Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience.

BACKGROUND Totally implantable central venous port systems provide a safe and effective, long-term means of access for administration of hyperosmolar, local irritant medication, such as chemotherapy, antibiotics and parenteral nutrition. AIM To evaluate the combination of access site and level of experience on fluoroscopy times (FT) and dose area products (DAP) during implantation of port catheters in a large patient population. MATERIALS AND METHODS A total of 1,870 patients (992 women, 878 men; age: 61±13.14 years) were reviewed investigating two groups of junior (≤50 implantations) and senior (>50) radiologists. RESULTS Senior radiologists required less FT/DAP (0.24 s/57.3 μGy m2 versus 0.43 s/68.2 μGy m2, respectively; p<0.001). Right jugular vein access required the least FT/DAP (0.25 s/56.15 μGy m2) and right-sided implantation lower FT/DAP (right: 0.26 s/56.4 μGy m2, left: 0.40 s/85.10 μGy m2, p<0.001). CONCLUSION Due to DAP/FT reductions, the right jugular vein seems to be the most favorable implantation side for port systems. For further dose reduction, residents should be well-trained.

[1]  M. Mello,et al.  Risk factors for central line–associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study , 2017, Pediatric blood & cancer.

[2]  C. Geng,et al.  Totally implantable venous access port systems and associated complications: A single-institution retrospective analysis of 2,996 breast cancer patients. , 2016, Molecular and clinical oncology.

[3]  Konstantinos Zarogoulidis,et al.  Pneumothorax as a complication of central venous catheter insertion. , 2015, Annals of translational medicine.

[4]  S. White,et al.  Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room. , 2015, Journal of the American College of Radiology : JACR.

[5]  Guorong Wang,et al.  Factors Influencing Intracavitary Electrocardiographic P-Wave Changes during Central Venous Catheter Placement , 2015, PloS one.

[6]  B. Gebauer.  Venöse Zugänge – Implantation und Komplikationsmanagement , 2015, Interventionelle Radiologie Scan.

[7]  R. Duszak,et al.  Increased fluoroscopy time for central venous catheter placement by radiology residents versus staff radiologists. , 2013, Journal of the American College of Radiology : JACR.

[8]  Michael S Gee,et al.  Relationship between radiologist training level and fluoroscopy time for voiding cystourethrography. , 2013, AJR. American journal of roentgenology.

[9]  D. Hahn,et al.  Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devices approved for high-pressure injections. , 2012, The British journal of radiology.

[10]  R. Günther,et al.  Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception. , 2011, European journal of radiology.

[11]  U. Teichgräber,et al.  Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems , 2011, European Radiology.

[12]  Ming-Shian Lu,et al.  Analysis of risk factors for central venous port failure in cancer patients. , 2009, World journal of gastroenterology.

[13]  F. Cavalli,et al.  Randomised comparison of complications from three different permanent central venous access systems. , 2009, Swiss medical weekly.

[14]  D. Radice,et al.  Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial. , 2009, Annals of oncology : official journal of the European Society for Medical Oncology.

[15]  S. Costa,et al.  An 11-year retrospective study of totally implanted central venous access ports: complications and patient satisfaction. , 2009, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[16]  H. Wagner,et al.  Combined ultrasound and fluoroscopy guided port catheter implantation--high success and low complication rate. , 2009, European journal of radiology.

[17]  S. Breitenstein,et al.  Infectious Port Complications Are More Frequent in Younger Patients with Hematologic Malignancies than in Solid Tumor Patients , 2008, Oncology.

[18]  H. Wolf,et al.  Venous Access Ports: Frequency and Management of Complications in Oncology Patients , 2008, Oncology Research and Treatment.

[19]  C. Araujo,et al.  A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients. , 2008, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[20]  W. Hsu,et al.  Experience of anesthesiologists with percutaneous nonangiographic venous access. , 2007, Journal of clinical anesthesia.

[21]  Haraldur Bjarnason,et al.  An investigation of operator exposure in interventional radiology. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[22]  Donald L. Miller,et al.  Radiation doses from venous access procedures. , 2006, Radiology.

[23]  S. H. Lee,et al.  Comparison of complications between transjugular and axillosubclavian approach for placement of tunneled, central venous catheters in patients with hematological malignancy: a prospective study , 2005, European Radiology.

[24]  R. Wagner,et al.  [Complications of central venous access devices: outcome analysis of 2359 implantations]. , 2005, Deutsche medizinische Wochenschrift.

[25]  W. Schummer,et al.  [Extravasal position of central venous catheters despite unsuspicious ECG-guidance]. , 2005, Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS.

[26]  Vincent Vinh-Hung,et al.  Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports , 2005, Supportive Care in Cancer.

[27]  M. Stockler,et al.  Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature , 2004, British Journal of Cancer.

[28]  U. Teichgräber,et al.  [Long-term central venous lines and their complications]. , 2004, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[29]  A. Zerati,et al.  Totally implantable venous catheters for chemotherapy: experience in 500 patients , 2004, Sao Paulo medical journal = Revista paulista de medicina.

[30]  G. Martinelli,et al.  Use of totally implantable central venous access ports for high-dose chemotherapy and peripheral blood stem cell transplantation: results of a monocentre series of 376 patients. , 2004, Annals of oncology : official journal of the European Society for Medical Oncology.

[31]  J. Cardella,et al.  Society of Interventional Radiology clinical practice guidelines. , 2003, Journal of vascular and interventional radiology : JVIR.

[32]  M. Kalinowski,et al.  [Transjugular implantation of venous port catheter systems]. , 2003, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[33]  N. Moureau,et al.  Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. , 2002, Journal of vascular and interventional radiology : JVIR.

[34]  B. Funaki,et al.  Subcutaneous chest ports via the internal jugular vein. A retrospective study of 117 oncology patients. , 2002, Acta radiologica.

[35]  F. Orsi,et al.  A randomized, prospective trial of central venous ports connected to standard open‐ended or Groshong catheters in adult oncology patients , 2001, Cancer.

[36]  H. Weiss,et al.  Central Venous Access Ports Placed by Interventional Radiologists: Experience with 125 Consecutive Patients , 2001, CardioVascular and Interventional Radiology.

[37]  P. Witteveen,et al.  Totally implantable venous access devices: evaluation of complications and a prospective comparative study of two different port systems. , 2000, The Netherlands journal of medicine.

[38]  T. Burke,et al.  Outcome of 350 implanted chest ports placed by interventional radiologists. , 1997, Journal of vascular and interventional radiology : JVIR.

[39]  B. Funaki,et al.  Radiologic placement of subcutaneous infusion chest ports for long-term central venous access. , 1997, AJR. American journal of roentgenology.

[40]  M. Mauro,et al.  Radiology-assisted placement of implantable subcutaneous infusion ports for long-term venous access. , 1992, Radiology.

[41]  J. Niederhuber,et al.  Totally implanted venous and arterial access system to replace external catheters in cancer treatment. , 1982, Surgery.

[42]  W. Stahl.  Subclavian Vein Catheterizations: A Prospective Study I. Non‐Infectious Complications , 1971, Annals of surgery.