Analysis of chest X-ray plain film images of intravenous ports inserted via the superior vena cava.
OBJECTIVE
The optimal tip position for an intravenous port and the angle between the locking nut and the catheter are still debatable. This study evaluates the use of chest X-ray plain films for screening patients with potential intravenous port complications.


METHODS
We reviewed, retrospectively, 1505 patients who had an intravenous port implanted between January 1 and December 31, 2006 at Chang Gung Memorial Hospital, and were followed up until June 30, 2010. Of the 1119 patients with an intravenous port implanted via the superior vena cava (SVC), 279 underwent re-interventions for complications. There were four different types of single lumen port, and entry vessels on the right side were utilized as the predominant entry sites through the vessel cut-down method for catheter cannulation. The anatomic catheter tip was confirmed on the postero-anterior view of plain chest X-ray films. We used the Picture Arching and Communicating System (PACS) (GE, Fairfield, CT, USA) to record the angle and distance in degrees and centimeters, respectively.


RESULTS
The tracheal carina was seen easily on the chest X-ray plain film and the location of the catheter tip and the angle between the locking nut and the catheter were identified. The location of the catheter tip was significantly related to migration (p < 0.0001). The cut-off value of the receiver operating characteristic (ROC) curve for location and migration was 0.68 cm below the carina. The area under the curve (AUC) was 0.8385 and had favorable predictive power.


CONCLUSIONS
The ideal position of an intravenous port to avoid migration is 0.68 cm below the carina. For surgeons, a quantified reference may minimize technical errors. Patients with shallow tip location should be followed up regularly and aggressive intervention initiated for any intravenous port malfunction.
Division of Chest Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Jui-Ying
JY
Fu
Ching-Feng
CF
Wu
Po-Jen
PJ
Ko
Ching-Yang
CY
Wu
Tsung-Chi
TC
Kao
Sheng-Yueh
SY
Yu
Yun-Hen
YH
Liu
Hung-Chang
HC
Hsieh
D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000145:classification; D004868:Equipment Failure; D005500:Follow-Up Studies; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D013902:Radiography, Thoracic / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D062666:Vascular Access Devices / Q000009:adverse effects*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging* / Q000601:surgery*