Chest Port Placement Research Articles

Abstract No. 20 Right- versus Left-Sided Chest Ports in Oncologic Patients: Are There Any Differences in Complication Rates after Propensity Score Matching?

There is a lack of consensus as to whether the laterality of central venous chest port (port) placement is a risk factor for port complications. This is partly because confounding variables were suboptimally controlled in prior studies. The purpose of this study is to retrospectively compare the port-related complication rate between right-sided and left-sided ports placed in oncologic patients using propensity score matching. A total of 3,126 consecutive adult (≥18 years old) oncologic patients (male/female: 1,571/1,555, median age: 62) who had a port placed between 2013 and 2021 were included in this study. Patients with port complications (infectious, mechanical, thrombotic, and skin complications) were identified through chart review. Propensity score matching generated a cohort of 277 pairs of patients for the right-sided and left-sided port groups that are balanced across 11 potentially confounding variables. The overall complication rate of each group was compared using Poisson regression. Multivariate proportional subdistribution hazard regression (PSHREG) analysis was also conducted to determine if port laterality is an independent risk factor for overall port complications. The cumulative follow-up period for the matched cohorts was 259,250 catheter-days (median per patient: 311 catheter-days, range:10–2,879 catheter-days). In the left-sided port group, a total of 59 ports (21.3%) were found to be associated with complications (36 infectious, 7 mechanical, 11 thrombotic, 12 skin-related), while 31 ports in the right-side port group (11.2%, P = 0.0013) were associated with complications (13 infections, 3 mechanical, 8 thrombotic, 8 skin-related), accounting for complication rates of 0.46 and 0.24 complications/1000 catheter-days, respectively (P = 0.0022). PSHREG analysis of the matched cohort further demonstrated laterality of port as an independent risk factor for port complication (hazard ratio = 2.015, 95% confidence interval = 1.306-3.108, P = 0.0015). Left-sided ports were associated with a higher risk of port complications when compared with right-sided ports in adult oncological patients based on propensity score matching analysis. The right-sided port placement is recommended to minimize the risk of port complications.

The Effect of Immediate Versus Delayed Port Access on 30-Day Infection Rate.

This study compared the 30-day infection risk of chest ports accessed on the same day as placement and chest ports with delayed initial access. The aim was to evaluate a larger data set that provided evidence for the development of port access guidelines. A retrospective chart review of 3322 chest port placement procedures performed between October 15, 2003, and June 10, 2015, was conducted at the interventional radiology department of a single institution. Procedure notes and health records were reviewed to determine time of initial port access, evidence of infection within a 30-day window of port placement, and causal organism(s) of infection. The results demonstrated that 64 ports (1.93%) met infection criteria within 30 days of placement, including 30 of the 945 ports immediately accessed and 34 of the 2377 ports not immediately accessed (3.17% vs 1.43%; P < .005). Dual lumen devices had a statistically significant higher rate of infection compared with single lumen devices (P = .006). This study concluded that there is a statistically significant higher rate of infection if a port is accessed immediately versus when access is deferred to later than 24 hours after placement.

3:09 PM Abstract No. 356 Chest port flipping: incidence and risk factors

To retrospectively investigate the incidence and risk factors of chest port flipping in adult patients (age ≥18 years). A total of 2859 adult patients (male: 1442 and female: 1417, median age: 61) who underwent chest port (port) placement between January 2013 and August 2019 were included in the study. There were 2707 (94.7%) oncology and 152 (5.3%) non-oncology patients. Either single (n = 915) or double lumen (n = 1944) ports were placed without suture fixation. Patients with port flipping were identified through chart and imaging review. Port flipping was diagnosed when the port was not accessible and the reservoir had rotated at least 90°. To elucidate the risk factors for port flipping, binary logistic regression analysis was conducted with using variables from patients’ demographics (age, sex, body mass index (BMI), clinical history) and port characteristics (right vs. left placement, number of lumen(s)). A total of 10 patients with port flipping (0.3%) including 9 female and one male were identified. The median time to port flipping was 14.5 days (range, 2-63 days). All except one were single-lumen ports. Seven patients (70%) had BMI>30. Of all, 4 were exchanged for double lumen ports, 3 including one double lumen port were removed, 2 were fixed with sutures, and 1 was replaced in a new pocket. In multivariate analysis, single lumen (odds ratio (OR) 17.9, confidence interval (CI) 2.26-142.9, P = <0.01) was significant, and BMI>30 (OR 3.74, CI 0.96-14.6, P = 0.06) and female sex (OR 7.78, CI 0.98-61.7, P = 0.052) were marginally significant risk factors for port flipping. Flipping of ports placed without suture fixation is a rare complication. Suture fixation may need to be considered when placing a single lumen port in female patients with BMI>30 to prevent port flipping.

Peripherally inserted central catheter ports: A vascular access specialist's systematic approach

Implanted ports are an important vascular access device for patients with malignancies requiring long-term chemotherapy. Peripherally placed ports are increasing in use as they are a safe, cost-effective alternative to chest-placed ports. Most peripheral ports can be placed bedside by specialist nurses in designated clinical areas rather than costly operating rooms or interventional radiology suites. Peripheral ports are considered less invasive compared with chest port placement because of reduced procedural risk. To enhance the success rate of peripheral port placement and minimize risks, we provide vascular access specialists with a systematic approach along with some technical advice tips and tricks to help avoid mechanical complications such as repeated puncture of the vein, excessive bleeding, thrombosis or skin dehiscence, as wellas latent complications such as catheter migration and catheter-related blood stream infection.

Association between Periprocedural Neutropenia and Early Infection-related Chest Port Removal.

Background Patients who require long-term central venous access can present for port placement with depressed immune function as a result of their treatment or disease process. At present, there is no consensus regarding whether neutropenia at the time of port placement confers a higher risk for early infection-related port removal. Purpose To compare the incidence of early infection-related chest port removal in adults when placed in neutropenic versus nonneutropenic patient groups. Materials and Methods This retrospective cohort study examined 2580 port placements in 1081 men (41.9%) and 1499 women (58.1%) at a single tertiary medical center between June 2007 and July 2017. Mean patient age ± standard deviation was 56 years ± 14 (range, 18-91 years). The electronic medical record was used to identify neutropenia (absolute neutrophil count <1500 cells/mm3) at the time of port placement and incidence of infection-related port removal. Electronic medical record follow-up was conducted for 30 days following port placement. End points were infection-related port removal or death related to port infection within 30 days. Statistical analysis compared the neutropenic (n = 159) and nonneutropenic (n = 2421) patient groups by using a χ2 test for categorical data and a Student t test for continuous variables, with a Fisher exact test to compare incidence of port removal and death related to port infection. Results Ports placed in patients with neutropenia had an infection-related removal rate of 3.8% (six of 159) versus 0.91% (22 of 2421) in patients without neutropenia (P = .003). Patients with neutropenia had a port infection-related death rate of 0.63% (one of 159) versus 0.12% (three of 2421) for patients without neutropenia (P = .22). Conclusion Neutropenia in adults at the time of implantable subcutaneous chest port placement was associated with a higher risk for early infection-related port removal. There was no difference in the incidence of death related to port infection in neutropenic or nonneutropenic populations. © RSNA, 2019 See also the editorial by Johnson in this issue.

Abstract No. 632 A retrospective analysis of lidocaine with epinephrine versus lidocaine alone in the placement of chest ports: does the vasoconstrictive effect of epinephrine result in shorter procedure times?

The vasoconstrictive effect of epinephrine makes it a theoretically useful addition to lidocaine in the placement of chest ports. Recently, there has been a national shortage of lidocaine with epinephrine (LE) resulting in the routine use of lidocaine without epinephrine (L) for port placement. Based on anecdotal evidence, this has resulted in increased procedural bleeding and longer procedure times. The goal of the current study is to retrospectively compare chest port procedure times in patients receiving LE versus L. A retrospective analysis of 139 patients undergoing chest port placement from January through July 2017 was performed. Patient demographics included gender, age and procedure indication. Technical variables included number of port lumens, port laterality, local anesthetic type, use of sharp versus blunt dissection and procedure time. Laboratory parameters included platelet and international normalized ratio. Primary outcome included mean procedure time in minutes. Secondary outcome included port removal secondary to infection and/or hematoma. Descriptive statistics in addition to student’s t-test for comparison of means was performed. 139 patients (33 men, 106 women, mean age 57.4 years) were analyzed. 77 (55.4%) patients had ports placed with LE; 62 (44.6%) with L. 3 ports (2.2%) were removed because of hematoma and/or infection. No significant difference in mean procedure time between the two groups (23.6 (SD 6.4) LE vs 25.1 (SD 10.4) L, P = 0.30) was observed. Among operators utilizing sharp dissection techniques, significant differences in mean procedure time were observed (19.2 (SD 4.3) LE vs 25.4 (SD 8.5) L, P = 0.02). No significant differences were observed in those operators utilizing blunt dissection techniques (24.5 (SD 6.4) LE vs 25.0 (SD 10.8) L, P = 0.74). No significant differences in procedural time or procedural complications were observed in patients receiving LE compared to L. Operators utilizing sharp dissection techniques may benefit from the use of LE for local anesthesia.

3:36 PM Abstract No. 195 Chest port placement in patients with a history of port removal: is there any difference in the incidence of complications between ports placed in the same and opposite side of chest wall as the prior port?

3:36 PM Abstract No. 195 Chest port placement in patients with a history of port removal: is there any difference in the incidence of complications between ports placed in the same and opposite side of chest wall as the prior port?

Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

BackgroundTotally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate.Materials and methodsData on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room.ResultsBetween 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30–120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic.ConclusionOur results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

3:36 PMAbstract No. 420 - Implantable chest port placement in young patients with severe neutropenia

3:36 PMAbstract No. 420 - Implantable chest port placement in young patients with severe neutropenia

Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room

PurposeTo compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). MethodsThis study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients’ demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. ResultsEarly complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P < .0001). Overall average cost to place chest ports in an OR setting was almost twice that of placement in the IR suite. ConclusionsHospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections.

5:36 PM, Abstract No. 326 - Advanced stage breast cancer is associated with catheter-tip thrombus formation following subcutaneous chest port placement

5:36 PM, Abstract No. 326 - Advanced stage breast cancer is associated with catheter-tip thrombus formation following subcutaneous chest port placement

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

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.

Further Data About Upper Extremity Ports

We would like to reply to the questions raised by article published in the April 2010 issue by Goltz et al. [1], ‘‘Peripherally Placed Totally Implantable Venous Access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients.’’ The authors report on one of the largest series of percutaneous ultrasound-guided arm vein access with concomitant port chamber placement in the forearm. The authors state—and we fully agree—that percutaneous access via radiological guidance increases the technical success rate and greatly decreases the procedurerelated complication rate in comparison to the surgical techniques. With ultrasound real-time guidance, the technical success vein access rate reaches up to 99–100% vs. 94% by venography guidance [2–4]. To our opinion, the latter should only be indicated in obese patients, in whom ultrasound scan is often of poor quality, and in patients with previous ipsilateral catheter [5]. Goltz et al. also question two main issues: the value of antibiotic prophylaxis, and the necessity of randomized trials comparing upper extremity and surgical chest port device insertion techniques. We recently collected the data of a randomized trial granted by the French Ministry of Health, the aim of which was to compare image-guided arm port device insertion in the interventional radiology suite (R) to surgical chest port placement using the cephalic vein cutdown in the operating room (S) [6]. Among 382 oncology patients, 230 were randomized to one of the two groups. Patients receiving anticoagulant therapy or with a history of thromboembolic events were excluded from the trial. No patients received antibiotic prophylaxis before venous device placement. Our analysis showed that septic complications, including local and systemic infections, accounted for 0.02 of 100 patient-days (cumulative duration with implanted port device of 61,082 days). Compared to the reported septic rate of Goltz et al. of 0.013 per 100 patient-days obtained with antibiotic prophylaxis (cumulative duration of 372,499 days), this difference seems to be nonsignificant by Fisher’s exact test. We thus advocate such a prophylaxis in selected patients including immunocompromised patients or those presenting diabetes mellitus. Concerning septic complications, in our own trial, bacterial result assessment disclosed a strong predominance of Staphylococcus aureus in patients with sepsis in whom the procedure had been performed in the radiology suite, whereas resistant germs (nosocomial infections) were found in the operating room group (surgical chest port patients). It is noteworthy that the C-reactive protein curve mapped during follow-up was used as a key retrospective diagnostic tool to incriminate the port device as the cause of sepsis in doubtful cases. A marked drop in C-reactive protein levels after removal of the suspicious device was P.-Y. Marcy (&) N. Amoretti Interventional Radiology Department, Antoine Lacassagne Cancer Research Institute, Sophia Antipolis University, 33 Avenue Valombrose, 06189 Nice cedex 1, Nice, France e-mail: pierre-yves.marcy@cal.nice.fnclcc.fr; pymarcy@hotmail.com

Complication Rates and Outcomes of 536 Implanted Subcutaneous Chest Ports: Do Rates Differ Based on the Primary Operator's Level of Training?

Totally implanted subcutaneous central venous access devices (chest ports) are an attractive option for patients in need of intermittent, recurrent venous access. In our department, these are placed by different operator types including interventional radiology (IR) attending physicians, dedicated IR nurse practitioners (NP), and IR fellows/radiology residents. The purpose of our study is to assess the rate of complications of subcutaneous chest port placement among the different operator types.A retrospective review of all subcutaneous central venous access devices implanted in our department between October 8, 2004, and October 19, 2007, was undertaken. Total numbers of port days, overall complication rates for all operators, as well as complication rates for the various operator types were calculated and were compared using the chi square test.A total of 558 patients had totally implanted subcutaneous central venous access devices placed during the period of study. Of these, 536 had documented follow-up and comprise the study population. A total of 89 were placed by attending physician alone, 133 by an NP, and 314 by an IR fellow or resident, with supervision by an attending physician. Mean duration of port usage was 341 days with 182,522 total port days. A total of 39 complications occurred (7.28%), including 27 infections (5%). There was no statistically significant difference in overall complication rates, including infection rates, among operator groups (P = .925).Our results confirm that well-trained physician extenders and trainees can safely perform chest port placement and that these providers, under appropriate supervision, can help provide improved access to chest port placement for patients and referring clinicians.

Chest Port Placement with Use of the Single-incision Insertion Technique

To evaluate the single-incision technique for the placement of subcutaneous chest ports. Advantages, technical success, and complications were assessed. From March 2007 through May 2008, 161 consecutive chest ports were placed with a modified single-incision technique and sonographic and fluoroscopic guidance via the right internal jugular vein (IJV; n = 130), right external jugular vein (n = 1), right subclavian vein (n = 1), or left IJV (n = 28). The primary indication was for long-term chemotherapy; all patients had malignancy. All single-incision chest port insertions were technically successful. Ports were placed in patients 19 months to 93 years of age (mean, 56.3 y), with a mean follow-up of 203.6 device-days per patient and a total of 32,779 catheter access days. No procedure-related complications, pocket hematomas, venous thromboses, or pneumothoraces were observed. Minor delayed complications occurred in three patients. Premature catheter removal was required for two patients (1.2%; 0.006 per 100 catheter-days). One port was removed less than 30 days after implantation for infection of the pocket (0.61%; 0.003 per 100 catheter-days). Another catheter was removed because of patient dissatisfaction and unconfirmed concerns with arrhythmia (0.61%; 0.003 per 100 catheter-days). One minor superficial wound infection was successfully treated with oral antibiotics, with the port kept in place. Use of a single-incision technique for chest port implantation in adult and pediatric oncology patients is feasible. This may be the preferred method of subcutaneous port placement, as it has a very low complication rate and a high success rate. Prospective evaluation is needed to compare it versus the conventional two-incision technique.

A comparison between distal and proximal port device insertion in head and neck cancer

Aim To compare technical feasibility and complications of radiologically arm port device implantation using arm venography exclusively (API-Group B) with chest port placement using cephalic vein cutdown (CVC-Group A), in advanced consecutive head and neck cancer patients (HNP). Methods Port device placement was attempted in 225 consecutive HNP. Decision for inclusion in Group A or B was made first by the availability of the surgeon/radiologist to perform the procedure, second by contraindications of each technique. Patient transfer from one group to the other was recorded as well as technical feasibility, complications and device specific duration in this retrospective study. Results Technical success was statistically higher in Arm Port Group (99.1%) compared to Chest Port Group (75.2%). Device specific duration rate of the whole population was 53% (95%CI) [0.47–0.60] at 6 months, 44.1% (95%CI) [24.4–37.8] at 12 months and 8% (95%CI) [4.4–14.5] at 24 months. Median follow-up was 5.55 months (range: 0.032–9.6] in Group A versus 5.90 months [range: 0.06–27.6] ( p = ns) in Group B. Complication rate was 15.9% in Group A versus 8.9% in Group B corresponding to a complication rate per patient-implantation-days of 0.66/1000 patient-days (A) versus 0.42/1000 patient-days (B). Premature port device explantation rate was 4.4% (A) versus 5.4% (B). Axillary and subclavian venous thrombosis was the main complication and occurred in 12 Group A patients and three Group B patients. Venous thrombosis rate was 0.37/1000 patient-days (A) and 0.13/1000 patient-days (B) ( p = 0.03). Conclusions A few data exist about device insertion in HNP in whom venous cervical access is contraindicated. This comparative study demonstrates that both implantation techniques are safe and effective. The higher technical success rate with 0% heavy sedation, the lower venous thrombosis rate in the API group, and the 5.3% (A–B) patient transfer rate argue in favour of arm port placement in HNP. Indications for API include patients with an ipsilateral major pectoralis-myocutaneous flap, with radiodermatitis, tumour recurrence in the neck and upper chest, or with respiratory impairment.

Radiologically Placed Venous Ports in Children

To evaluate the procedural and follow-up results of radiologic central venous port placement in pediatric patients. Between July 2002 and July 2006, 127 chest ports were placed in 122 pediatric patients (80 boys, 42 girls). Five patients underwent port implantation twice. The mean age of the patients was 8.5 years (range, 4 months to 18 years). The most common underlying disease was leukemia (66%). Internal jugular vein access was used in all patients. All types of anesthesia or sedation for the procedures were applied by anesthetists in the angiography suite. Retrospective evaluation of an electronic database and hospital charts was performed for the detailed follow-up. Technical success rate was 100%. The mean catheter life was 459 days (total, 51,373 d; range, 16-1,297 catheter-days). Overall, 82 ports are still in use, 10 patients are deceased, and eight (7.1%) and 12 (10.7%) ports were removed at the end of treatment or as a result of complications, respectively. One patient (0.9%) died 167 days after port implantation as a result of unconfirmed port-related sepsis. Eight ports (7.1%) were explanted as a result of infectious complications, three (2.7%) required removal for skin erosion, and one (0.9%) was explanted as a result of a broken catheter. The rate of confirmed overall port-related infection was 14.3%, or 0.31 infections per 1,000 catheter days. Fifteen patients were lost to follow-up. Chest port placement by interventional radiologists in pediatric patients is safe, with a high rate of technical success and low rate of complications.

Radiation Doses from Venous Access Procedures

To retrospectively analyze radiation dose data for six common venous access procedures. Institutional review board approval was obtained for this HIPAA-compliant study; informed consent was not required. Data review was limited to a quality assurance database. Patient medical records were not reviewed. We retrospectively analyzed radiation dose data from a prospective quality assurance program. Dose data were analyzed for 1010 instances of six different venous access placement procedures performed between February 1998 and July 2004. Radiation dose measurements were generated automatically by the interventional fluoroscopy units and were recorded at the conclusion of each procedure. Descriptive and summary statistical analyses were performed to determine median, minimum, and maximum values of radiation dose for each procedure. A P value of less than .05 indicated a significant difference. Because the data distribution was highly skewed, logarithmic transformation was performed. Dose data for four different venous access procedures (excluding chest port placement and peripherally inserted central catheter placement) were compared with a one-way analysis of variance. Pairwise comparisons with the Tukey honestly significant difference test were subsequently performed for each analogue where analysis of variance demonstrated a significant result. No procedure yielded a cumulative dose of more than 950 mGy or a peak skin dose of more than 760 mGy. The highest mean cumulative dose (ie, 88 mGy), mean dose-area product (ie, 873 cGy . cm(2)), and mean peak skin dose (ie, 43 mGy) were observed for tunneled dialysis catheter placements. Significant differences in dose were observed for tunneled catheter placement versus nontunneled catheter placement (<.001 to .027). No significant differences in dose were observed for larger-diameter versus smaller-diameter catheters. Radiation doses from venous access procedures are low. Even extreme outlier cases are unlikely to produce doses high enough to cause skin effects, especially when knowledgeable operators using well-calibrated equipment perform the procedures.

Radiological placement of chest ports in pediatric oncology patients.

A single center's procedural and follow-up results of radiological chest port placement in pediatric oncology patients are presented. Between July 2002 and December 2003, 37 children (20 boys, 17 girls; age range, 4 months to 16 years; mean 6.7 years) underwent chest port placement. All patients received only one port through the internal jugular vein access, and all of the implantations were performed in the interventional radiology suite. Our database and electronic charts were retrospectively reviewed to obtain follow-up data. All chest ports were successfully implanted. The mean catheter life was 223 days (range: 15-450 days), with a total of 8,258 catheter days. Twenty-eight ports are still in use, four patient deceased, one port was prematurely removed because of a late infection, and four patients were lost to follow-up. Infection rate was 2.7% (0.12/1,000 catheter days). Malfunction due to partial catheter thrombosis and fibrin sheath formation was observed in three patients (8.1% or 0.36/1,000 catheter days), and all were relieved with rt-TPA dwell. None of the ports were revised or removed because of blockage, malposition or difficulty accessing the port. The peri-procedural complication rate was 0%. Chest ports in children can be inserted in interventional radiology suites under imaging guidance with high rates of technical success. The rates of infection and complications are comparable to that of surgically placed ports.

Relationship between Chest Port Catheter Tip Position and Port Malfunction after Interventional Radiologic Placement

The relationship between catheter tip position of implanted subcutaneous chest ports and subsequent port malfunction was investigated. Tip movement from initial supine position to subsequent erect position was also evaluated. Patients who underwent imaging-guided internal jugular chest port placement between July 2001 and May 2003 were identified with use of a quality-assurance database. Sixty-two patients were included in the study (22 men and 40 women), with a mean age of 58 years (range, 27-81 years). Catheter tip location on the intraprocedural chest radiograph was determined with use of two methods. First, the distance from the right tracheobronchial angle (TBA) was recorded (TBA distance). Second, tip location was classified into six anatomic regions: 1, internal jugular veins; 2, brachiocephalic veins; 3, superior vena cava (SVC; n = 11); 4, SVC/right atrial junction (n = 22); 5, upper half of right atrium (n = 25); and 6, lower half of right atrium (n = 4). For the duration of follow-up, catheter tip location was documented, as were all episodes of catheter malfunction. Patients with catheter tips initially placed in position 3 had a higher risk of port malfunction (four of 11; 36%) than patients with catheter tips located in position 5 (two of 25; 8%). This difference narrowly fell short of statistical significance (P =.057). When comparing intraprocedural chest radiographs to the first erect chest radiographs, significant upward tip movement was noted. The tips migrated cephalad an average of 20 mm (P =.003) and 1.0 position units (P =.001). Catheter tips placed in the SVC tended to have a greater risk of port malfunction compared with those positioned in the right atrium. Chest ports migrated cephalad between the supine and erect positions.