title: Efficacy and safety of ultrasound-guided placement of central venous port systems via the right internal jugular vein in elderly oncologic patients: our single-center experience and protocol.
abstract: BACKGROUND
  Ultrasound-guidance has become the routine method for internal jugular vein (IJV) catheterization reducing dramatically failure and complication rates for central venous port (CVP) placement.
  
  
  OBJECTIVE
  The aim of this study was to determine the safety and efficacy of ultrasound-guided IJV CVP placement in elderly oncologic patients.
  
  
  METHODS
  Between January 2013 and December 2015, 101 elderly oncological patients underwent right IJV CVP placement under ultrasound-guidance. The length of catheter introduction ranged from 18 to 21 cm. Intraoperative fluoroscopy (IF) was always performed intraoperatively. Chest X-ray (CXR) was always performed 30 min after the end of the procedure.
  
  
  RESULTS
  The morbidity rate was 1.98%; two arterial punctures were reported with one self-limiting hematoma. Two patients (1.98%) had catheter misplacements, recognized by intraoperative IF. No patients (0%) experienced pneumothorax (PNX), confirmed at CXR. Patients were all discharged at maximum 6 h from the procedure.
  
  
  CONCLUSIONS
  The risk of catheter misplacement, PNX, and arterial/nerve puncture remains present with this technique. Lower rates of catheter misplacement have been reported after right IJV puncture, probably for its straight vertical course. Our results are in accordance with literature (1 counter-lateral subclavian vein and 1 counter-lateral internal jugular vein misplacements). All misplacements were detected intraoperatively. The PNX rates after cannulation of the IJV vary between 0.0 and 0.5%. We had no PNX occurrence.
  
  
  CONCLUSIONS
  Ultrasonography (US) has improved safety and effectiveness of port system placements. While routine post-procedural CXR seems avoidable, IF should be considered mandatory.
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy. al.canfora@gmail.com.
authors.forename: Alfonso
authors.identifier: http://orcid.org/0000-0002-2655-5018
authors.initials: A
authors.lastname: Canfora
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.|Department of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferronetti
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Marte
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Di Maio
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ciorra
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Esposito
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Giuliano
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fregola
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Barra
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cuzzovaglia
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bottino
authors.affiliation: Department of General Surgery, Evangelic Hospital Villa Betania, Via Argine 604, 80147, Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Maida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods; D014463:Ultrasonography / Q000379:methods*; D062666:Vascular Access Devices
keywords: Cancer; Central venous port; Elderly patients; Internal jugular vein; Ultrasound-guidance