Ultrasound-guided positioning of totally implantable access port systems: a single-center experience

Introduction

Totally implantable access ports (TIAPs) are extensively used for long-lasting intravenous access. They can be associated with early and late complications, which are related to an optimal site of insertion and tip positioning [1]. Despite fluoroscopic guidance being the gold standard, ultrasound can be a suitable and easier tool to guide venipuncture and catheter positioning, provided a postprocedural chest X-ray is taken to rule out tip malpositioning [2]. Our aim was to assess safety of this technique in terms of the best site of insertion, tip position and rate of complications.

Methods

A total of 360 TIAPs were implanted between December 2007 and September 2008 in a dedicated surgical room at the ICU of the University of Florence, Italy. Insertion was performed by trained intensivists, using an ultrasound-guided technique. A chest X-ray scan was performed after the procedure to rule out a catheter's tip malposition and pneumothorax. Early and late complications were noted and recorded. A Fisher test (P < 0.05) was done to test for association between the site of insertion and either tip position or occurrence of complications.

Results

From a total of 360 TIAPs implanted, the rate of malposition was seven catheters (1.9%). The site of insertion that consented the best rate of correct placement was the right internal jugular vein (P < 0.05). The incidence of complications was 17 out of 360 procedures (4.7%). Early complications included five arterial punctures and one pneumothorax, while late complications included four TIAP displacements, one pocket infection, three catheter-related infections and three thromboses. A correlation was found between occurrence of late complications and left insertion sites (P < 0.05).

Conclusion

Ultrasound-guided venipuncture for TIAP implantation was safely conducted in the majority of patients. The right internal jugular vein was the best insertion site in terms of the best rate of correct catheter tip position and lower incidence of complications.