One year using the Modified Single Incision Technique (MSIT) for subcutaneous chest-port placement: one center experience

Congress:

ECR 2012

Poster Number:

C-2158

Type:

Scientific Paper

Keywords:

Interventional vascular, Vascular, Oncology, Fluoroscopy, Venous access, Catheters, Technical aspects, Neoplasia, Metastases

Authors:

A. Romero Jaramillo, M. Perez Lafuente, N. Salmeron Alemany, A. Gelabert Barragan, I. Diez Miranda, A. Segarra Medrano; Barcelona/ES

DOI:

10.1594/ecr2012/C-2158

DOI-Link:

https://dx.doi.org/10.1594/ecr2012/C-2158

Fig. 1: Precurved needle. Jugular vein entry point marked (violet mark).

$Fig. 2: Needle pathway marked with violet ink. Needle entry site at infraclavicular fossa, heading toward supraclavivular fossa.$

Fig. 2: Needle pathway marked with violet ink. Needle entry site at infraclavicular...

Fig. 3: Needle approaching anterior wall of the internal jugular vein.

Fig. 4: Needle tip inside the lumen of internal jugular vein.

Fig. 5: Detail of the subcutaneous tract, and endoluminal microguidewire

Fig. 6: Subcutaneous pocket already done and microguidewire before exchanging for stiff...

Fig. 7: Subcutaneous tract dilation before inserting peelaway sheath.

Fig. 8: Port catheter inserted over the wire through the peelaway sheath

Fig. 9: Surgical wound after suturing by planes.

Fig. 10: Control shows final result. Note tracheostomy canule and the smooth pathway of...

Methods and Materials

From april 2010 until may 2011, 100 unselected chest ports were placed using MSIT. Forty two men and fifty eight women with ages between 9 months and 82 years old, mean 56,97 years. All ports were implanted in an angiography suite in an sterile fashion under local anesthesia in adults and with general anesthesia in pediatric patients.

Previous informed consent is obtained. Internal jugular vein puncture is performed coming from the infraclavicular fossa in caudo-craneal direction always using ultrasound guidance with a micropuncture set needle, previously preformed to an arc shape by hand. The microguidewire is advanced to inferior vena cava with fluoroscopy guidance. Then the port pocket incision is performed horizontally from the needle to each side and the pocket is disected. The introducer of the micropunture set is placed over the microguidewire and the wire exchanged for a stiff hydrophilic guidewire that is advanced to inferior vena cava. Next the peelaway introducer is advanced over the stiff guidewire and the port's catheter is advanced over the wire, measured, cut and attached to the port. The port is then introduced inside the pocket and fixed with reabsorbable 2/0 suture. Next it's proved and flushed with saline and finally heparinized. Pocket suture is performed in two different planes with rebsorbalbe 4/0 monofilament suture, first the subcutaneous plane and then the skin with an intradermic continous suture.

In all cases a complete port set was used. Eighty nine low profile ports, ten standard ports an one pediatric device were implanted. Eighty one catheters were placed via right internal jugular vein and nineteen on the left. Technical and procedural outcomes were registered. Follow up was done with a control phone call 48 hr. post implant, wound examination 7-10 days after implant, follow up and posterior events registered.