Chest port implantation with Ultasound venous guidance puncture technique. Luc Rotenberg Johannesburg Oct 2018

1. !!
C h e s t p o r t i m p l a n t a t i o n b y
venous access with US Guidance
Luc Rotenberg, RPO, ISHH
Clinique Hartmann – CMC Ambroise Paré
26-27 bd Victor Hugo, 92200 Neuilly Sur Seine – France
www.radiologieparisouest.com
dr.rotenberg@radiologieparisouest.com
Johannesburg Oct 2018

2. !!
Chest port implantation by
venous access with US Guidance
Luc Rotenberg, RPO, ISHH
Clinique Hartmann – CMC Ambroise Paré
26-27 bd Victor Hugo, 92200 Neuilly Sur Seine – France
www.radiologieparisouest.com
dr.rotenberg@radiologieparisouest.com
Johannesburg Oct 4th 2018

3. !
Clinical Pathway
Balistic preoperative consultation
§ Report Study
§ Interrogatory (risk factors…)
§ Balistic approch
§ Targeted
§ Device and guidance technique choice
§ Patient explanation of :
§ Intervention
§ complications
§ Possible results and implications
§ Pricing
§ Written informed consent is required before all interventions +++
临床综合治疗模式
术前靶向方案

4. !
§ Before intervention
§ End point venous access
§ Local structures:
§ pleura
§ sub clavian artery
§ clavicle
§ feasability
US checking venous access
§ 超声引导检查介入静脉

5. !
Compression of the Vein

6. !
Vein compression

7. !
Vein compression

8. !
Compression of the Vein

9. !
Key point
• Installation +++
• Fast intervention
– Start with easy access
– Phantom training

10. !
Puncture technique
Access/ / long probe axis
– Out plane : Perpendicular to the major axis of the probe
– In plane : In the longitudinal axis of the probe

11. !
Out Plane Access
orthogonal

12. !
Out Plane Access
orthogonal

13. !
In Plane Access
Longitudinal

14. !
Sterile pouch

15. !
INTERNAL JUGULAR VEIN
direct puncture

16. !
HOW ?
JUGULAR VEIN APPROACH:
UltraSounds locating is more reliable than anatomical landmarks
HIND Br Med J 2003:361
MAC GEEN N Eng J Med 2003:1123

17. !
In plane approach
Courtesy of Dr Eric Desruennes

18. !
Courtesy of Dr Eric Desruennes
In plane approach

19. !
US guidance
ultrasound guidance with sterile pouch allows direct puncture of the subclavian vein and avoids the tunneling

20. !

21. !
US guidance

22. !
US guidance

23. !
US guidance

24. !
Compression and ponction scv
Puncture of the subclavian vein is always distant from the clavicle :
2-4 cm up of the costovertebral joint), and not crossing over.
Orthogonal approach
Out plane way

25. !
No pinch of syndrom
Puncture of the subclavian vein is always distant from the clavicle :
2-4 cm up of the costovertebral joint), and not crossing over.

26. !
Longitudinale approach
In plane way
Courtesy of Dr Eric Desruennes

27. !
Subclavian Port

28. !

29. !

30. !

31. !
Take home :
US guidance ports access
1. Technique
1. US guidance scv ponction
2. Verticale or oblique scare in deltopectoral groove, 1 to 2 cm
3. Direct SCV ponction through the ports hole :
1. no tunelisation
4. Xray intervention guidance
5. Deep point with vicryl 3.0 and intradermal surjet monocryl 4.0 and/or biological glue
2. Advantages / misadvantages
1. Esthetic
2. Fonctionnal
3. Fast
4. Few complication since 10 years:
1. pneumothorax = 0,
2. pinch-off = 0
5. Operating dependant