EL Bouazzaoui Abderrahim1*, Jabrane Marouane1, Touzani Soumaya1, Houari Nawfal1, Maaroufi Mustapha2, Tsigbe Wisdom Kwasi1, Boukatta Brahim1 and Kanjaa Nabil1
1Anesthesiology and Intensive Care Department A4, Hassan II University Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
2Radiology Department, Hassan II, University Hospital. Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
*Corresponding Author: EL Bouazzaoui Abderrahim, Anesthesiology and Intensive Care Department A4, Hassan II University Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
Received: December 02, 2021; Published: December 15, 2021
Introduction: There is an increasing demand for Totally Implantable Intravenous Access Ports (TIVAP), mainly to facilitate the initiation of intravenous chemotherapy. Ultrasound guidance during venipunctures for the placement of these TIVAP catheters is a good technique that is highly recommendable for Practicians. We present a prospective study for the placement of TIVAP using Ultrasound-guided percutaneous approach in 288 patients. The objective of this study is to demonstrate the contribution of Ultrasound guidance in making the procedure for the placement of these devices a safe one and also to study the complications that may arise from the placement of these intravenous devices.
Patients and Methods: This is a prospective study over a period of 7 years from January 2015 until July 2021 carried out in the A4 multipurpose anesthesia-intensive care unit of the CHU Hassan II in Fez. All the TIVAP were inserted under Ultrasound guidance. The parameters studied were: the sex of the patient, age, the cancer to be treated, the puncture site, the side of the puncture, the ultrasound technique, the per- and post-operative complications that occurred during or after the placement of the intravenous device.
Results: The study includes 288 Totally Implantable Venous Access Ports (TIVAP) placed in 288 patients of which 52.7% male and 47.2% female. The reasons for chemotherapy were diverse. Ultrasound exploration of the veins was systematic in all patients before starting the implantation procedure. Two cases of venous thrombosis were incidentally diagnosed during these preoperative explorations. Venipuncture was performed at the axillary area in 67.70% of cases, against 31.5% of cases at the internal jugular area, and in the end 1.05% of cases of these punctures were at the femoral area. The ultrasound technique for venipuncture was in the ultrasound plane in 71.18% of cases, compared with 28.81% of venipunctures performed outside the ultrasound plane. Venipuncture was obtained during the first trial in 100% of cases. We did not observe any case of pneumothorax, arterial puncture or hematoma. The duration of the TIVAP procedure varied between 45 and 90 minutes depending on the case. Four cases of aberrant path of the TIVAP catheter were observed on the chest X-rays;which was systematically taken at the end of the insertion procedures. These aberrant paths were subsequently corrected via endovascular route by interventional radiology. In the long term, we noted one case of extravasation of the chemotherapy product, two cases of surgical site infection and one case of catheter exposure.
Discussion and Conclusion: The use of ultrasound decreases the risk of pleural damage and the formation of pneumothorax. Ultrasound guidance also decreases the risk of hematoma by reducing the number of punctures and avoiding arterial punctures. Ultrasound exploration also helps to verify the anatomical location of the vein, its permeability and the presence or absence of deep vein thrombosis. Thus, the use of ultrasound makes the procedure for inserting TIVAP a safe and secured one.
Keywords: Totally Implantable Venous Access Ports (TIVAP); X-ray; Ultrasound; Chemotherapy
Citation: EL Bouazzaoui Abderrahim., et al. “The Use of Ultrasound in the Placement of Totally Implantable Veinous Access Ports (TIVAP) for Chemotherapy”.Acta Scientific Medical Sciences 6.1 (2022): 157-164.
Copyright: © 2022 EL Bouazzaoui Abderrahim., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.