Key result
Intraoperative fluoroscopy provided accurate catheter tip location in 63.9% of patients, while shorter height, longer implanted catheter length, and larger superior vena cava diameter increased the risk of central catheter migration.
Why the study?
Does intraoperative fluoroscopy accurately predict catheter tip location in oncology patients receiving intravenous ports?
Cohort (n=346)
No
Does intraoperative fluoroscopy accurately predict catheter tip location in oncology patients receiving intravenous ports?
Intraoperative fluoroscopy accurately predicts catheter tip location in the majority of patients, and a catheter length formula of height/10 may serve as a useful reference to minimize central migration.
Fluoroscopy accuracy may be insufficient for sole reliance in port placement; supports hypothesis-generating risk factors but requires prospective validation.
Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20 mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P = 0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P = 0.02), and longer implanted catheter length (P = 0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy.
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Wu et al. (2015) conducted a cohort in Oncology patients requiring intravenous port implantation for chemotherapy (n=346). Intraoperative fluoroscopy-guided intravenous port implantation was evaluated on Accurate catheter tip location (nonmovement, defined as <1 cm difference between intraoperative fluoroscopy and postoperative chest plain film). Intraoperative fluoroscopy provided accurate catheter tip location in 63.9% of patients, while shorter height, longer implanted catheter length, and larger superior vena cava diameter increased the risk of central catheter migration.
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