gms | German Medical Science

Introduction: Malignancies of the head and neck rank fifth in frequency world wide. Medical treatment plays an increasingly important role as new chemo- and immunotherapies are developed. This requires placement of sufficiently sized catheters, often in central vessels. Placement in peripheral veins is simple and effective, but often requires multiple placements that lead to patient discomfort und a risk for increased infections. Multiple placements, however, lead to patient discomfort and increased infections, which are especially problematic for the oncological patient. Port systems have been used in Germany since the 1980´s. Patients profit from increased comfort and medical personnel find them easy to use. Placement is most common in the subclavian vein following surgical exposition and under fluoroscopic guidance. An alternative trend has developed using ultrasound guidance. Further approaches include placement in the internal jugular vein or the arm. We describe an ultrasound guided approach with ecg and post operative radiographic control.

Materials and methods: Port placement in the subclavian vein using a Seldinger technique was performed in 40 patients requiring medical oncological treatment. The first 10 port systems were provided by Braun, the next 30 by PFM. The PFM system included a peel-away-shield, which made handling more comfortable.

Results: Ultrasound guided port placement was successful in all 40 cases. Subclavian access was successful after a single puncture in 20 cases. 10 cases required 2, another 10 cases 3 or more puncture attempts. In one of these cases the jugular vein was used as an alternative location. No perioperative adverse side effects requiring further treatment were observed. In one case a pneumothorax was suspected in the radiographic control. In 3 cases hematoma developed requiring revision surgery. In one case a defective port system was removed by another department following improper care. In one case a patient developed shivering and fever after port use. Despite the fact that bacteremia could not be proven, the port system was removed and showed bacterial growth. Extrusion, dislocation, blockage or pinch-off syndromes were not observed.

Discussion: Fluoroscopically guided port placement is a well established procedure. Our results indicate that ultrasound guided port placement via the subclavian vein with ecg-control by an ENT is a safe and effective alternative.