Expanding our interventional skills: Placement of totally implantable injection ports by internists/intensivists

Totally implantable injection ports are usually placed by surgeons or radio logists using fluoroscopic guidance. In a prospective study we evaluated th e efficacy of percutaneous insertion of these devices without the use of fl uoroscopic control by internists/intensivists experienced in the placement of permanent cuffed catheters. The supraclavicular approach to the subclavi an vein was chosen for first line puncture site because of its low rate of malpositions and complications. 101 ports were inserted in 101 consecutive patients, 96 from the supraclavi cular approach. Difficulties in introducing the catheter through the peel-a way sheath, misplacement into adjacent vessels, secondary migration, or fra gmentation of a line were not observed. Function was excellent in all ports . Three pneumothoraces (3 %) and three arterial punctures (3 %), none of wh ich required intervention, were recorded. Two ports (2 %) had to be revised , one due to local hematoma and another because of inadequate catheter leng th. Catheter survival was 94 % in a 30-month observation period. Placement of totally implantable port systems by internists/intensivists ex perienced in placing central venous lines is safe and efficient, thus the i mplantation can easily be performed with minimal technical expenditure in t he setting of an intensive care unit. The supraclavicular approach is suita ble for insertion of permanent infusion port systems without fluoroscopic c ontrol.