Evaluation of the Position of the Central Venous Catheter Tip of Implantable Venous Access Devices in the Occurrence of Postoperative Thrombotic and Non-Thrombotic Complications

Background: The catheter tip of totally implanted venous access devices (TIVAD) is a risk factor for postoperative complications. The study aim was to assess the early (EC) and late complications (LC) associated with the position of the catheter tip in patients with cancer. Methods: We reviewed cancer patients who had a TIVAD placed in 2020. EC (<90 days), LC (>90 days) and risk factors for TIVAD-associated complications were assessed. The vertical mismatch of the catheter tip compared to a “ideal position”: >10mm below the carina and >20 mm belowthe right main bronchus (RMB) was assessed on post-implantation chest x-ray. Results: 301 patients were included, with a median time of port follow at 9.4 months. All TIVADs were inserted via the internal jugular vein (IJV). The mean distance between the catheter tip and the carina or RMB was 21.3 mm and6.63 mm respectively. In total, 11.3% TIVADs developed EC and 5.6% had LC. An association was found between the position of the catheter tip from the carina (≤ 10mm vs > 10mm) and the occurrence of EC (18.3% vs 8.6%, p=0.01) and for the insertion site (left IJV vs right IJV) (19.1% vs 9.0% p=0.02). In multivariate analysis, left IJV insertion (OR 2.76), and a catheter tip located ≤ 10 mm below the carina (OR 2.71) were the significant independent risk factors of EC. Conclusions: TIVAD catheter tip located at less than 10 mm below the carina and a left-side inserted catheter are at higher risk of short-term complications.