Trigger arrhythmia to confirm the position of totally implantable access ports (TIAP)

Abstract

Checking the position by triggering arrhythmia while performing TIAP with cephalic vein cutdown in case of C-arm was not available is simple and safe.

Modification of approach for totally implantable venous access device decreases rate of complications

“…Insertion of the catheter without imaging support may be successful in the majority of patients, thus avoiding additional costs of US or fluoroscopy [16,17]. The practice of implanting these catheters as an outpatient procedure, without perioperative radiological control, is well-established [18,19].…”

“…Careful attention to anatomic landmarks and operator experience with the placement of central venous catheters via SV is the most important factor for avoidance of complications such as pneumothorax [16]. Insertion of the catheter without imaging support may be successful in the majority of patients, thus avoiding additional costs of US or fluoroscopy [16,17]. The practice of implanting these catheters as an outpatient procedure, without perioperative radiological control, is well-established [18,19].…”

Conversion From Cephalic Vein to External Jugular Vein

“…The cephalic vein was identified for about 1 cm, the distal end was ligated, and the proximal end was lifted. Then the TIAP catheter was introduced after making a tiny hole over the cephalic vein as described by Hsieh et al 2 Once the cephalic vein cut-down method failed, the percutaneous subclavian puncture method (29 cases; method of group A) and the external jugular vein cutdown method (27 cases; method of group B) were tried.…”

“…TIAPs are usually inserted in the subclavian region, and could be completed by 2 methods: cut-down and percutaneous. 1,2 The cutdown method has the advantage of direct vision of the cephalic vein and thus have no risks of pneumothorax, hemothorax, and injury of larger vessels. 3,4 However, cephalic vein cut-down has a failure rate of 6% to 30%.…”

Prone positioning induced tachyarrhythmias from an implantable central venous access device

“…Movement of the catheter tip may lead to mechanical irritation of the myocardium and result in cardiac arrhythmias. Indeed, rhythm disturbances are frequently seen during TIVAS insertion, with some centres even using a trigger arrhythmia to confirm catheter tip position [2]. While the majority of the associated dysrhythmias are largely benign, and are reversible by minor catheter adjustment before fixation, such as slight withdrawal, it is important to remain aware of the potential for central venous catheter displacement to cause more serious cardiac arrhythmias.…”