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Efficacy and safety of ultrasound-guided placement of central venous port systems via the right internal jugular vein in elderly oncologic patients: our single-center experience and protocol

Abstract

Background

Ultrasound-guidance has become the routine method for internal jugular vein (IJV) catheterization reducing dramatically failure and complication rates for central venous port (CVP) placement.

Aims

The aim of this study was to determine the safety and efficacy of ultrasound-guided IJV CVP placement in elderly oncologic patients.

Methods

Between January 2013 and December 2015, 101 elderly oncological patients underwent right IJV CVP placement under ultrasound-guidance. The length of catheter introduction ranged from 18 to 21 cm. Intraoperative fluoroscopy (IF) was always performed intraoperatively. Chest X-ray (CXR) was always performed 30 min after the end of the procedure.

Results

The morbidity rate was 1.98%; two arterial punctures were reported with one self-limiting hematoma. Two patients (1.98%) had catheter misplacements, recognized by intraoperative IF. No patients (0%) experienced pneumothorax (PNX), confirmed at CXR. Patients were all discharged at maximum 6 h from the procedure.

Discussion

The risk of catheter misplacement, PNX, and arterial/nerve puncture remains present with this technique. Lower rates of catheter misplacement have been reported after right IJV puncture, probably for its straight vertical course. Our results are in accordance with literature (1 counter-lateral subclavian vein and 1 counter-lateral internal jugular vein misplacements). All misplacements were detected intraoperatively. The PNX rates after cannulation of the IJV vary between 0.0 and 0.5%. We had no PNX occurrence.

Conclusion

Ultrasonography (US) has improved safety and effectiveness of port system placements. While routine post-procedural CXR seems avoidable, IF should be considered mandatory.

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Abbreviations

IJV:

Internal jugular vein

CVP:

Central venous port

USG:

Ultrasound-guidance

IF:

Intraoperative fluoroscopy

CXR:

Chest X-ray

PNX:

Pneumothorax

US:

Ultrasonography

References

  1. 1.

    Patel RY, Friedman A, Shams JN et al (2010) Central venous catheter tip malposition. J Med Imaging Radiat Oncol 54:35–42. doi:10.1111/j.1754-9485.2010.02143.x

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Plumhans C, Mahnken AH, Ocklenurg C et al (2011) Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception. Eur J Radiol 79:338–342. doi:10.1016/j.ejrad.2009.12.010

    Article  PubMed  Google Scholar 

  3. 3.

    Rabindranath KS, Kumar E, Shail R et al (2011) Use of real-time ultrasound guidance for the placement of hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis 58:964–970. doi:10.1053/j.ajkd.2011.07.025

    Article  PubMed  Google Scholar 

  4. 4.

    Frankel HL, Kirkpatrick AW, Elbarbary M et al (2015) Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients—part I: general ultrasonography. Crit Care Med 43:2479–2502. doi:10.1097/CCM.0000000000001216

    Article  PubMed  Google Scholar 

  5. 5.

    Vezzani A, Brusasco C, Palermo S et al (2010) Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography. Crit Care Med 38:533–538. doi:10.1097/CCM.0b013e3181c0328f

    Article  PubMed  Google Scholar 

  6. 6.

    Pikwer A, Bååth L, Davidson B et al (2008) The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients. Anaesth Intensive Care 36:30–37

    CAS  PubMed  Google Scholar 

  7. 7.

    Yilmazlar A, Bilgin H, Korfali G et al (1997) Complications of 1303 central venous cannulations. J R Soc 90:319–321

    CAS  Google Scholar 

  8. 8.

    Miao J, Ji L, Lu J et al (2014) Randomized clinical trial comparing ultrasound-guided procedure with the Seldinger’s technique for placement of implantable venous ports. Cell Biochem Biophys 70:559–563. doi:10.1007/s12013-014-9956-x

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Eisen LA, Narasimhan M, Berger JS et al (2006) Mechanical complications of central venous catheters. J Intensive Care Med 21:40–46. doi:10.1177/0885066605280884

    Article  PubMed  Google Scholar 

  10. 10.

    Sivasubramaniam S, Hiremath M (2008) Central venous catheters: do we need to review practice on positioning? JICS 9:228–231

    Google Scholar 

  11. 11.

    Miccini M, Cassini D, Gregori M et al (2016) Ultrasound-guided placement of central venous port systems via the right internal jugular vein: are chest X-ray and/or fluoroscopy needed to confirm the correct placement of the device? World J Surg 40:2353–2358

    Article  PubMed  Google Scholar 

  12. 12.

    Gebauer B, El-Sheik M, Vogt M et al (2009) Combined ultrasound and fluoroscopy guided port catheter implantation. Eur J Radiol 69:517–522

    Article  PubMed  Google Scholar 

  13. 13.

    Pikwer A, Bååth L, Perstoft I et al (2009) Routine chest x-ray is not required after a low-risk central venous cannulation. Acta Anaesthesiol Scand 53:1145–1152. doi:10.1111/j.1399-6576.2009.01980.x

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Lessnau KD et al (2005) Is chest radiography necessary after uncomplicated insertion of a triple-lumen catheter in the right internal jugular vein, using the anterior approach? Chest. doi:10.1378/chest.127.1.220

    Google Scholar 

  15. 15.

    Hourmozdi JJ, Markin A, Johnson B et al (2016) Routine chest radiography is not necessary after ultrasound-guided right internal jugular vein catheterization. Crit Care Med. doi:10.1097/CCM.0000000000001737

    PubMed  Google Scholar 

  16. 16.

    Donmez H, Tokmak TT, Yildirim A et al (2012) Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma? J Clin Ultrasound 40:142–146. doi:10.1002/jcu.21884

    Article  PubMed  Google Scholar 

  17. 17.

    Silberzweig JE, Sacks D, Khorsandi AS et al (2003) Society of Interventional Radiology Technology Assessment Committee: reporting standards for central venous access. J Vasc Interv Radiol 14:S443–S452

    Article  PubMed  Google Scholar 

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Authors contributions

AC, CM, AF, and GM contributed equally to this work, collected and analyzed the data, and drafted the manuscript; VDM and GC provided analytical oversight; PM and VB designed and supervised the study; MGE, MEG, GF, and LB revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Alfonso Canfora.

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The authors declare that they have no conflict of interest. On behalf of all authors, the corresponding author states that there is no conflict of interest.

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For this type of study, formal consent is not required.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Canfora, A., Mauriello, C., Ferronetti, A. et al. Efficacy and safety of ultrasound-guided placement of central venous port systems via the right internal jugular vein in elderly oncologic patients: our single-center experience and protocol. Aging Clin Exp Res 29, 127–130 (2017). https://doi.org/10.1007/s40520-016-0680-9

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Keywords

  • Central venous port
  • Elderly patients
  • Ultrasound-guidance
  • Cancer
  • Internal jugular vein