Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

Abstract

ObjectiveTo assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein.Materials and MethodsWe retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records.ResultsA total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively).ConclusionRadiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.

Heparin versus Saline Solution for Locking of Totally Implantable Venous Access Port (TIVAP): Cohort Study of the First Kurdistan Series of TIVAP

“…No any arterial puncture reported despite that we did not used any sonographic guide to localize the vein, these findings is are not agreed by other investigators who reported that the use of sonographic guidance may decrease the rate of puncture related complications [20]- [23].…”

Malfunction of Totally Implantable Central Venous Ports

“…If the TICVP is inserted via the left internal jugular vein, and the catheter is slightly retracted, the end of catheter tip may be pressed against the lateral wall of the superior vena cava causing occlusion of the catheter. Thrombosis within the chamber and catheter can be resolved by thrombolysis using urokinase (5).…”

“…The ultrasound guided puncture of veins and fluoroscopic positioning of the catheter tip result in safe implantation procedures and a reduction in immediate complications that may include pneumothorax, arterial puncture, and hematoma formation (4)(5)(6)(7). However, the malfunction of TICVPs (inability to infuse and/or the regurgitation of fluid) is still an important factor that interrupts the use of the device (8).…”

“…Interventional radiologists mostly prefer the internal jugular vein as a venous access site under ultrasonic and fluoroscopic guidance (4)(5)(6)(7). The ultrasound guided puncture of veins and fluoroscopic positioning of the catheter tip result in safe implantation procedures and a reduction in immediate complications that may include pneumothorax, arterial puncture, and hematoma formation (4)(5)(6)(7).…”

“…The need for a TICVP insertion has dramatically increased over the last few decades in parallel with the various intravenous chemotherapeutic agents used in cancer patients. Various types of TICVPs are currently implanted by way of several techniques and venous access by vascular surgeons, interventional radiologists, and oncologists (1)(2)(3)(4)(5)(6).…”