Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

Abstract

Purpose:To report our early experience in image-guided chemoport insertions by interventional radiologists.Materials and Methods:This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy.Results:The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%), followed by catheter-related infection (9/161; 5.6%). Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8%) chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit.Conclusion:Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

Insertion of Totally Implantable Central Venous Access Devices by Surgeons

“…In many studies about TICVAD, procedures were performed more commonly by interventional radiologists than by general surgeons and thoracic surgeons [ 2 , 6 , 8 , 9 , 10 ]. TICVAD insertion by interventional radiologists was performed under ultrasound guidance while the blind technique was used in procedures performed by surgeons [ 2 , 4 , 6 , 8 , 9 , 11 , 12 , 13 ]. We also used the blind technique, in which TICVAD insertion was performed by using the Seldinger maneuver without ultrasound guidance and chest PA, to check the catheter's position and to detect a pneumothorax or a hemothorax.…”

“…Of the early postprocedure complications, the most dangerous complications are a pneumothorax and a hemothorax [ 7 , 11 , 13 , 14 ]. Fortunately, we did not experience these fatal events.…”

“…The guide wire must be inserted below the right atrium because, in a few cases, irritation of the right atrium or the right ventricle has been reported as a possible risk for arrhythmia [ 5 ]. When selecting the internal jugular vein, the surgeon must confirm, by using ultrasound and/or a relatively smooth in-and-out of the guide wire, that the jugular vein, not the carotid artery, has been punctured [ 5 , 11 ]. Considering the purpose of a TICVAD for long-term usable intravenous access, we need to take many precautions to prevent long-term complications, such as inflammation, thrombosis, occlusion, and skin necrosis.…”

Preliminary experience on subcutaneous venous access device (chemoport) in a teaching hospital in Kathmandu

“…It can be kept for two years. It is now safe, easy and cosmetically acceptable procedure 1 . Chemoport can be inserted to right internal jugular vein (IJV) or right subclavian vein.…”

“…Chemoport can be inserted to right internal jugular vein (IJV) or right subclavian vein. Many centers prefer right IJV as the fi rst choice 1,2 as complication like pneumothorax can be avoided.…”