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. 2021 Jan;44(1):129-135.
doi: 10.1002/clc.23518. Epub 2020 Nov 25.

Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children

Shujun Yang  1   2   3   4   5   6 , Xiangru Kong  7   2   3   4   5   6 , Lifei Liu  1   2   3   4   5   6 , Ying Xu  1   2   3   4   5   6 , Jun Zhang  7   2   3   4   5   6
Affiliations

Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children

Shujun Yang et al. Clin Cardiol. 2021 Jan.

Abstract

A totally implantable venous access port (TIVAP) is important in children who need intravenous infusion for a long time. A number of studies have shown methods for locating the tip of the TIVAP catheter. To explore whether transesophageal echocardiography (TEE) can be used to accurately locate the TIVAP catheter tip through a subclavian approach and to improve the rate of correct TIVAP catheter placement and reduce complications of TIVAP placement. In 36 children who needed TIVAP implantation surgery, we used real-time TEE guidance to place the catheter tip around the crista terminalis. In all children, chest X-rays were used to figure out whether the catheter tip as localized by TEE was within the T5-T7 segment. Then, we compared the length of the catheter calculated by the height formula and the actual catheter length applied under TEE guidance. The medical records, surgical details, nursing records, and recorded complications were collected during the follow-up. The success rate of TIVAP implantation was 100% in all enrolled patients and no hemopneumothorax or pinch-off syndrome occurred. Compared with TEE, chest X-ray showed a coincidence rate of 80.56% in correctly detecting the TIVAP catheter tip locate. The height-derived catheter length (11.0 [9.6, 11.8]) cm and the TEE-derived catheter length (10.0 [9.3, 10.8]) cm were significantly different (p < .001). TEE can be used to guide TIVAP catheter positioning through a left subclavian approach in children accurately and successfully and more accurate than chest X-ray and height calculation formula.

Keywords: chest X-ray; subclavian vein; superior vena cava; totally implantable venous access port; transesophageal echocardiography.

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Conflict of interest statement

Author Shujun Yang declares that she has no conflict of interest. Author Xiangru Kong declares that he has no conflict of interest. Author Lifei Liu declares that he has no conflict of interest. Author Ying Xu declares that she has no conflict of interest. Author Jun Zhang declares that he has no conflict of interest.

Figures

FIGURE 1
FIGURE 1
TEE images during catheter puncture and localization. (A) TEE image of the catheter entering the SVC inlet during the left subclavian vein puncture. (B) TEE image of the catheter tip finally positioned above the crista terminalis. RA, right atrium; SVC, superior vena cava; TEE, transesophageal echocardiography
FIGURE 2
FIGURE 2
Distribution of catheter length (the height length and the TEE‐guided length) in scatter plot. TEE, transesophageal echocardiography
FIGURE 3
FIGURE 3
(A) Chest X‐ray of PLSVC child, the guide wire through the right atrium into the inferior vena cava, unable to locate the accurate place. (B) Chest X‐ray of the child with mediastinal tumors could not see the projection of the heart and could not accurately identify the position of the guide wire in the right atrium. (C) Pathway of guide wire in children with normal cardiac anatomy. The red line is the part of the guide wire in the left SCV section. The green line is the part of the guide wire in the SVC section. The yellow line is the part of the guide wire in the RA section. PLSVC, persistent left superior vena cava; RA, right atrium; SCV, subclavian vein; SVC, superior vena cava
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