Retrospective Analysis of Totally Implantable Venous Access Ports which was Performed using the Patient's Height as a Guide, and the Effect of Catheter Tip Position on Complications.

Abstract

Objective: Totally implantable venous access ports (TIVAP) provide safe and com-fortable venous access for chemotherapy. This study evaluates the reliability of Lum's measurement technique for central venous catheter tip positioning and its impact on complications.

Methods: Clinical and radiologic data of 297 patients under-going TIVAP implantation were analyzed. The primary endpoint was optimal catheter tip positioning (within 2 cm above to 1 cm below the cavoatrial junction) and its effect on complications. Secondary endpoints included the impact of catheterization site and tip position relative to the carina.

Results: Among 297 patients, 59.9% had catheter tips in the target zone, and 93.9% were below the carina. Target zone positioning did not significantly affect catheter occlusion or thromboembolism (P=0.066, P=0.773). However, thromboembolism (1/18; 5.6% vs. 1/279; 0.4%, P=0.009) and catheter occlusion (2/18; 11.1% vs. 3/279; 1.1%, P=0.001) were more frequent when the tip was above the carina. Patients with tips in the target zone and below the carina had similar complication rates (P=0.565, P=0.748, P=0.644). Catheterisation was performed via the internal jugular vein (IJV) or subclavian vein (SCV). Target zone positioning was more frequent with IJV catheterization (P=0.047), while catheter occlusion was higher with SCV access (P=0.024).

Conclusion: Positioning the catheter tip below the carina and preferring IJV as the first-choice catheterization site may reduce complications.