Evaluation of the catheter tip position among children with totally implantable port during 2015 in Dr. Sheikh Children’s hospital

Reza Shojaeian, Mohammad Mahdi khazravi



Introduction: Totally implantable port insertion is a common procedure in pediatrics surgery and the main concern is the position of catheter tip, which is directly related to its complications, failure and durability. The best position is in superior vena cava (SVC)/ right atrium (RA) junction which is compatible with carina or T5-T6 vertebral level in chest x-ray. In our center we routinely use surface anatomy to estimate the adequate length for the tip to reach SVC/RA junction. In this study we compared the precision and accuracy of this method by post-operative chest x-ray study.

Materials and Methods: as a retrospective study we evaluated the accuracy of surface anatomical land marks to estimate the catheter tip position, considering the carina or vertebra in chest x-ray which represents the SVC/RA junction. Fourty eight patients were included and their records were reviewed in Dr. Sheikh Children’s hospital in Mashhad.

Results: Considering the carina as the best radiographic land mark, we had accurate tip position only in 29.2%, over insertion in 45.8% and under inserted catheter tip in 10.4%. Considering the vertebral bodies as radiographic land mark, 50% were over inserted, 35.4% accurate and 14.6% under inserted.

Conclusion: Regarding our high rate of catheter tip mal-position arising from considering surface anatomy alone, we suggest not only to rely on surface anatomy but use imaging modalities such as portable X-ray, fluoroscopy or ultra-sonography within the operation room while inserting implantable port devices.


pediatrics; implantable catheter; superior vena cava; access port; chest x ray

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Witthayapraphakorn L, Khositseth A, Jiraviwatana T, et al: Appropriate length and position of the central venous catheter insertion via right internal jugular vein in children. Indian Pediatr 2013;50(8):749-52.

Tarr GP, Pak N, Taghavi K, et al: Defining the surface anatomy of the central venous system in children. Clin Anat 2016;29(2):157-64.

Yoon SZ, Shin TJ, Kim HS, et al: Depth of a central venous catheter tip: length of insertion guideline for pediatric patients. Acta Anaesthesiol Scand 2006;50(3):355-7.

Yoon SZ, Shin JH, Hahn S, et al: Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients. Br J Anaesth 2005;95(4):514-7.

Dulce M, Steffen IG, Preuss A, et al: Topographic analysis and evaluation of anatomical landmarks for placement of central venous catheters based on conventional chest X-ray and computed tomography. Br J Anaesth 2014;112(2):265-71.

Kim SC, Heinze I, Schmiedel A, et al: Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe: an observational pilot study. Eur J Anaesthesiol 2015;32(1):29-36.

Nowlen TT, Rosenthal GL, Johnson GL, et al: Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002;110(1 Pt1):137-42.

Yoder D: Cardiac perforation and tamponade: the deadly duo of central venous catheters. Int J Trauma Nurs 2001;7(3):108-12.

Na HS, Kim JT, Kim HSet al: Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients. Br J Anaesth 2009;102(6):820-3.

DOI: https://doi.org/10.22037/irjps.v4i2.21466


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