Abstract
Introduction Central venous port (CVP) placement is traditionally performed under fluoroscopy
guidance. However, efforts for radiation dose reduction in children have allowed the
introduction of ultrasound guidance (USG) and anatomic landmarks as an alternative
technique for CVP placement. The aim of this study is to determine whether intraoperative
fluoroscopy (IF) is required to confirm the correct position of the catheter tip in
children.
Patients and Methods A prospective, single-center study was performed between July and December 2017.
Standard venous access site was the right internal jugular vein under USG. Estimated
catheter length (ECL) was measured using anatomic landmarks. Ideal catheter length
(ICL) was measured after placement under fluoroscopy guidance in the same patient.
Age, sex, radiation dose, and complications were also analyzed. A t-test for paired samples and intraclass correlation coefficient were performed to
analyze results.
Results A total of 30 consecutive patients aged 7 ± 2 years underwent CVP placement. The
mean ECL was 17.1 ± 1.8 cm, while the mean ICL was 17.7 ± 1.8 cm. The mean difference
between measurements was 0.28 cm (95% confidence interval [CI], –0.29 to 0.86; p = 0.324). Intraclass correlation coefficient analysis showed an agreement of 0.95
(95% CI, 0.91–0.98) between measurements. Mean radiation exposure during the procedure
was 1.060.78 mGym2 during 0.34 ± 0.6 minutes. There were no complications registered during CVP placement.
Conclusion The correlation between IF and USG and anatomically guided catheter tip placement
is optimal. These results suggest that fluoroscopy and the radiation exposure it entails
can be safely avoided in selected children.
Keywords
children - central venous port systems - tip placement - radiation exposure - intraoperative
fluoroscopy
