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Efficacy, Safety, and Cost-Effectiveness of Intracavitary Electrocardiography-Guided Catheter Tip Placement for Totally Implantable Venous Access Port

  • Zhan Liu
    Affiliations
    Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China

    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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  • Xia Zheng
    Affiliations
    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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  • Yanan Zhen
    Affiliations
    Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China

    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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  • Xiaopeng Liu
    Affiliations
    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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  • Fan Lin
    Affiliations
    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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  • Zhidong Ye
    Affiliations
    Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China

    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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  • Peng Liu
    Correspondence
    Correspondence to: Peng Liu, Department of Cardiovascular Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing 100029, P.R. China
    Affiliations
    Peking University China-Japan Friendship School of Clinical Medicine, Beijing, P.R. China

    Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
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Published:December 18, 2021DOI:https://doi.org/10.1016/j.avsg.2021.11.021

      Objective

      Intracavitary electrocardiography (IC-ECG) has been extensively used for locating the catheter tip of the central venous access devices (CVADs) with favorable safety and accuracy. We aimed to evaluate the efficacy, safety, and cost-effectiveness of IC-ECG-guided catheter tip placement for totally implantable venous access port (TIVAP) by comparing with the standard fluoroscopy method.

      Methods

      A total of 231 patients who underwent TIVAP implantation from September 2019 to April 2021 were enrolled in the retrospective study. Fluoroscopy and IC-ECG were conducted intraoperatively to confirm the position of catheter tips. Demographic characteristics, surgical data, the catheter tip position, complication rate, and incidence, cost of procedures, and indwelling time were compared between the two groups. Univariate and multivariate analyses were used to identify the risk factors of TIVAP-related complications.

      Results

      There was no significance between the fluoroscopy group and the IC-ECG group in terms of the rate of ideal position (P = 0.733). Nine patients (3.9%) developed TIVAP-related complications. Complication rates and incidence were similar in the fluoroscopy group and the IC-ECG group (3.1% and 0.114/1000 catheter days vs. 4.4% and 0.105/1000 catheter days). The Kaplan-Meier curve showed that there was no significant difference in indwelling time between the 2 groups (Log Rank P = 0.634). Binary logistic regression analysis showed that body mass index (BMI) was an independent risk factor for TIVAP-related complications (OR = 1.334, 95%CI: 1.139 - 1.563, P < 0.001). The IC-ECG group was less costly than the fluoroscopy group (¥9928 ± 362 vs. ¥11762 ± 431, P < 0.001).

      Conclusions

      IC-ECG-guided catheter tip placement for TIVAP is feasible, safe, and cost-effective, with high accuracy, low risk of complications, and lower cost. It may be considered as an alternative to the standard fluoroscopy method for catheter tip placement of TIVAP.
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