Prospective study of the behavior of totally implantable long-term catheters in patients with mammary hypertrophy.

BackgroundThe aim of this study was to evaluate the change in the position of totally implantable venous catheters (TIVC) tips in patients with mammary hypertrophy, comparing them to patients without this condition in both the supine and upright position. MethodsThis was a prospective study involving consecutive patients who underwent the implantation of totally implantable central venous catheters (TIVC) in internal jugular or subclavian veins with reservoir placement on the thoracic wall. Data were collected with regard to demographic and clinical features of the included patients, including: age (years), height (cm), weight (Kg), BMI, malignancy type, occurrence of previous non-deforming procedures to the breasts, presence of a Peripherally Inserted Central Catheter (PICC) during TIVC implantation, and history of DVT (punctured vein and laterality). The catheter tips position in an upright stance was documented through a routine postoperative chest X-ray, using a posterior-to-anterior incidence technique, also including a radiopaque ruler permitting the measuring of its distance from the carina in centimetres. The intraclass correlation coefficient between the intraoperative and postoperative distance variation recorded by Observers 1 and 2 was excellent (r =0.773). ResultsSignificant caudal TIVC tip displacement was determined by previous nondeforming surgery to the chest wall (p=0.002); and significant proximal displacement was calculated by the presence of PICC during TIVC implantation (p =0.042). The Sacchini index did not exhibit a significant association with changes in catheter tip locations after surgery. ConclusionSignificant caudal TIVC tip displacement was determined by previous non-deforming surgery to the thoracic wall (p=0.002); and significant proximal displacement was determined by the presence of a PICC during TIVC implantation (p=0.042). Mammary hypertrophy, as assessed by the Sacchini index, was not statistically correlated to catheter tip displacement (p=0.612).