Annals of Surgical Oncology

, Volume 4, Issue 7, pp 597–602 | Cite as

Fluoroscopy-free placement of standard chest wall subcutaneous chronic venous access devices

  • James L. Frank
  • Beth Halla
  • Jane L. Garb
  • William P. Reed
Original Articles


Background: This study was undertaken to evaluate the potential benefits of using an electromagnetic detection system to guide the intraoperative placement of chronic venous access devices (CVADs).

Study Design: An electromagnetic detection system was used to guide catheter placement during 54 procedures. Surgery and radiation exposure times were recorded. An oncology nursing follow-up questionnaire assessed device function. A cost analysis was performed. Outcomes were compared to similar data from a fluoroscopic historical control group.

Results: Eight study patients required intraoperative fluoroscopy; in 46 procedures (85%) the electromagnetic detection system was the sole modality employed to guide CVAD placement. One line was subsequently found in the internal mammary vein (2% false negative rate). Mean surgery times for placement of CVADs were 79.5 and 84.5 minutes for the study and control groups (p=NS). Mean radiation exposure rates were 0.16 and 0.86 minutes per patient for the study and control groups (p<0.01). There was no significant difference in device function between groups. Major complications in the study group were rare. Mean cost of CVAD placement was $1993 and $2517 for the study and control groups (p=0.005), respectively.

Conclusions: The use of the electromagnetic detection system resulted in accurate placement of chest wall CVADs in the majority of patients. This resulted in significant reductions in radiation exposure and cost of CVAD placement.

Key Words

Chronic venous access device Port-A-Cath Cost containment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Francis KR, Picard DL, Fajardo MA, Pizzi WF. Avoiding complications and decreasing costs of central venous catheter placement utilizing electrocardiographic guidance.Surg Gynecol Obstet 1992;175:208–11.PubMedGoogle Scholar
  2. 2.
    Watters VA, Grant JP. Use of electrocardiogram to position right atrial catheters during surgery.Ann Surg 1997;225:165–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Schuman R, Ragsdale J. Peripheral ports are a new option for central venous access.J Am Coll Surg 1995;180:456–60.PubMedGoogle Scholar
  4. 4.
    Rubenstein EB, Fender A, Rolston KV, et al. Vascular access by physician assistants: evaluation of an implantable peripheral port system in cancer patients.J Clin Oncol 1995;13:1513–9.PubMedGoogle Scholar
  5. 5.
    Salem RS, Ward BA, Ravikumar TS. A new peripherally implanted subcutaneous permanent central venous access device for patients requiring chemotherapy.J Clin Oncol 1993;11:2181–5.PubMedGoogle Scholar
  6. 6.
    Carre MC, Vega RM, Carles J, et al. Central venous brachial catheter (P.A.S. Port TM) and catheter scanning system (Cath-finder TM).J Surg Oncol 1994;55:190–3.PubMedGoogle Scholar
  7. 7.
    Morris P, Buller R, Kendall S, Anderson B. A peripherally implanted permanent central venous access device.Obstet Gynecol 1991;78:1138–42.PubMedGoogle Scholar
  8. 8.
    Finney R, Albrink MH, Hart MB, Rosemurgy AS. A cost-effective peripheral venous port system placed at the bedside.J Surg Res 1992;53:17–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Pullyblank AM, Carey PD, Pearce SZ, Tanner AG, Guillou PJ, Monson JRT. Comparison between peripherally implanted ports and externally sited catheters for long-term venous access.Ann R Coll Surg Engl 1994;76:33–8.PubMedGoogle Scholar
  10. 10.
    Eastridge BJ, Lefor AT. Complications of indwelling venous access devices in cancer patients.J Clin Oncol 1995;13:233–8.PubMedGoogle Scholar
  11. 11.
    Grannan KJ, Taylor PT. Early and late complications of totally implantable venous access devices.J Surg Oncol 1990;44:52–4.PubMedGoogle Scholar
  12. 12.
    Pegues D, Axelrod P, McClarren C, et al. Comparison of infections in Hickman and implanted port catheters in adult solid tumor patients.J Surg Oncol 1992;49:156–62.PubMedGoogle Scholar
  13. 13.
    Sariego J, Bootorabi B, Matsumoto T, Kerstein M. Major long-term complications in 1,422 permanent venous access devices.Am J Surg 1993;165:249–51.PubMedGoogle Scholar
  14. 14.
    Mueller BU, Skelton J, Callender DP, et al. A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients.J Clin Oncol 1992;10:1943–8.PubMedGoogle Scholar
  15. 15.
    Keung YK, Watkins K, Chen SC, Groshen S, Silberman H, Douer D. Comparative study of infectious complications of different types of chronic central venous access devices.Cancer 1994;73:2832–7.PubMedGoogle Scholar
  16. 16.
    Puel V, Caudry M, Metayer PL, et al. Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports.Cancer 1993;72:2248–52.PubMedGoogle Scholar
  17. 17.
    Puig-La Calle J, Sanchez SL, Serra EP, Honorato LA, Raventos VA, Puig-La Calle J. Totally implanted device for long-term intravenous chemotherapy: experience in 123 adult patients with solid neoplasms.J Surg Oncol 1996;62:273–8.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 1997

Authors and Affiliations

  • James L. Frank
    • 1
  • Beth Halla
    • 1
  • Jane L. Garb
    • 1
  • William P. Reed
    • 1
  1. 1.From the Division of Surgical Oncology, Department of SurgeryBaystate Medical CenterSpringfield

Personalised recommendations