and sixty-nine patients, who underwent CV port placement in their chest wall, were reviewed retrospectively in this study. They were divided into two groups, the S (subclavian vein) group and I (internal jugular vein) group, according to the venipuncture site. We analyzed the data from the medical records and examined the differences in complications between the two groups. ResultsThe median event free period among all patients was 228 days (range: 5–1877), the cumulative follow-up period was 97,176 catheter days. There were no significant differences between the two groups in terms of sex, age, body mass index (BMI), primary disease, reason for implant, past history of diabetes mellitus and occurrence of procedural complications. The median event free days were 200.0 (6–1846) in the S group and 246.0 (5–1877) days in the I group. The rate of event-free port availability after one, two and three years was 84.6, 74.0 and 66.5% in the S group, and 84.4, 80.3 and 80.3% in the I group respectively, which were not significantly different between the two groups. ConclusionsComplications of CV port placement have no correlation with the subclavian or jugular vein puncture sites.

Result of the feasibility study of lidocaine (LDC) for peripheral venous pain induced by oxaliplatin (L-OHP).

e21624 Background: For the patients with colorectal cancer, CapeOx or SOX, combination of L-OHP with oral fluoropyrimidines Capecitabine or S-1, is commonly used in clinical practice. These regimens, different from FOLFOX, do not necessarily require central venous port placement and can be administered via peripheral vein. However, peripheral vascular pain induced by administration of L-OHP was discussed. Methods: LDC was concomitantly administered through the lateral duct of drip route from 30 minutes before to end of L-OHP administration, to patients with colorectal cancer who are to be administered L-OHP (100 mg/m2 or more) via the peripheral vein for the first time. LDC dose was set at two levels of 0.5 (Level 1) and 1.5 (Level 2) mg / kg / Hr. Safety, symptoms of pain and pharmacokinetics of LDC were evaluated. The DLT criteria were (1) an allergic reaction of Grade 2 or higher, (2) non-hematological toxicity of Grade 3 or more related to LDC, (3) cessation of administration of L-OHP or LDC, (4) higher than 5 mcg / mL of blood concentration of LDC. Results: A total of nine patients were enrolled (Level 1: 3, Level 2: 6). No DLTs were observed. The average Cmax of LDC was 0.4 (range: 0.3 - 0.5) mcg/ml at Level 1 and 1.3 (0.5 - 2.3) mcg / ml at Level 2. In the pain assessment (VAS score), in Level 1, 2 cases did not feel pain, 1 case was 3/10. In Level 2, there were no pain in 4 cases and 2/10 in the remaining 2 cases. Conclusions: To alleviate vascular pain caused by peripheral intravenous administration of L-OHP, concomitant administration of LDC could be safe and effective. Clinical trial information: UMIN000011393.

Efficacy and safety of ultrasound-guided placement of central venous port systems via the right internal jugular vein in elderly oncologic patients: our single-center experience and protocol.

Ultrasound-guidance has become the routine method for internal jugular vein (IJV) catheterization reducing dramatically failure and complication rates for central venous port (CVP) placement. The aim of this study was to determine the safety and efficacy of ultrasound-guided IJV CVP placement in elderly oncologic patients. Between January 2013 and December 2015, 101 elderly oncological patients underwent right IJV CVP placement under ultrasound-guidance. The length of catheter introduction ranged from 18 to 21cm. Intraoperative fluoroscopy (IF) was always performed intraoperatively. Chest X-ray (CXR) was always performed 30min after the end of the procedure. The morbidity rate was 1.98%; two arterial punctures were reported with one self-limiting hematoma. Two patients (1.98%) had catheter misplacements, recognized by intraoperative IF. No patients (0%) experienced pneumothorax (PNX), confirmed at CXR. Patients were all discharged at maximum 6h from the procedure. The risk of catheter misplacement, PNX, and arterial/nerve puncture remains present with this technique. Lower rates of catheter misplacement have been reported after right IJV puncture, probably for its straight vertical course. Our results are in accordance with literature (1 counter-lateral subclavian vein and 1 counter-lateral internal jugular vein misplacements). All misplacements were detected intraoperatively. The PNX rates after cannulation of the IJV vary between 0.0 and 0.5%. We had no PNX occurrence. Ultrasonography (US) has improved safety and effectiveness of port system placements. While routine post-procedural CXR seems avoidable, IF should be considered mandatory.

Ultrasound-Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X-Ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device?

Percutaneous central venous port (CVP) placement using ultrasound-guidance (USG) via right internal jugular vein is described as a safe and effective procedure. The aim of this study is to determine whether intraoperative fluoroscopy (IF) and/or postoperative chest X-ray (CXR) are required to confirm the correct position of the catheter. Between January 2012 and December 2014, 302 adult patients underwent elective CVP system placement under USG. The standard venous access site was the right internal jugular vein. The length of catheter was calculated based on the height of the patient. IF was always performed to confirm US findings. 176 patients were men and 126 were women and average height was 176.2cm (range 154-193cm). The average length of the catheter was 16.4cm (range 14-18). Catheter malposition and pneumothorax were observed in 4 (1.3%) and 3 (1%) patients, respectively. IF confirmed the correct position of the catheter in all cases. Catheter misplacement (4 cases) was previously identified and corrected on USG. Our rates of pneumothorax are in accordance with those of the literature (0.5-3%). Ultrasonography has resulted in improved safety and effectiveness of port system implantation. The routine use of CXR and IF should be considered unnecessary.