Combined approach for port-a-cath implantation -a dependable alternative

Background: Port-a-Cath are routinely warranted as a universal venous access for chemotherapy, due to their operational ease, comparatively less complications and relative ease of maintenance. Catheter implantation can be done either by surgical approach by vein cut-down technique or ultrasound-guided percutaneous technique or by landmark technique using fluoroscopy .Here we present our data on our novel technique.

Methods:  A descriptive cross-sectional study of 92 consecutive patients who underwent Port-a-Cath implantation for adjuvant therapy, from August 2017 through to July 2019 was done. The procedure was carried out in the minor operation theatre under local anaesthesia with anaesthetist doing a transthoracic echocardiography and surgeon doing a cephalic vein cut down under echocardiography guidance, as a day care procedure. This allowed the catheter to reach the superior vena cava smoothly thus avoiding inadvertent cannulation of the internal jugular vein.

Results: Four (4.34%) of t92 patients required additional sedation. No patients required to be re-explored in lieu of erroneous placement of the catheter. In all patients the catheter was placed properly in the superior vena cava- right atrial junction. Late complications amounted to 8.69% of the study group, this included flip over, puncture site infection and catheter blockage. All patients were followed-up for a period of 1 to 6 months.

Conclusions: We advocate a combined approach of echocardiography guided Port-a-Cath insertion through cephalic vein cut down as a simple, safe, with satisfactory success rate. It offers a suitable alternative to the other invasive procedures performed under image guidance and avoids radiation exposure and malposition.