Outcomes of Totally Implantable Venous Access Device Implantation without Fluoroscopic Guidance on the Right Side in Patients with Breast Cancer

Introduction: Totally implantable venous access devices (TIVADs), commonly known as chemo ports, are essential for the safe delivery of vesicant chemotherapeutic agents and other intravenous therapies in cancer patients.Fluoroscopic or echocardiographic guidance is traditionally used to ensure optimal catheter tip positioning at the superior vena cava-right atrium (SVC-RA) junction to minimize complications.However, these imaging modalities are not always accessible in resource-limited settings.This study evaluates the outcomes of right-sided TIVAD implantation without fluoroscopic guidance in breast cancer patients using a modified Peres' formula for catheter depth estimation. Patients and methods:In this retrospective review of a prospectively maintained database, 64 patients with breast carcinoma underwent TIVAD implantation between June 2018 and January 2025.All procedures were performed under local anesthesia with ultrasound-guided right internal jugular vein (IJV) catheterization in the lowest part of the neck.Catheter depth was calculated using the modified Peres' formula: [(height in cm/10) -4].Postoperative chest X-ray was used to assess the positioning of the catheter.Complications and TIVAD-related outcomes were recorded and analyzed.Results: Among 64 patients, the total indwelling catheter days were 37,559, with a median of 687 days [interquartile range (IQR): 460-757].Eight (12.5%)TIVADs were removed prematurely, five (7.8%) patients died with TIVAD in situ, and two (3.1%) removals were due to catheter migration into the right atrium, causing arrhythmia.One major malposition was detected on postoperative chest X-ray, which required repositioning.No cases of thrombosis, catheter fracture, or embolism were noted.Right-sided access was feasible even in patients with right-sided breast cancer and did not interfere with surgery or radiotherapy.Conclusion: Right IJV access and implantation on the right side remains practical even for right-sided breast cancers.The modified Peres' formula enables safe and effective TIVAD placement in resource-constrained environments without the need for fluoroscopy.