Port-A-Cath placement without the aid of fluoroscopy or localizing devices: a community hospital series

Traditionally, Port-A-Caths are placed with the aid of intraoperative fluoroscopy or other localizing devices. Confirmation of catheter placement and location are made intraoperatively, and this practice adds considerable cost to the overall procedure with questionable benefit. We examined the experience of a community surgeon who does not use fluoroscopy or localizing devices to see whether this complication rate or need for manipulation of the catheter was high as well as cost savings per case.

A retrospective review of 107 Port-A-Caths cases were evaluated for patient age, indication for port placement, sex, pneumothorax, need for repositioning of catheter, access site, catheter tip location, need for operative intervention related to port placement, and death. Location of the catheter was confirmed by dictated chest x-ray results and need for repositioning by the surgeon's operative note. Cost of fluoroscopy as well as C-arm use and chest x-ray studies were also used to calculate savings.

Of the 107 Port-a-Cath cases, two (1.9%) pneumothoraces occurred and two (1.9%) catheters were repositioned; no deaths and no operative interventions related to Port-a-Cath placements occurred. Seventy-six (71%) of the ports were accessed via a left subclavian approach, and the remainder were accessed via right subclavian, right internal jugular, left internal jugular, and external jugular approaches. One catheter was repositioned due to a kink noted on postoperative chest x-ray study, and the other was noted to be ascending the left internal jugular vein. Cost of the C-arm was USD 174 for less than 1 hour and for fluoroscopy was USD 396 for less than 1 hour.

In our study, only two catheters (1.9%) needed to be repositioned. This comes at an estimated savings of USD 40,000 for this series. Based on our experience, Port-A-Caths can be placed safely without fluoroscopy or localization devices with no added morbidity and significant cost savings to the patient.