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Fast Track Ultrasound Protocol to Detect Acute Complications After Totally Implantable Venous Access Device Placement

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Abstract

Background

The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization.

Methods

Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared.

Results

Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p < 0.001).

Conclusions

Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.

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Acknowledgment

Financially supported by Department of Anesthesiology, National Taiwan University Hospital.

Disclosure

The authors declare no conflict of interest.

Author information

Correspondence to Chih-Peng Lin MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplemental Video 1. Trace the catheter from subclavian vein to brachiocephalic vein and observe the catheter travel toward mediastinum (AVI 592 kb)

Supplemental Video 2. Trace from internal jugular vein to brachiocephalic vein to document that there is no catheter malposition (AVI 659 kb)

Supplemental Video 3. Document a catheter malposition to internal jugular vein (AVI 557 kb)

Supplementary Fig. 1a. A scan from the lateral supraclavicular fossa traces the catheter’s path from the subclavian vein into the brachiocephalic vein (JPG 2158 kb)

Supplementary Fig. 1b. A scan from the medial supraclavicular fossa traces the catheter’s path from the subclavian vein into the brachiocephalic vein (JPG 1911 kb)

Supplementary Fig. 2. Definition of final catheter tip location. A: Catheter tip located within 1–cm above or below caval-atrial junction. B: Catheter tip located within 2–cm below lower end of position A. C: Catheter tip located below position B but still within right atrium. D: Catheter tip located above upper end of position A but still with in SVC. Tip location at position A or B was considered optimal. Once the catheter tip located at position C or D was defined as suboptimal (JPG 872 kb)

Supplementary Fig. 3. Chest radiography revealed a kinked catheter in the superior vena cava (JPG 534 kb)

Supplemental Video 1. Trace the catheter from subclavian vein to brachiocephalic vein and observe the catheter travel toward mediastinum (AVI 592 kb)

Supplemental Video 2. Trace from internal jugular vein to brachiocephalic vein to document that there is no catheter malposition (AVI 659 kb)

Supplemental Video 3. Document a catheter malposition to internal jugular vein (AVI 557 kb)

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Wu, C., Lin, F., Wang, Y. et al. Fast Track Ultrasound Protocol to Detect Acute Complications After Totally Implantable Venous Access Device Placement. Ann Surg Oncol 22, 1943–1949 (2015). https://doi.org/10.1245/s10434-014-4222-4

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Keywords

  • Pneumothorax
  • Ultrasound Examination
  • Internal Jugular Vein
  • Superior Vena Cava
  • Brachiocephalic Vein