Top

World Journal of Surgery

Published in:

01-10-2016 | Original Scientific Report

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?

Authors: Michelangelo Miccini, Diletta Cassini, Matteo Gregori, Sergio Gazzanelli, Simone Cassibba, Daniele Biacchi

Published in: World Journal of Surgery | Issue 10/2016

Abstract

Background

Percutaneous central venous port (CVP) placement using ultrasound-guidance (USG) via right internal jugular vein is described as a safe and effective procedure. The aim of this study is to determine whether intraoperative fluoroscopy (IF) and/or postoperative chest X-ray (CXR) are required to confirm the correct position of the catheter.

Methods

Between January 2012 and December 2014, 302 adult patients underwent elective CVP system placement under USG. The standard venous access site was the right internal jugular vein. The length of catheter was calculated based on the height of the patient. IF was always performed to confirm US findings.

Results

176 patients were men and 126 were women and average height was 176.2 cm (range 154–193 cm). The average length of the catheter was 16.4 cm (range 14–18). Catheter malposition and pneumothorax were observed in 4 (1.3 %) and 3 (1 %) patients, respectively. IF confirmed the correct position of the catheter in all cases. Catheter misplacement (4 cases) was previously identified and corrected on USG. Our rates of pneumothorax are in accordance with those of the literature (0.5–3 %).

Conclusion

Ultrasonography has resulted in improved safety and effectiveness of port system implantation. The routine use of CXR and IF should be considered unnecessary.

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

Patel RY, Friedman A, Shams JN, Silberzweig JE (2010) Central venous catheter tip malposition. J Med Imaging Radiat Oncol 54:35–42CrossRefPubMed

Plumhans C, Mahnken AH, Ocklenurg C, Keil S, Behrendt FF, Günther RW, Schoth F (2011) Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception. Eur J Radiol 79(3):338–342CrossRefPubMed

Brown JR, Slomski C, Saxe AW (2009) Is routine postoperative chest X-ray necessary after fluoroscopic-guided subclavian central venous port placement. J Am Coll Surg 209(2):287

Losert H, Prokesch R, Grabenwoger M, Waltl B, Apsner R, Sunder-Plassmann G, Muhm M (2000) Inadvertent transpericardial insertion of a central venous line with cardiac tamponade failure of preventive practices. Intensive Care Med 26:1147–1150CrossRefPubMed

Vezzani A, Brusasco C, Palermo S, Launo C, Mergoni M, Corradi F (2010) Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography. Crit Care Med 38:533–538CrossRefPubMed

Van Beek EJ (2005) Routine chest radiographs following central line insertion not always necessary! Chest 127(1):10–12CrossRefPubMed

Ahn SJ, Kim HC, Chung JW, An SB, Yin YH, Jae HG, Park JH (2012) Ultrasound and fluoroscopy-guide placement of central venous ports via internal jugular vein: retrospective analysis of 1254 port implantations at a single center. Korean J Radiol 13(3):314–323CrossRefPubMedPubMedCentral

Sanabria A, Henao C, Bonilla R, Castrillon C, Cruz H, Ramirez W, Navarro P, Gonzalez M, Diaz A (2003) Routine chest roentgenogram after central venous catheter insertion is not always necessary. Am J Surg 186(1):35–39CrossRefPubMed

10.

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

11.

Maury E, Guglielminotti J, Alzieu M, Guidet B, Offenstadt G (2001) Ultrasonic examination, an alternative to chest radiography after central venous catheter insertion? Am J Respir Crit Care Med 164:403–405CrossRefPubMed

12.

Dede D, Akmangit I, Yildirim ZN, Sanverdi E, Sayin B (2008) Ultrasonography and fluoroscopy-guided insertion of chest ports. EJSO 34:1340–1343CrossRefPubMed

13.

Matsushima K, Frankel HL (2010) Bedside ultrasound can safely eliminate the need for chest radiographs after central venous catheter placement: CVC sono in the surgical ICU (SICU). J Surg Res 163:155–161CrossRefPubMed

14.

Cavanna L, Civardi G, Vallisa D, Di Nunzio C, Cappucciati L, Bertè R, Cordani MR, Lazzaro A, Cremona G, Biasini C, Muroni M, Mordenti P, Gorgni S, Zaffignani E, Ambroggi M, Bidin L, Palladino MA, Rodinò C, Tibaldi L (2010) Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: a prospective observational study of 1978 consecutive catheterizations. World J Surg Oncol 8:91CrossRefPubMedPubMedCentral

15.

Gekle R, Dubensky L, Haddad S, Bramante R, Cirilli A, Catlin T, Patel G, D’Amore J, Slesinger TL, Raio C, Modayil V, Nelson M (2015) Saline flush test: can bedside sonography replace conventional radiography for confirmation of above-the-diaphragm central venous catheter placement? J Ultrasound Med 34(7):1295–1299CrossRef

16.

Mudan S, Giakoustidis A, Morrison D, Iosifidou S, Raobaikady R, Neofytou K, Stebbing J (2015) 1000 Porta-a-cath placements by subclavian vein approach: single surgeon experience. World J Surg 39:328–334CrossRefPubMed

17.

Seiler CM, Frohlich BE, Dorsam UJ, Kienle P, Buchler MW, Knaebel HP (2006) Surgical technique for totally implantable access ports (TIAP) needs improvement: a multivariate analysis of 400 patients. J Surg Oncol 93(1):24–29CrossRefPubMed

18.

Karakousis CP (2007) Surgical technique for totally implantable access ports (TIAP) needs improvement. J Surg Oncol 95(2):180–181CrossRefPubMed

19.

Trerotola SO, Thompson S, Chittams J, Vierregger KS (2007) Analysis of tip malposition and correction in peripherally inserted central catheters placed at bedside by a dedicated nursing team. J Vasc Interv Radiol 18(4):513–518CrossRefPubMed

20.

Venkatesan T, Sen N, Korula PJ, Surendrababu NR, Raj JP, John P, Christopher S (2007) Blind placements of peripherally inserted antecubital central catheters: initial catheter tip position in relation to carina. Br J Anaesth 98(1):83–88CrossRefPubMed

21.

Miao J, Ji L, Lu J, Chen J (2014) Randomized clinical trial comparing ultrasound-guided procedure with the Seldinger’s technique for placement of implantable venous ports. Cell Biochem Biophys 70:559–563CrossRefPubMed

22.

Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF (2006) Mechanical complications of central venous catheters. J Intensive Care Med 21(1):40–46CrossRefPubMed

23.

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

24.

Forauer AR, Dasika NL, Gemmete JJ, Theoharis C (2003) Pericardial tamponade complicating central venous interventions. J Vasc Interv Radiol 14(2):255–259CrossRefPubMed

25.

Losert H, Prokesch R, Grabenwöger M, Waltl B, Apsner R, Sunder-Plassmann G, Muhm M (2000) Inadvertent transpericardial insertion of a central venous line with cardiac tamponade failure of preventive practices. Intensive Care Med 26(8):1147–1150CrossRefPubMed

26.

McGee WT, Ackerman BL, Rouben LR, Prasad VM, Bandi V, Mallory DL (1993) Accurate placement of central venous catheters: a prospective, randomized, multicenter trial. Crit Care Med 21(8):1118–1123CrossRefPubMed

27.

McGee WT, Moriarty KP (1996) Accurate placement of central venous catheters using a 16-cm catheter. J Intensive Care Med 11(1):19–22CrossRefPubMed

28.

Peres PW (1990) Positioning central venous catheters—a prospective survey. Anaesth Intensive Care 18(4):536–539PubMed

29.

Gilon D, Schechter D, Rein AJ, Gimmon Z, Or R, Rozenman Y, Slavin S, Gotsman MS, Nagler A (1998) Right atrial thrombi are related to indwelling central venous catheter position: insights into time course and possible mechanism of formation. Am Heart J 135(3):457–462CrossRefPubMed

30.

Plaus WJ (1990) Delayed pneumothorax after subclavian vein catheterization. JPEN J Parenter Enteral Nutr 14(4):414–415CrossRefPubMed

31.

Rankine JJ, Thomas AN, Fluechter D (2000) Diagnosis of pneumothorax in critically ill adults. Postgrad Med J 76(897):399–404CrossRefPubMedPubMedCentral

32.

Gann M Jr, Sardi A (2003) Improved results using ultrasound guidance for central venous access. Am Surg 69(12):1104–1107PubMed

33.

Randolph AG, Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24(12):2053–2058CrossRefPubMed

34.

Lichtenstein D, Mezière G, Biderman P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25(4):383–388CrossRefPubMed

Title: 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?
Authors: Michelangelo Miccini
Diletta Cassini
Matteo Gregori
Sergio Gazzanelli
Simone Cassibba
Daniele Biacchi
Publication date: 01-10-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 10/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3574-2

At a glance: The STEP trials

Springer Medicine

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?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2016

Comparison of Salvage Living Donor Liver Transplantation and Local Regional Therapy for Recurrent Hepatocellular Carcinoma

Efficacy of Prophylactic Mesh in End-Colostomy Construction: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis

Validation of a Nomogram to Predict the Risk of Perioperative Blood Transfusion for Liver Resection

Edward John Hinchey (1934 to Present): Father of Modern Age of Acute Complicated Diverticulitis of the Colon

Spirometric Lung Age Predicts Postoperative Pneumonia After Esophagectomy