title: Relationship between chest port catheter tip position and port malfunction after interventional radiologic placement.
abstract: OBJECTIVE
  The relationship between catheter tip position of implanted subcutaneous chest ports and subsequent port malfunction was investigated. Tip movement from initial supine position to subsequent erect position was also evaluated.
  
  
  METHODS
  Patients who underwent imaging-guided internal jugular chest port placement between July 2001 and May 2003 were identified with use of a quality-assurance database. Sixty-two patients were included in the study (22 men and 40 women), with a mean age of 58 years (range, 27-81 years). Catheter tip location on the intraprocedural chest radiograph was determined with use of two methods. First, the distance from the right tracheobronchial angle (TBA) was recorded (TBA distance). Second, tip location was classified into six anatomic regions: 1, internal jugular veins; 2, brachiocephalic veins; 3, superior vena cava (SVC; n = 11); 4, SVC/right atrial junction (n = 22); 5, upper half of right atrium (n = 25); and 6, lower half of right atrium (n = 4). For the duration of follow-up, catheter tip location was documented, as were all episodes of catheter malfunction.
  
  
  RESULTS
  Patients with catheter tips initially placed in position 3 had a higher risk of port malfunction (four of 11; 36%) than patients with catheter tips located in position 5 (two of 25; 8%). This difference narrowly fell short of statistical significance (P =.057). When comparing intraprocedural chest radiographs to the first erect chest radiographs, significant upward tip movement was noted. The tips migrated cephalad an average of 20 mm (P =.003) and 1.0 position units (P =.001).
  
  
  CONCLUSIONS
  Catheter tips placed in the SVC tended to have a greater risk of port malfunction compared with those positioned in the right atrium. Chest ports migrated cephalad between the supine and erect positions.
authors.affiliation: Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Jakob C L
authors.initials: JC
authors.lastname: Schutz
authors.forename: Aalpen A
authors.initials: AA
authors.lastname: Patel
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Solomon
authors.forename: David B
authors.initials: DB
authors.lastname: Freiman
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Tuite
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Andrew
authors.initials: A
authors.lastname: Kwak
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Chittams
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications* / Q000517:prevention & control; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D012189:Retrospective Studies; D018709:Statistics, Nonparametric