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Placement of port-a-cath through the right internal jugular vein under ultrasound guidance

Posizionamento di port-a-cath sotto guida ecografica per via giugulare destra

  • Vascular and Interventional Radiology / Radiologa Vascolare e Interventistica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study was undertaken to demonstrate the effectiveness of ultrasound (US)-guided placement of porta-cath (PC) through the right internal jugular vein (RIJV) by evaluating the onset of early and late complications.

Materials and methods

From 30 June 2008 to 30 June 2011, we placed 695 port-a-caths in 694 patients with a mean age of 58 years. Exclusion criteria were active infection, bleeding disorders and life expectancy <6 months. The procedures were performed in the angiography suite under local anaesthesia. After US-guided puncture of the RIJV, the subcutaneous pocket was prepared, followed by tunnelling of the vein and closure of the surgical wound. In order to evaluate pneumothorax (PNX), all patients underwent chest X-ray a few hours after the end of the procedure unless there were clinical indications. We evaluated the technical success of the procedure and the rate of complications.

Results

Technical success was achieved in all cases. The device was kept in place for an average of 168 days. There was one case of PNX (0.14%) as shown on chest X-ray and five cases of late complications (0.70%): one case of intracatheter thrombosis (0.14%), two cases of disconnection between the reservoir and catheter (0.28%) and two cases of PC infection (0.28%).

Conclusions

This procedure incurs very small number of complications compared with other positioning techniques using accesses such as the subclavian vein. Complications recorded in our study are comparable, in type and incidence, to those found by other authors, with the most frequent being device infection.

Riassunto

Obiettivo

Scopo del presente lavoro è stato dimostrare l’efficacia del posizionamento di port-a-cath (PC) attraverso la vena giugulare interna destra (VGID) sotto guida ecografica (US) valutando l’insorgenza di complicanze.

Materiali e metodi

Dal 30 giugno 2008 al 30 giugno 2011 abbiamo posizionato 695 PC in 694 pazienti con età media di 58 anni. I criteri di esclusione sono: infezione in atto, coagulopatie e aspettativa di vita inferiore ai 6 mesi. Le procedure sono state eseguite in sala angiografica previa anestesia locale. Abbiamo effettuato la puntura sottoguida US delle VGID, poi è stata preparata la tasca sottocutanea e tunnelizzazione del tramite e chiusura della ferita chirurgica. Per valutare lo pneumotorace (PNX) abbiamo eseguito un radiogramma del torace dopo qualche ora dalla procedura salvo diversa indicazione clinica. Abbiamo valutato la riuscita della procedura e il tasso di complicanze.

Risultati

La riuscita tecnica dell’impianto è stata ottenuta nella totalità dei casi. Il dispositivo è stato mantenuto in sede per una media di 168 giorni/paziente. Abbiamo registrato uno PNX (0,14%) evidenziato all’Rx di controllo e 5 casi di complicanze tardive (0,70%): 1 caso di trombosi intra-catetere (0,14%), 2 casi di deconnessioni tra il reservoir ed il catetere (0,28%) e 2 casi di infezioni del port (0,28%).

Conclusioni

Le complicanze che abbiamo osservato sono paragonabili sia in termini di incidenza che di tipologia a quelle riscontrate da altri autori; infatti anche dal nostro studio emerge che l’infezione del dispositivo risulta essere la complicanza più frequente.

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Authors and Affiliations

  1. Scuola di Specializzazione di Radiologia Diagnostica ed Interventistica, Università degli Studi di Milano, Via A. Di Rudinì 8, 20142, Milano, Italy

    E. Capalbo, M. Peli, M. Lovisatti, M. Cosentino & G. Cornalba

  2. U.O. Radiologia Diagnostica ed Interventistica, Dipartimento di Scienza Diagnostiche, A.O. San Carlo Borromeo, Via Pio II 3, 20153, Milano, Italy

    E. Capalbo, M. Peli, M. Lovisatti, M. Cosentino, V. Ticha & M. Cariati

  3. U.O. Radiologia Diagnostica ed Interventistica, A.O. San Paolo, Via A. Di Rudinì 8, 20142, Milano, Italy

    G. Cornalba

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  1. E. Capalbo
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  2. M. Peli
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  3. M. Lovisatti
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  4. M. Cosentino
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  5. V. Ticha
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  6. M. Cariati
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  7. G. Cornalba
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Correspondence to E. Capalbo.

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Capalbo, E., Peli, M., Lovisatti, M. et al. Placement of port-a-cath through the right internal jugular vein under ultrasound guidance. Radiol med 118, 608–615 (2013). https://doi.org/10.1007/s11547-012-0894-6

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  • DOI: https://doi.org/10.1007/s11547-012-0894-6

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