title: Application of an ultrasound-guided low-approach insertion technique in three types of totally implantable access port.
abstract: BACKGROUND
  Totally implantable access ports (TIAPs) are alternatives to central venous catheters for patients requiring chemotherapy. Since January 2003, we have used a central approach two-point incision technique to insert TIAPs. Following advances in ultrasound technique and clinical experience for tunneled dialysis catheter placement, we modified the central approach to a low-approach technique.
  
  
  METHODS
  From January 2009 to June 2010, patients consulted for TIAP insertion in our department were enrolled in our study. Different brands and materials of central venous catheters of TIAPs were inserted by the low-approach two-point incision technique (Phase I) or the low-approach one-point incision technique (Phase II). The insertion time, failure rate, procedural and late complications, degree of satisfaction, and cosmetic scores were recorded.
  
  
  RESULTS
  Ninety-seven patients and 107 patients were implanted via the two-point and one-point low-approach techniques, respectively, with different kinds of TIAP. No matter which type of TIAP was used, the success rate in both phases was 100% without procedural complications using the low-approach technique. The average time for device insertion was 30 minutes for the two-point incision technique used during Phase I and 26-28 minutes for the one-point incision technique used during Phase II. Satisfaction and cosmetic scores were high.
  
  
  CONCLUSIONS
  Our study highlights a revised technique for placement of TIAP systems of differing types of material or size. Not only was the curvature of the device catheter smooth, but patients were satisfied with the cosmetic appearance.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Cheng
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Chien-Kun
authors.initials: CK
authors.lastname: Ting
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Ya-Chun
authors.initials: YC
authors.lastname: Chu
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: ptchen@vghtpe.gov.tw.
authors.forename: Pin-Tarng
authors.initials: PT
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional
keywords: catheterization; central venous catheter; jugular vein; totally implantable access port; ultrasound