The Percutaneous Radiological Correction Rate Is 0.5% in Upper Extremity Port Device Cancer Patients

Excerpt

I read with great interest the recent article by Gebauer et al. [1]. There is no doubt that percutaneous interventional radiological procedures nowadays represent the gold standard in the correction of central venous catheter malposition, except in some particular cases including venous thrombosis, small catheter-bearing veins, and deeply embedded catheters. We share the authors’ opinion concerning the higher rate of malpositionned catheters in surgically implanted port patients. This is due to the absence of real-time fluoroscopy monitoring during catheterization and catheter tip positionning [2]. According to a personal survey concerning 1000 arm port device insertions using image guidance, the reported rate of malpositioned catheters was 0.5% [3], which is far lower than the rate of 6% reported in surgical series [1]. Two patients suffered from palpitations due to a too-long catheter tip beating into the atrium; two patients had ipsilateral and contralateral migration in the internal jugular vein, respectively; and one obese patient (body mass index, 41) had a catheter tip retraction in the ipsilateral left innominate vein. The latter presented with a bulky mediastinal tumor inducing pronounced catheter kinks. In such a case, we do think that the catheter tip must be placed 1 to 2 cm below the regular position (atrial caval junction) due to the risk of liberation of original catheter elasticity during daily-life activities of the patient. During the procedure, when the back end of the catheter moves down 1 cm, elasticity will cause its tip to move another 2 cm farther down. Flexibility of a too-short implanted catheter may move upstream when the patient coughs, moves upright, or moves the arms [4, 5]. We strongly recommend testing the catheter course and tip location under those conditions before connecting the catheter to the port chamber during placement. Furthermore, considering the high incidence of catheter tip migration in the internal jugular vein (>50%) in chest and arm ports [1, 3], the patient must be told to consult when presenting with otalgia or lateral neck pain, especially in the case of blind surgical device placement and bulky mediastinal tumors. We do think that the extremely low rate of migrated catheters (0.5%) at our institution is due to the rigor of catheter tip placement under fluoroscopy and per operative testing of the catheter elasticity reserve. …