title: Fast Track ultrasound protocol to detect acute complications after totally implantable venous access device placement.
abstract: BACKGROUND
  The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization.
  
  
  METHODS
  Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared.
  
  
  RESULTS
  Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p < 0.001).
  
  
  CONCLUSIONS
  Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Wu
authors.forename: Feng-Sheng
authors.initials: FS
authors.lastname: Lin
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Wang
authors.forename: Wei-Han
authors.initials: WH
authors.lastname: Chou
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Lin
authors.forename: Wei-Zen
authors.initials: WZ
authors.lastname: Sun
authors.forename: Chih-Peng
authors.initials: CP
authors.lastname: Lin
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D014465:Ultrasonics; D014463:Ultrasonography