Fluoroscopy-free placement of standard chest wall subcutaneous chronic venous access devices.

ABSTRACT

BACKGROUND: This study was undertaken to evaluate the potential benefits of using an electromagnetic detection system to guide the intraoperative placement of chronic venous access devices (CVADs). STUDY DESIGN: An electromagnetic detection system was used to guide catheter placement during 54 procedures. Surgery and radiation exposure times were recorded. An oncology nursing follow-up questionnaire assessed device function. A cost analysis was performed. Outcomes were compared to similar data from a fluoroscopic historical control group. RESULTS: Eight study patients required intraoperative fluoroscopy; in 46 procedures (85%) the electromagnetic detection system was the sole modality employed to guide CVAD placement. One line was subsequently found in the internal mammary vein (2% false negative rate). Mean surgery times for placement of CVADs were 79.5 and 84.5 minutes for the study and control groups (p = NS). Mean radiation exposure rates were 0.16 and 0.86 minutes per patient for the study and control groups (p < 0.01). There was no significant difference in device function between groups. Major complications in the study group were rare. Mean cost of CVAD placement was $1993 and $2517 for the study and control groups (p = 0.005), respectively. CONCLUSIONS: The use of the electromagnetic detection system resulted in accurate placement of chest wall CVADs in the majority of patients. This resulted in significant reductions in radiation exposure and cost of CVAD placement.