Pitfalls in Portacath location using the landmark technique: case report
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BioMed Central
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Case report
Pitfalls in Portacath location using the landmark technique: case report Susannah M Wyles1, Garry Browne2 and Gerald PH Gui*1 Address: 1Academic Surgery (Breast Unit) and, Royal Marsden NHS Foundation Trust, London, UK and 2Department of Anaesthetics, Royal Marsden NHS Foundation Trust, London, UK Email: Susannah M Wyles - [email protected]; Garry Browne - [email protected]; Gerald PH Gui* - [email protected] * Corresponding author
Published: 5 June 2007 International Seminars in Surgical Oncology 2007, 4:13
doi:10.1186/1477-7800-4-13
Received: 22 February 2007 Accepted: 5 June 2007
This article is available from: http://www.issoonline.com/content/4/1/13 © 2007 Wyles et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract A 34 year old woman diagnosed with breast cancer and liver metastases underwent a left subclavian Portacath insertion. During the procedure, the clinical features and the findings of intra-operative investigations provided conflicting evidence of the catheter position. This report highlights the potential difficulties in establishing long-term central venous access, the limitations of common investigations and safety issues relating to the process of subclavian line insertion.
Background Portacaths (Bard Medical Division, Georgia, USA) are routinely used for central venous access in patients with poor peripheral veins who require chemotherapy, either in the adjuvant or metastatic disease setting. The technique provides a permanent, closed venous system with easy vascular access for drug delivery and blood draw that is more discrete and convenient than Hickmann lines and peripherally inserted central catheters (PICC), where part of the system lies ex-vivo. We present a case report that highlights potential difficulties in identifying the catheter position and consider the limitations of common methods of confirming the catheter location.
Case presentation A woman was aged 34 years when she presented with a T2 G2 N0 right breast cancer that was ER negative, PgR negative and HER-2 3+. She was otherwise well with no family history of cancer. She was started on 5 fluorouracil, epirubicin and cyclophosphamide (FEC) chemotherapy with gosarelin (Zoladex) and recombinant human granulocyte-colony stimulating factor, G-CSF, (Filgrastim) sup-
port. Prior to starting trastuzumab (Herceptin), a MUGA scan was performed showing a normal resting gated left ventricular ejection fraction of 57% and a normal size left ventricle. As she described increasing shortness of breath over the proceeding 6 months, a CT scan was done which showed no abnormality in the lung parenchyma but several scattered metastases were identified within the liver varying in size up to 3.5 cm with the largest lesion
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