Evaluation of the catheter tip position among children with totally implantable port during 2015 in Dr. Sheikh Children’s hospital

Abstract

Introduction: Totally implantable port insertion is a common procedure in pediatrics surgery and the main concern is the position of catheter tip, which is directly related to its complications, failure and durability. The best position is in superior vena cava (SVC)/ right atrium (RA) junction which is compatible with carina or T5-T6 vertebral level in chest x-ray. In our center we routinely use surface anatomy to estimate the adequate length for the tip to reach SVC/RA junction. In this study we compared the precision and accuracy of this method by post-operative chest x-ray study. Materials and Methods: as a retrospective study we evaluated the accuracy of surface anatomical land marks to estimate the catheter tip position, considering the carina or vertebra in chest x-ray which represents the SVC/RA junction. Fourty eight patients were included and their records were reviewed in Dr. Sheikh Children’s hospital in Mashhad. Results: Considering the carina as the best radiographic land mark, we had accurate tip position only in 29.2%, over insertion in 45.8% and under inserted catheter tip in 10.4%. Considering the vertebral bodies as radiographic land mark, 50% were over inserted, 35.4% accurate and 14.6% under inserted. Conclusion: Regarding our high rate of catheter tip mal-position arising from considering surface anatomy alone, we suggest not only to rely on surface anatomy but use imaging modalities such as portable X-ray, fluoroscopy or ultra-sonography within the operation room while inserting implantable port devices.

Keywords

• pediatrics
• implantable catheter
• superior vena cava
• access port
• chest x ray