Combined approach for port-a-cath implantation-a dependable alternative

Abstract

Background: Port-a-Cath are routinely warranted as a universal venous access for chemotherapy, due to their operational ease, comparatively less complications and relative ease of maintenance. Catheter implantation can be done either by surgical approach by vein cut-down technique or ultrasound-guided percutaneous technique or by landmark technique using fluoroscopy. Here we present our data on our novel technique. Methods: A descriptive cross-sectional study of 92 consecutive patients who underwent Port-aCath implantation for adjuvant therapy, from August 2017 through to July 2019 was done. The procedure was carried out in the minor operation theatre under local anaesthesia with anaesthetist doing a transthoracic echocardiography and surgeon doing a cephalic vein cut down under echocardiography guidance, as a day care procedure. This allowed the catheter to reach the superior vena cava smoothly thus avoiding inadvertent cannulation of the internal jugular vein. Results: Four (4.34%) of 92 patients required additional sedation. No patients required to be reexplored in lieu of erroneous placement of the catheter. In all patients the catheter was placed properly in the superior vena cava-right atrial junction. Late complications amounted to 8.69% of the study group, this included flip over, puncture site infection and catheter blockage. All patients were followed-up for a period of 1 to 6 months. Conclusions: We advocate a combined approach of echocardiography guided Port-a-Cath insertion through cephalic vein cut down as a simple, safe, with satisfactory success rate. It offers a suitable alternative to the other invasive procedures performed under image guidance and avoids radiation exposure and malposition.