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. 2017 Dec 7;17(1):131.
doi: 10.1186/s12893-017-0329-4.

Use of a hydrophilic coating wire reduces significantly the rate of central vein punctures and the incidence of pneumothorax in totally implantable access port (TIAP) surgery

Georgios Polychronidis, Roland Hennes, Cosima Engerer  1 , Phillip Knebel  1 , Daniel Schultze  1 , Thomas Bruckner  2 , Beat P Müller-Stich  1 , Lars Fischer  3   4
Affiliations

Use of a hydrophilic coating wire reduces significantly the rate of central vein punctures and the incidence of pneumothorax in totally implantable access port (TIAP) surgery

Georgios Polychronidis et al. BMC Surg. .

Abstract
in English, German

Background: Insertion of a Totally Implantable Access Port (TIAP) can be performed either via Central Vein Puncture (CVP) or Brachiocephalic Vein Cut-down (venous section-VS). The primary success rate of TIAP implantation using VS rarely ever achieves 100%. The objective of this study was to describe a modified VS approach using a hydrophilic coated wire (TVS).

Methods: From 01.01.2015 to 31.12.2015, all patients receiving TIAP implantations were screened. During this time, all patients in whom the primary VS procedure was found to be unsuccessful were analysed.

Results: In 2015, 1152 patients had TIAP implantations performed by 24 different surgeons. Of these, 277 patients needed a second line rescue strategy either by CVP (n = 69) or TVS (n = 208). There were no statistically significant differences regarding demographics or indication for TIAP implantation between CVP and TVS. The operation time and the qualification of the operating surgeon between CVP and TVS did not differ significantly. After the introduction of the guidewire with a hydrophilic coated wire, the need for CVP decreased significantly from 12.7% to 8.8% (p < 0.0001). In patients receiving CVP as a second line rescue strategy, the incidence of pneumothorax (n = 3 patients (4.3%)) was significantly higher compared to patients with TVS as a second line rescue strategy (n = 1 patient (0.48%), p = 0.02).

Conclusion: The use of a hydrophilic coated wire significantly decreased the number of CVP and the incidence of pneumothorax. TVS is a safe and successful second-line rescue strategy.

Background: Insertion of a Totally Implantable Access Port (TIAP) can be performed either via Central Vein Puncture (CVP) or Brachiocephalic Vein Cut-down (venous section-VS). The primary success rate of TIAP implantation using VS rarely ever achieves 100%. The objective of this study was to describe a modified VS approach using a hydrophilic coated wire (TVS).

Methods: From 01.01.2015 to 31.12.2015, all patients receiving TIAP implantations were screened. During this time, all patients in whom the primary VS procedure was found to be unsuccessful were analysed.

Results: In 2015, 1152 patients had TIAP implantations performed by 24 different surgeons. Of these, 277 patients needed a second line rescue strategy either by CVP (n = 69) or TVS (n = 208). There were no statistically significant differences regarding demographics or indication for TIAP implantation between CVP and TVS. The operation time and the qualification of the operating surgeon between CVP and TVS did not differ significantly. After the introduction of the guidewire with a hydrophilic coated wire, the need for CVP decreased significantly from 12.7% to 8.8% (p < 0.0001). In patients receiving CVP as a second line rescue strategy, the incidence of pneumothorax (n = 3 patients (4.3%)) was significantly higher compared to patients with TVS as a second line rescue strategy (n = 1 patient (0.48%), p = 0.02).

Conclusion: The use of a hydrophilic coated wire significantly decreased the number of CVP and the incidence of pneumothorax. TVS is a safe and successful second-line rescue strategy.

Keywords: Guide wire; Pneumothorax; Totally implantable access port; Venous cut-down.

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Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was approved by the local ethics committee of the University of Heidelberg (S-584/2016).

Consent for publication

Not applicable

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of this retrospective study
Fig. 2
Fig. 2
a-d Incision for Totally Implantable Access Port (TIAP) implantation according to: anatomical landmarks (a), with intraoperative situs (b), Vein cut-down/Venae Sectio using microsurgical instruments (c), and insertion of the guidewire with a hydrophilic coating (Terumo ® wire) (d). # Ramus pectoralis merging into V. thoracoacromialis. * Ramus pectoralis of A. thoracoacromialis
Fig. 3
Fig. 3
Number of Totally Implantable Access Port (TIAP) implantations (black boxes) and percentage of performed Central Vein Punctures (CVP) (grey circles) performed between 2012 and 2015. * The two-tailed p value is less than 0.0001 (as seen in a comparison of 2015 with 2014). # Up to December 2013, modified vein cut-down was performed by using a MHMedical Tec GmbH® guide-wire. The Terumo® wire was used sporadically in individual patients throughout 2014; however, it was introduced systematically in 2015
See this image and copyright information in PMC

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