Key result
Venipuncture close to the clavicle and gentle catheter curves are linked to fewer catheter fractures.
Why the study?
Complications due to prolonged placement of subcutaneously implanted central venous ports, including catheter fracture, have been reported, necessitating investigation of appropriate puncture points and port placement sites to prevent catheter fracture in right internal jugular port placement.
Does venipuncture close to the clavicle and a gentle catheter curve prevent catheter fracture in patients undergoing right internal jugular port placement?
Observational (n=709)
Does venipuncture close to the clavicle and a gentle catheter curve prevent catheter fracture in patients undergoing right internal jugular port placement?
Venipuncture close to the clavicle (<3 cm) and a gentle catheter curve (~90° angle) are associated with a lower risk of catheter fracture in right internal jugular port placements.
May support closer clavicular venipuncture and gentler curves to lower fracture risk; leaves open prospective confirmation before practice change.
BACKGROUND: For subcutaneously implanted central venous ports, some complications due to prolonged placement have been reported. We investigated the appropriate puncture points and port placement sites to prevent catheter fracture in right internal jugular port placement. METHODS: This retrospective study included 709 patients who underwent right internal jugular vein puncture and port implantation in the right precordium between 1 May 2012 and 31 March 2018. The cases were divided into undamaged catheter group and damaged catheter group comprising normal and fracture cases, respectively. The catheter angle, distance from the clavicle, tip position, and curvature radius were measured from fluoroscopic images obtained at the time of implantation. The t-test was used in statistical analysis. RESULTS: Median angles were 91.6° in the undamaged catheter group and 58.0° in the damaged catheter group. Median distances were 26.0 mm in the undamaged catheter group and 36.6 mm in the damaged catheter group. Median tip positions were 51.6 mm in the undamaged catheter group and 37.5 mm in the damaged catheter group. Median curvature radii were 9.2 R in the undamaged catheter group and 7.1 R in the damaged catheter group. Significant differences were found in the angle, height, and curvature radius between the two groups. CONCLUSION: Our results indicate that a venipuncture as close to the clavicle as possible (less than 3 cm) and a gentle catheter curve (close to 90° angle) are associated with a lower risk of catheter fracture.
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Matsunari et al. (2019) conducted an observational in Right internal jugular port placement (n=709). Venipuncture point and port chamber site vs. Undamaged catheter group was evaluated on Catheter fracture. A venipuncture close to the clavicle (median distance 26.0 mm vs 36.6 mm) and a gentle catheter curve (median angle 91.6° vs 58.0°) are associated with a lower risk of catheter fracture.
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