FLUOROSCOPY-FREE PLACEMENT OF STANDARD CHEST-WALL SUBCUTANEOUS CHRONIC VENOUS ACCESS DEVICES

Background: This study was undertaken to evaluate the potential benefi ts of using an electromagnetic detection system to guide the intraoper ative placement of chronic venous access devices (CVADs). Study Design : An electromagnetic detection system was used to guide catheter place ment during 54 procedures. Surgery and radiation exposure times were r ecorded. An oncology nursing follow-up questionnaire assessed device f unction. A cost analysis was performed. Outcomes were compared to simi lar data from a fluoroscopic historical control group. Results: Eight study patients required intraoperative fluoroscopy; in 46 procedures ( 85%) the electromagnetic detection system was the sole modality employ ed to guide CVAD placement. One line was subsequently found in the int ernal mammary vein (2% false negative rate). Mean surgery times for pl acement of CVADs were 79.5 and 84.5 minutes for the study and control groups (p = NS). Mean radiation exposure rates were 0.16 and 0.86 minu tes per patient for the study and control groups (p < 0.01). There was no significant difference in device function between groups. Major co mplications in the study group were rare. Mean cost of CVAD placement was $1993 and $2517 for the study and control groups (p = 0.005), resp ectively. Conclusions: The use of the electromagnetic detection system resulted in accurate placement of chest wall CVADs in the majority of patients. This resulted in significant reductions in radiation exposu re and cost of CVAD placement.