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Erschienen in: World Journal of Surgery 10/2016

23.05.2016 | 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?

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

Erschienen in: World Journal of Surgery | Ausgabe 10/2016

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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.
Literatur
1.
Zurück zum Zitat Yilmazlar A, Bilgin H, Korfali G, Eren A, Ozkan U (1997) Complications of 1303 central venous cannulations. J R Soc 90:319–321 Yilmazlar A, Bilgin H, Korfali G, Eren A, Ozkan U (1997) Complications of 1303 central venous cannulations. J R Soc 90:319–321
2.
Zurück zum Zitat Patel RY, Friedman A, Shams JN, Silberzweig JE (2010) Central venous catheter tip malposition. J Med Imaging Radiat Oncol 54:35–42CrossRefPubMed Patel RY, Friedman A, Shams JN, Silberzweig JE (2010) Central venous catheter tip malposition. J Med Imaging Radiat Oncol 54:35–42CrossRefPubMed
3.
Zurück zum Zitat 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 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
4.
Zurück zum Zitat 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 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
5.
Zurück zum Zitat 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 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
6.
Zurück zum Zitat 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 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
7.
Zurück zum Zitat Van Beek EJ (2005) Routine chest radiographs following central line insertion not always necessary! Chest 127(1):10–12CrossRefPubMed Van Beek EJ (2005) Routine chest radiographs following central line insertion not always necessary! Chest 127(1):10–12CrossRefPubMed
8.
Zurück zum Zitat 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 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
9.
Zurück zum Zitat 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 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.
Zurück zum Zitat Gebauer B, El-Sheik M, Vogt M, Wagner HJ (2009) Combined ultrasound and fluoroscopy guided port catheter implantation. Eur J Radiol 69:517–522CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Dede D, Akmangit I, Yildirim ZN, Sanverdi E, Sayin B (2008) Ultrasonography and fluoroscopy-guided insertion of chest ports. EJSO 34:1340–1343CrossRefPubMed Dede D, Akmangit I, Yildirim ZN, Sanverdi E, Sayin B (2008) Ultrasonography and fluoroscopy-guided insertion of chest ports. EJSO 34:1340–1343CrossRefPubMed
13.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Karakousis CP (2007) Surgical technique for totally implantable access ports (TIAP) needs improvement. J Surg Oncol 95(2):180–181CrossRefPubMed Karakousis CP (2007) Surgical technique for totally implantable access ports (TIAP) needs improvement. J Surg Oncol 95(2):180–181CrossRefPubMed
19.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Sivasubramaniam S, Hiremath M (2008) Central venous catheters: do we need to review practice on positioning? JICS 9:228–231 Sivasubramaniam S, Hiremath M (2008) Central venous catheters: do we need to review practice on positioning? JICS 9:228–231
24.
Zurück zum Zitat Forauer AR, Dasika NL, Gemmete JJ, Theoharis C (2003) Pericardial tamponade complicating central venous interventions. J Vasc Interv Radiol 14(2):255–259CrossRefPubMed Forauer AR, Dasika NL, Gemmete JJ, Theoharis C (2003) Pericardial tamponade complicating central venous interventions. J Vasc Interv Radiol 14(2):255–259CrossRefPubMed
25.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat McGee WT, Moriarty KP (1996) Accurate placement of central venous catheters using a 16-cm catheter. J Intensive Care Med 11(1):19–22CrossRefPubMed 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.
Zurück zum Zitat Peres PW (1990) Positioning central venous catheters—a prospective survey. Anaesth Intensive Care 18(4):536–539PubMed Peres PW (1990) Positioning central venous catheters—a prospective survey. Anaesth Intensive Care 18(4):536–539PubMed
29.
Zurück zum Zitat 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 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.
Zurück zum Zitat Plaus WJ (1990) Delayed pneumothorax after subclavian vein catheterization. JPEN J Parenter Enteral Nutr 14(4):414–415CrossRefPubMed Plaus WJ (1990) Delayed pneumothorax after subclavian vein catheterization. JPEN J Parenter Enteral Nutr 14(4):414–415CrossRefPubMed
32.
Zurück zum Zitat Gann M Jr, Sardi A (2003) Improved results using ultrasound guidance for central venous access. Am Surg 69(12):1104–1107PubMed Gann M Jr, Sardi A (2003) Improved results using ultrasound guidance for central venous access. Am Surg 69(12):1104–1107PubMed
33.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
Metadaten
Titel
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?
verfasst von
Michelangelo Miccini
Diletta Cassini
Matteo Gregori
Sergio Gazzanelli
Simone Cassibba
Daniele Biacchi
Publikationsdatum
23.05.2016
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 10/2016
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3574-2

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