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
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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.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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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.
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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 (Suppl 1), 127–130 (2017). https://doi.org/10.1007/s40520-016-0680-9
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DOI: https://doi.org/10.1007/s40520-016-0680-9