Implantation of a totally implantable venous access port (TIVAP) through the subclavian vein under CT guidance is a highly safe and precise method that can effectively reduce the incidence of complications and facilitate early detection of potential complications.
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Method Article
Computed Tomography (CT) Guided Implantation of a Totally Implantable Venous Access Port (TIVAP) through Subclavian Vein
In This Article
Summary
Abstract
Totally implantable venous access ports (TIVAPs) have been proven to be safe and effective and are commonly used in cancer patients. Here, we introduce the entire procedure of CT-guided implantation of a TIVAP through the subclavian vein. A total of 283 nasopharyngeal carcinoma patients, including 215 males and 68 females, underwent TIVAP through the right subclavian vein, with an average age of 46.4 years (range 13-74). One patient experienced a failed right subclavian vein puncture but was able to successfully undergo a left subclavian vein puncture guided by ultrasound. The average operation time was 36.2 min (range 20-90 min), and the length of the catheter was 17.1 cm (range 14-21 cm). There were 3 cases of arterial puncture, 1 case of catheter displacement, 2 cases of hemothorax, 2 cases of pneumothorax, 2 cases of thrombosis, and 2 cases of wound infection. The overall complication rate was 5.3% (15/283). The computed tomography (CT)-guided implantation of a totally implantable venous access port (TIVAP) via the subclavian vein can, therefore, be considered a safe and reliable technique.
Introduction
Most patients with advanced cancer require long-term central venous access for the safe delivery of chemotherapeutic agents, total parenteral nutrition, antibiotics, transfusion of blood and blood products1,2,3. Totally implantable venous access port (TIVAPs) and peripherally inserted central catheters (PICCs) are widely used for these purposes. Compared to peripherally inserted central catheters (PICCs), totally implantable venous access ports (TIVAPs) are increasingly favored among cancer patients due to their demonstrated advantages, including higher catheterization succes....
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Protocol
The Institutional Review Board of Sun Yat-sen University Cancer Center approved the protocol described. Informed consents were waived due to the retrospective nature of this study.
1. Preparations
- Prior to performing the procedure, assess the available information and clarify the surgical indications. Ensure there are no active infections and anatomical deformities of the cervical and thorax region that impede central venous access routes, such as clavicle fractures.
- Ensure the patient has completed hematology examination, blood test, and coagulation function. Exclusion criteria included coagulopathy (....
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Results
A total of 283 nasopharyngeal carcinoma patients underwent TIVAP through the right subclavian vein, with an average age of 46.4 years (range 13-74), including 215 males and 68 females (Table 1). One patient experienced a failed right subclavian vein puncture but was able to successfully undergo a left subclavian vein puncture guided by ultrasound. The average operation time was 36.2 min (range 20-90 min), and the length of the catheter was 17.1 cm (range 14-21 cm). There were 3 cases of arterial puncture.......
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Discussion
First implantation of a TIVAP was performed in 1982 by John Niederhuber using the cephalic vein with the surgical technique10. Now it is generally used in oncology. There are two approaches to perform TIVAPs, the surgical approach and the percutaneous approach. Due to the specialized surgical skills required for the open technique and the widespread perception of percutaneous methods as a more straightforward and safer alternative, the surgical approach has experienced a decline in utilization, wi.......
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Disclosures
The authors declare no conflict of interest.
Acknowledgements
This study was supported by Natural Science Foundation of Guangdong Province, China (Grant No. 2021A1515010479), Guangdong Province Key Field R&D Program Project (2019B110233001), and Guangdong Province Science and Technology Planning Project (2017A010105028).
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Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| Basic Surgical Instrument Set | 120-5000 | Fine Science Tools Inc. | ISO 13485 certified |
| Computed Tomography System (SOMATOM Definition AS) | 20173301123 | Siemens Healthcare GmbH | NMPA valid until 2027-08-21 |
| Heparin Sodium Injection (5000 IU/mL) | H51021209 | Chengdu Haitong Pharmaceutical Co., Ltd. | NMPA Approval H51021209 |
| Implantable Vascular Access Port (Celsite) | 20173661677 | B. Braun Medical SAS (France) | CE Mark No. 0123 |
| Lidocaine HCl Injection (2%, 10mL) | H3102107 | Shanghai Zhaohui Pharmaceutical Co., Ltd. | NMPA Approval H31021073 |
| Patient Monitor (CARESCAPE B650) | 20213170093 | GE Medical Systems Finland Oy | NMPA National Medical Device Registration No. 20213170093 |
| Povidone-iodine Skin Disinfectant Solution | 3211-0003 | Likang Pharmaceutical Technology Jiangsu Co., Ltd | Jiangsu Provincial Health License |
| Sodium Chloride Injection (0.9%, 500mL) | H43020455 | Hunan Kelun Pharmaceutical Co., Ltd. | NMPA Approval H43020455 |
| Sterile Surgical Gloves (Latex, Size 7.5) | MG-100 | Winner Medical (Guilin) Co., Ltd. | Guiyang Medical Equipment Registration No. 20152140022 |
| Surgical Scalpel Blade (#11) | SL-011 | Suzhou Shilai Medical Equipment Co., Ltd. | Suxie registration 20162021476 |
References
- Viart, H., Combe, C., Martinelli, T., Thomas, J., Hida, H. Comparison between implantation costs of peripherally inserted central catheter and implanted subcutaneous ports. Ann Pharm Fr. 73, 239-244 (2015).
- Zhang, N., Piao, M., Zhao, H. Highlights....
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