Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Feasibility and Safety of a Technique Intended to Place the Catheter Tip in the Right Atrium without Abutment Against the Cardiac Wall during Implantation of the Totally Implantable Venous Access Port

완전이식형 정맥 접근 포트 삽입 시 카테터 팁을 심벽에 닿지 않고 우심방 내 위치시키는 방법의 타당성과 안전성

  • Hyejin Park (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Tae-Seok Seo (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Myung Gyu Song (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Woo Jin Yang (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine)
  • 박혜진 (고려대학교 의과대학 고려대학교 구로병원 영상의학과) ;
  • 서태석 (고려대학교 의과대학 고려대학교 구로병원 영상의학과) ;
  • 송명규 (고려대학교 의과대학 고려대학교 구로병원 영상의학과) ;
  • 양우진 (고려대학교 의과대학 고려대학교 구로병원 영상의학과)
  • Received : 2023.05.24
  • Accepted : 2023.07.26
  • Published : 2024.01.01
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Abstract

Purpose To assess the safety and feasibility of intentionally positioning the catheter tip in the right atrium (RA) without an abutment during implantation of a totally implantable venous access port (TIVAP). Materials and Methods We enrolled 330 patients who had undergone TIVAP implantation between January and December 2016 and postoperative chest CT. The TIVAP was placed using the single-incision technique to access the axillary vein directly from the incision line. To position the catheter tip in the RA without abutment, blood return was checked before cutting. Catheter length and complications were evaluated by retrospectively reviewing medical images and records. Results All patients achieved successful catheter tip positioning without abutment or dysfunction. The median tip position was 15.3 mm distal to the cavoatrial junction (CAJ) on fluoroscopy and 6 mm distal to the CAJ on CT. Catheter tips migrated a median of 10.4 mm cephalically on CT compared to fluoroscopy. Thromboses were detected in the RA and superior vena cava in one patient each. Conclusion Intentional catheter tip positioning in the RA without abutment is a safe and feasible technique with a low incidence of thrombosis and no observed dysfunction.

목적 완전이식형 정맥 접근 포트 이식 시 카테터 팁을 심벽에 닿지 않으면서 우심방 내 위치시키는 기술의 타당성과 안전성에 대하여 평가하였다. 대상과 방법 2016년 1월부터 12월까지 완전이식형 정맥 접근 포트를 삽입하고 추적관찰 CT를 시행한 환자 총 330명이 연구에 포함되었다. 정맥 접근 포트는 절개선에서 직접 액와정맥으로 접근하는 단일절개법을 적용하여 이식하였다. 카테터 팁을 자르기 전 정맥 환류를 확인하여 우심방 내벽에 닿지 않도록 위치를 확인하였다. 카테터의 길이 및 연관된 합병증은 의료영상 그리고 의료기록을 통해 후향적으로 평가하였다. 결과 모든 환자에서 카테터 팁은 심벽과의 닿음과 기능장애 없이 성공적으로 위치 조정되었다. 카테터 팁의 위치는 cavoatrial junction 기준으로 fluoroscopy에서 15.3 mm, 첫 번째 CT에서 6 mm 원위부에 있었다(중앙값). 카테터 팁은 fluoroscopy 대비 첫 번째 CT에서 10.4 mm 머리 방향으로 이동하였다(중앙값). 추적 CT에서 우심방과 상대정맥에서 각각 1건씩의 혈전증이 발견되었다. 결론 카테터 팁을 심벽에 닿지 않으면서 우심방 내 의도적으로 위치시키는 것은 혈전증 발생률이 낮고 기능장애가 없는 기술적으로 가능하고 안전한 방법이다.

Keywords

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