Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route?

Abstract

Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20 mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P = 0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P = 0.02), and longer implanted catheter length (P = 0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy.

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

“…In spite of these strategies, many physicians continue to recommend the use of IF for CVP placement, citing a lower risk of tip malposition as well as catheter migration. [15][16][17] We believe that although IF helps secure correct catheter tip location, it may not be strictly necessary in all cases, and its use could be limited to situations of technical difficulties or complex patients.…”

Long-Term Results of a Standard Algorithm for Intravenous Port Implantation

“…In addition, pneumothorax [ 13 , 14 ] and catheter fracture related to pinch-off syndrome [ 19 ] are completely avoided. Fourth, enforce quality control by the addition of quantified catheter length formulae [ 20 ] for catheter length estimation and intra-operative fluoroscopy [ 21 ].…”