Pitfalls in Portacath location using the landmark technique: case report

Area of Science:

• Oncology
• Vascular Surgery
• Radiology

Background:

• Central venous access is crucial for cancer treatment, particularly with metastatic disease.
• Subclavian Portacath insertion is a common procedure for long-term venous access.
• Accurate catheter placement is essential for efficacy and patient safety.

Purpose of the Study:

• To report a case of conflicting intra-operative findings during subclavian Portacath insertion.
• To highlight challenges in establishing long-term central venous access.
• To discuss limitations of investigations and safety issues in line insertion.

Main Methods:

• Case report of a 34-year-old woman with breast cancer and liver metastases.
• Portacath insertion via left subclavian vein.
• Intra-operative assessment of catheter position using clinical features and investigations.

Main Results:

• Conflicting evidence regarding the catheter's true position was observed during the procedure.
• Difficulties were encountered in definitively establishing correct long-term central venous access.
• Limitations of standard diagnostic methods for confirming catheter placement were apparent.

Conclusions:

• Subclavian line insertion can present unexpected challenges in catheter placement.
• Reliance on single investigative methods may be insufficient for confirming central venous catheter position.
• Patient safety necessitates careful evaluation and consideration of potential complications during line insertion procedures.