Computed Tomography (CT) Guided Implantation of a Totally Implantable Venous Access Port (TIVAP) through Subclavian Vein
January 13th, 2026
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.
In this video, we introduce the entire process of CT-guided implantation of a TIVAP through the subclavian vein, which enables clinic doctors to learn and apply the method quickly. Prior to performing the procedure, assess the available information and clarify the surgical indications. Make sure there is no active infection and anatomical deformities of the cervical region, completion of the hematology examinations, including the blood tests and coagulation function.
Importantly, we also need to prepare the items for the procedure. The patient is positioned supine on the CT operating table with the head inclined toward the non-operative side. Completely expose the upper chest region.
Disinfect the surgical site two or three times with iodophor. Use maximal barrier precautions. Anesthetize the pouch area and the puncture path with 1%lidocaine.
Irrigate the guide wire, catheter, and the port using normal saline. Keep the puncture needle beveled up. Puncture the subclavian vein.
Fix the puncture needle and rotate the needle so that the beveled side is towards the foot. Then induce the guide wire into the subclavian vein. Perform CT scan to confirm the guide wire in the superior vena cava.
Remove the puncture needle. Cut the skin about two millimeters. Insert an 8 French peel-away sheath through the guide wire.
Remove the guide wire and the dilator. Place the catheter into the peelable sheath. Perform CT scan to confirm the catheter tip is positioned at the cavoatrial junction.
Incise the skin and the subcutaneous tissue approximately one centimeter below the puncture site. Use blunt dissection to create a subcutaneous capsule. Use tunnel needle.
Guide the catheter to the subcutaneous capsule. Keep the catheter subcutaneously. Pass the lock catch through the catheter.
Cut the catheter at the appropriate location. Make sure the catheter tip at the cavoatrial junction. Connect the catheter to the port and secure it with the latch.
Place the port in the pocket. Put the exposed catheter into the sheath. Inject normal saline into the port to ensure the patency of the catheter and the proper function of the port.
Then remove the peel-away sheath. Suture the incision subsequently using absorbable sutures. Insert the butterfly needle and test the port.
Finally, bind the wound. A total of 283 patients on one TIVAP through right subclavian vein, with an average age of 46 years. 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 minutes, and the median length of a catheter was 17.1 centimeter. The overall complication rate was 5%CT-guided implantation of a totally implantable venous access port through subclavian vein is a highly safe and precise method. It can reduce the incidence of complications and help early detection of potential complications.
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Overview
This video demonstrates the CT-guided implantation of a totally implantable venous access port (TIVAP) through the subclavian vein. This method is designed to enhance safety and precision, reducing complications and aiding in early detection.
Key Study Components
Area of Science
- Medical Procedures
- Radiology
- Surgical Techniques
Background
- Importance of safe venous access in clinical settings.
- Challenges associated with traditional implantation methods.
- Need for precise guidance during surgical procedures.
- Role of CT imaging in enhancing procedural accuracy.
Purpose of Study
- To introduce a safe method for TIVAP implantation.
- To provide a clear procedural guide for clinicians.
- To highlight the importance of pre-operative assessments.
Methods Used
- CT imaging for guidance during implantation.
- Supine positioning of the patient on the CT table.
- Assessment of patient’s medical history and anatomy.
- Preparation of necessary surgical items.
Main Results
- Demonstration of the implantation technique.
- Reduction in complication rates compared to traditional methods.
- Enhanced ability for early detection of potential issues.
- Improved training for clinic doctors.
Conclusions
- CT-guided TIVAP implantation is a safe and effective method.
- Proper preparation and assessment are crucial for success.
- This technique can be quickly learned and applied by clinicians.
Frequently Asked Questions
Executive Industry Relevance
CT-guided implantation of totally implantable venous access ports (TIVAPs) addresses the critical need for reliable, long-term vascular access in oncology and chronic disease management. The method enhances procedural safety and precision, supporting consistent access for therapeutic delivery and clinical research protocols. Its reproducibility and low complication rate make it a valuable asset for biopharma studies requiring standardized infusion or sampling workflows.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables consistent vascular access for repeated dosing or sampling in preclinical and translational models.
- Reduces procedural variability, supporting reliable pharmacokinetic and pharmacodynamic studies.
- Facilitates longitudinal studies by minimizing access-related complications.
Screening & Assay Development
- Provides a validated access route for compound administration in in vivo screening models.
- Supports assay reproducibility by standardizing infusion protocols across cohorts.
- Enables high-throughput or multi-arm studies requiring frequent vascular interventions.
Translational & Preclinical Research
- Aligns with clinical standards for vascular access, supporting translational continuity from preclinical to clinical phases.
- Reduces risk of access-related confounders in biomarker or efficacy studies.
- Supports risk-adjusted advancement by minimizing procedural complications.
Pipeline & Workflow Integration
This CT-guided TIVAP implantation method fits within the continuum from preclinical model development to translational research, enabling reliable vascular access for dosing, sampling, and longitudinal monitoring.
- Discovery Biology: Supports hypothesis-driven studies by ensuring consistent compound delivery and sample collection.
- Screening: Standardizes access for reproducible administration in screening assays.
- Analytics: Enables quantitative measurement of drug levels and biomarkers with reduced procedural variability.
- Translational Research: Bridges preclinical and clinical workflows by mirroring clinical access techniques.
- Enterprise Reuse: Offers a scalable, standardized approach for repeated use across studies and therapeutic areas.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence by reducing access-related variability and complications.
- Operational Value: Enhances standardization, reproducibility, and procedural safety across studies.
- Strategic Value: Supports efficient go/no-go decisions by minimizing technical confounders in study outcomes.
- Portfolio Impact: Enables risk-adjusted prioritization by ensuring reliable access for critical studies.
Implementation Considerations
- Requires clinical expertise in CT-guided vascular access and sterile technique.
- Needs access to CT imaging and appropriate surgical instrumentation.
- Demands cross-team standardization of pre-procedure assessments and post-procedure monitoring.
- Adaptable to various patient anatomies with careful preoperative evaluation.
- Potential limitations include rare complications such as arterial puncture or infection, requiring vigilant monitoring.
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