ARRS 2022 Abstracts

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2022. Technical Factors Associated with Failure for Internal Jugular Vein Access Ports: A Case-Control Study
Authors * Denotes Presenting Author
  1. Zain Khazi *; University of Missouri- Columbia
  2. Andrew Tarim; University of Missouri- Columbia
  3. Shahrazad Azizaddini; University of Missouri- Columbia
  4. Ambarish Bhat; University of Missouri- Columbia
Objective:
Although many studies have assessed patient factors associated with failure of central venous catheter port placement, there is a paucity of information regarding technical factors that impact failure of internal jugular vein (IJV) access port placement. Therefore, the purpose of the study is to determine technical factors that increase the risk of failure of IJV access ports. We hypothesize that catheter angle < 60 degrees, catheter height above clavicle, and catheter tip to carina distance are factors that independently increase the risk of IJV access port failure.

Materials and Methods:
Patients referred to the interventional radiology (IR) department for removal of all malfunctioning central venous access ports from March 2016 to March 2019 were analyzed ("referral group"). A "representative group" who underwent IJV access port placement in the IR department from 2017 to 2019 were analyzed. Basic patient characteristics, reason for port placement (chemotherapy vs intravenous access for long-term infusion), catheter height above clavicle, distance between carina and catheter tip position, and catheter angle above clavicle were collected. Pediatric patients (age <18 years) or subclavian vein access ports were excluded from the study. Subsequently, patients in the representative group were analyzed for port failure within 6 months. Univariate analysis was performed to compare differences in demographic and technical factors for IJV access port placement. Multivariate logistic regression analysis with backwards elimination was performed to determine independent risk factors for IJV access port failure.

Results:
There were 47 and 91 patients in the referral and representative groups, respectively. Of the 91 patients in the representative group, 10 (11%) patients underwent removal of port secondary to bacteremia within 6 months after initial placement. In total, there were 57 patients (47 from referral group and 10 from representative group) whose IJV access ports were removed. After adjusting for covariates, the multivariate analysis identified angle <60 degrees (Odds Ratio [OR]: 11.25, 95% CI: 1.2-14.7, p=0.04) and catheter tip <5cm distal to the carina (OR: 23.9, 95% CI: 5.6-89.2, p <0.01) as the only independent technical factors for IJV access port failure. Catheter height above clavicle (p=0.30), reason for port placement (p=0.36), laterality (p=0.66), sex (p=0.51), and age (p=0.34) were not associated with increased risk of IJV access port failure.

Conclusion:
An angle <60 degrees and placement of catheter tip <5 cm distal to the carina on AP view were associated with increased risk for IJV port failure. Catheter height above the clavicle was not an independent risk factor for IJV port failure.