Implantable port tip location based on patient position and BMI

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Abstract:

PURPOSE: To evaluate the extent of normal variation in implantable port devices between supine fluoroscopy and upright chest x-ray in relation to body mass index (BMI) based on three different measurement methods.

METHODS: Retrospectively, 80 patients with implanted central venous access port systems from 2012-01-01 until 2013-12-31 were analyzed. Three parameters (two quantitative and one semi-quantitative) were determined to assess port positions: projection of port capsule to anterior ribs (PCP) and intercostal spaces, ratio of extra- and intravascular catheter portions (EX/IV), normalized distance of catheter tip to carina (nCTCD). Changes were analyzed for males and females and normal-weight and overweight patients using analysis of variance with Bonferroni-corrected pairwise comparison.

RESULTS: PCP revealed significantly greater changes in chest x-rays in overweight women than in the other groups (p<0.001, F-test). EX/IV showed a significantly higher increase in overweight women than normal-weight women and men and overweight men (p<0.001). nCTCD showed a significantly greater increase in overweight women than overweight men (p = 0.0130). There were no significant differences between the other groups. Inter- and intra-observer reproducibility was high (Cronbach alpha of 0.923-1.0) and best for EX/IV.

CONCLUSIONS: Central venous port systems show wide normal variations in the projection of catheter tip and port capsule. In overweight women apparent catheter migration is significantly greater compared with normal-weight women and with men. The measurement of EX/IV and PCP are straightforward methods, quick to perform, and show higher reproducibility than measurement of catheter tip-to-carina distance.

Reference:

Wyschkon, S., Löschmann, J.P., Scheurig-Münkler, C., Nagel, S., Hamm, B. and Elgeti, T. (2015) Apparent migration of implantable port devices: normal variations in consideration of BMI. The Journal of Vascular Access. December 22nd. [Epub ahead of print].

doi: 10.5301/jva.5000502.

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