title: The "L-shaped tunneling technique": a modified technique facilitating a more discreet implantable port positioning.
abstract: OBJECTIVE
  Venous port catheters, also known as "totally implantable venous access devices" (TIVADs), are now the standard of care in patients requiring long-term intermittent intravenous drug administration. We describe a modification of the implantation technique that we use in our department in order to improve the cosmetic result of a TIVAD.
  
  
  METHODS
  After ultrasound-guided venous access in the internal jugular vein (IJV) or another appropriate vein has been obtained, we create a port pocket in the deltopectoral groove, in the upper-lateral chest wall, in a "far-lateral-oblique" orientation, respecting the individual patient's relaxed skin tension lines. Then we create a subcutaneous tunnel using a straight metal tunneler in two steps: first tunneling cranially and perpendicular to the port incision for a small distance, and then, after turning the tunneler at a right angle continuing in a straight line until we exit at the venous access site.
  
  
  RESULTS
  This configuration not only prevents catheter kinking, to ensure uninhibited flow, but also allows us to place the port pocket in a more discreet position, in order to offer a better cosmetic result to our patients.
  
  
  CONCLUSIONS
  Adoption of a "far-lateral-oblique" port implantation site along with the "L-shaped tunneling technique" will offer doctors who are implanting TIVADs a useful alternative for a better cosmetic result.
authors.affiliation: Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete - Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.affiliation: Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete - Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D017060:Patient Satisfaction; D011474:Prosthesis Design; D011677:Punctures; D018084:Ultrasonography, Interventional