Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience

Jonczyk, Martin; Gebauer, Bernhard; Rotzinger, Roman; Schnapauff, Dirk; Hamm, Bernd; Collettini, Federico

doi:10.21873/invivo.11222

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…With a median DAP of 130.3 μGy·m 2 and median fluoroscopy times of 56 s, the radiation doses found in our study are lower than those that have been reported in a study from 2006, analyzing 303 pectoral port implantation procedures (median DAP: 373 μGy·m 2 ; median FT: 210 s) [ 34 ]. In contrast, our procedure-related radiation doses exceed those of a study by Jonczyk et al [ 35 ] from 2018, in which median DAP values of 57.3 μGy·m 2 and median FT values of 24 s were reported in port implantation in a pectoral position performed by senior radiologists. In that study, authors found decreased radiation doses for jugular venous access compared to subclavian access routes and in right-sided jugular accesses compared to left.…”

Section: Discussioncontrasting

confidence: 81%

Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

et al. 2022

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Background Children with different underlying malignant diseases require long-term central venous access. As for port systems in a pectoral position, peripherally implanted port systems in the forearm revealed high levels of technical and clinical success in adult cohorts. Objective To investigate the technical and clinical outcomes of percutaneous central venous port implantation in the forearm in adolescents. Materials and methods Between April 2010 and August 2020, 32 children ages 9 to 17 years with underlying malignancy received 35 totally implantable venous access ports (TIVAPs) in the forearm. All venous port systems were peripherally inserted under ultrasound guidance. Correct catheter placement was controlled by fluoroscopy. As primary endpoints, the technical success, rate of complications and catheter maintenance were analyzed. Secondary endpoints were the side of implantation, vein of catheter access, laboratory results on the day of the procedure, procedural radiation exposure, amount of contrast agent and reasons for port device removal. Results Percutaneous TIVAP placement under sonographic guidance was technically successful in 34 of 35 procedures (97.1%). Procedure-related complications did not occur. During the follow-up, 13,684 catheter days were analyzed, revealing 11 complications (0.8 per 1,000 catheter-duration days), Of these 11 complications, 7 were major and 10 occurred late. In seven cases, the port device had to be removed; removal-related complications did not occur. Conclusion Peripheral TIVAP placement in the forearms of children is a feasible, effective and safe technique with good midterm outcome. As results are comparable with standard access routes, this technique may be offered as an alternative when intermittent venous access is required.

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Section: Discussioncontrasting

confidence: 81%

Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

et al. 2022

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“…Previous research has highlighted the significant role of a radiologist's experience in reducing periprocedural radiation. For instance, Joncyk et al demonstrated that senior radiologists required notably less FT (a reduction of 42%) and DAP (a reduction of 16%) for central venous port catheter implantation [24]. Similarly, Xu et al found that, when radiology residents performed central venous catheter implantations, compared to staff radiologists, FT nearly doubled [25].…”

Section: Discussionmentioning

confidence: 99%

“…Joncyk et al identified senior radiologists based on the total number of procedures, using a cutoff of 50 [24]. Conversely, Xu et al distinguished between residents and staff radiologists [25].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Periprocedural X-ray Exposure in Transarterial Radioembolization with Glass or Resin Microspheres

Ehrengut,

Vogt,

Leonhardi

et al. 2023

Diagnostics

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Background: Transarterial Radioembolization (TARE) is an effective treatment option for both primary and secondary liver malignancies. However, challenging anatomical conditions can lead to prolonged fluoroscopy times (FT), elevated doses of periprocedural X-radiation (DAP), and increased use of contrast agents (CAs). In this study, we examined the influence of our radiologists’ experience and the choice of microspheres on X-ray exposure and CA doses in TARE. Material and Methods: Datasets comprising 161 TARE and 164 preprocedural evaluation angiographies (TARE-EVA) were analyzed. Our study focused on assessing DAP, FT, and CA concerning both microsphere types, the radiologist’s experience, and whether the same radiologist performed both the TARE-EVA and the actual TARE. Results: In TARE, the use of resin microspheres resulted in significantly higher FT and CA compared to glass microspheres (14.3 ± 1.6 min vs. 10.6 ± 1.1 min and 43 ± 2.2 mL vs. 33.6 ± 2.1 mL, p < 0.05), with no notable differences in DAP (p = 0.13). Experienced radiologists demonstrated reduced FT/DAP, with a 19% decrease in DAP and 53% in FT during the evaluation angiography (p < 0.05) and a 49% reduction in DAP during the actual TARE (p < 0.05), with no statistical differences in FT. Performing TARE and TARE-EVA under the same radiologist led to a 43% reduction in DAP and a 25% decrease in FT (p < 0.05, respectively). Conclusions: To mitigate X-radiation exposure, it is advisable for radiologists to undergo thorough training, and, ideally, the same radiologist should conduct both the TARE and the TARE-EVA. While the use of glass spheres may decrease intraarterial CA, it does not significantly impact periprocedural X-ray exposure.

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“…The only constant issue is that they all require accurate positioning of the catheter tip. If the central venous catheter is too shallow, the incidence of phlebitis and venous thrombosis increases ( 28 ). If the catheter is implanted too deeply, the head end may enter the right atrium, which may lead to complications such as arrhythmia or myocardial injury ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Application of intracavitary ECG for positioning the totally implantable venous access port in the upper arm of cancer patients

et al. 2022

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Accurate positioning of the catheter tip is one of the most critical procedures in central venous catheter insertion. The traditional surface measurement method frequently has a large deviation and increases the X-ray exposure of doctors and patients. In the present retrospective study, cancer patients who received a totally implantable venous access port (TIVAP) in the upper arm using intracavitary electrocardiogram (ECG) guidance were compared with those where the traditional surface measurement method was used in terms of the rate of correct placement of the catheter tip, the rate of achieving the best position, the operation time and the complications. The results indicated that the correct placement rate and the best position rate of the catheter tip at the first attempt were higher in the ECG-guided group than in the traditional surface measurement method group (95.65 vs. 82.91% and 90.58 vs. 68.38%, respectively). The mean operation time was shorter in the ECG-guided group than in the surface measurement group (46.28 vs. 63.26 min). The incidence of complications in the ECG-guided group was 6.52%, while that in the surface measurement group was 10.26%. This indicated that the intracavitary ECG-guided tip positioning technique may improve the accuracy of tip catheter placement and shorten the operation time, thus reducing ionizing radiation caused by repeated positioning. Therefore, the intracavitary ECG-guided tip positioning technique is able to effectively place the tip of the TIVAD in the upper arm, holding great promise as a clinical application.

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Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience

Cited by 5 publications

References 41 publications

Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

Percutaneous implantation of peripherally inserted totally implantable venous access systems in the forearm in adolescent patients

Analysis of Periprocedural X-ray Exposure in Transarterial Radioembolization with Glass or Resin Microspheres

Application of intracavitary ECG for positioning the totally implantable venous access port in the upper arm of cancer patients

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