Background: The Cook Vital Port system was observed with fluoroscopy before elective removal. A previous publication noted that catheter fracture with this device occurred at the entry of the catheter into the vein used for catheter deployment. We hypothesized that catheter rupture at the vein entry site may be due to ballooning of the catheter during injection, or possibly due to angulation of the catheter during arm movements.
Methods: Port system contrast injection and fluoroscopy was performed for 50 consecutive patients who attended for elective arm vein port removal. Assessment of the angle of entry of the catheter into the arm vein was performed with the arm in anatomic position and during arm movements.
Results: There was no evidence of catheter ballooning or distortion during contrast injection. There was no evidence of fibrin sheath formation at the catheter tip. One catheter was observed to leak at the vein entry site with the injection of contrast. The only arm movement that affected the angle of the catheter at the vein entry site was flexion at the elbow. The average change in the angle of the catheter between anatomic position and full elbow flexion was 22.4°C.
Conclusions: The hypothesis of ballooning of the catheter at the vein entry site during injection was not confirmed. We observed a wide variation in catheter angulation with elbow flexion. The exact cause for catheter fracture remains unknown.