Image and intracavitary electrocardiogram-guided arm port placement in colorectal cancer: A retrospective comparative study

Table 1 Comparison of baseline characteristics between groups, n (%)

Characteristics	Experimental group (n = 103)	Control group (n = 113)	Statistics	P value
General characteristics
Age (year), mean ± SD	58.3 ± 12.1	59.6 ± 11.8	t = 0.812	0.418
Gender			χ2 = 0.046	0.831
Male	56 (54.4)	63 (55.8)
Female	47 (45.6)	50 (44.2)
BMI (kg/m²)	23.4 ± 3.2	22.9 ± 3.5	t = 1.079	0.282
Disease characteristics
Tumor location			χ2 = 0.094	0.759
Colon	58 (56.3)	66 (58.4)
Rectum	45 (43.7)	47 (41.6)
Tumor stage			χ2 = 0.286	0.867
Stage II	25 (24.3)	30 (26.5)
Stage III	49 (47.6)	50 (44.2)
Stage IV	29 (28.1)	33 (29.3)
Previous surgery	67 (65.0)	76 (67.3)	χ2 = 0.122	0.727
Treatment-related
Chemotherapy regimen			χ2 = 0.214	0.899
FOLFOX	47 (45.6)	55 (48.7)
FOLFIRI	33 (32.0)	33 (29.2)
Others	23 (22.4)	25 (22.1)
Chemotherapy cycles, mean ± SD	6.8 ± 2.3	6.5 ± 2.6	t = 0.908	0.365
Venous access site			χ2 = 0.152	0.927
Basilic vein	70 (68.0)	74 (65.5)
Brachial vein	20 (19.4)	24 (21.2)
Cephalic vein	13 (12.6)	15 (13.3)
Laboratory parameters
Albumin (g/L), mean ± SD	35.6 ± 4.7	36.2 ± 4.4	t = 0.982	0.327
Hemoglobin (g/L), mean ± SD	112.3 ± 18.5	109.8 ± 19.3	t = 0.986	0.325
Coagulation parameters
PT (second), mean ± SD	12.3 ± 1.1	12.5 ± 1.0	t = 1.451	0.149
APTT (second), mean ± SD	28.6 ± 3.2	29.1 ± 3.5	t = 1.118	0.265
PLT (× 109/L), mean ± SD	182 ± 56	175 ± 62	t = 0.888	0.376

BMI: Body mass index; FOLFOX: Folinic acid, fluorouracil, and oxaliplatin; FOLFIRI: Folinic acid, fluorouracil, and irinotecan; PT: Prothrombin time; APTT: Activated partial thromboplastin time; PLT: Platelet count.

Table 2 Comparison of catheter tip position accuracy between groups, n (%)

Parameter	Experimental group (n = 103)	Control group (n = 113)	χ2 value	P value
Catheter tip position			9.743	0.002
Ideal position1	100 (97.6)	96 (85.4)	-	-
Position too high2	2 (1.9)	9 (8.0)	4.286	0.038
Position too low3	1 (0.5)	8 (6.6)	5.142	0.023
Secondary displacement at 1-month follow-up	1 (1.0)	6 (5.3)	3.227	0.045
Subgroup analysis of ideal position rate
Male patients	54/56 (96.4)	58/63 (92.1)	1.216	0.270
Female patients	46/47 (97.9)	38/50 (76.0)	10.372	< 0.001
BMI < 23 kg/m2	41/42 (97.6)	48/52 (92.3)	1.419	0.234
BMI ≥ 23 kg/m2	59/61 (96.7)	48/61 (78.7)	9.145	< 0.001

¹Ideal position defined as lower 1/3 of superior vena cava or cavo-atrial junction according to infusion nurses society guidelines.

²Position too high: Middle or upper 1/3 of superior vena cava.

³Position too low: Inside right atrium.

BMI: Body mass index.

Table 3 Comparison of catheter adjustment and radiation exposure between groups, n (%)

Parameter	Experimental group (n = 103)	Control group (n = 113)	Statistics	P value
Catheter adjustment
Number of adjustments (times), mean ± SD	0.27 ± 0.46	1.45 ± 1.03	t = 10.652	< 0.001
Frequency of adjustments			χ2 = 77.183	< 0.001
0 time	76 (73.8)	21 (18.6)
1 time	25 (24.3)	40 (35.4)
≥ 2 times	2 (1.9)	52 (46.0)
Reasons for adjustment	(n = 23)	(n = 170)	χ2 = 48.216	< 0.001
Inaccurate position	0 (0)	128 (75.3)
Insufficient length	15 (65.2)	25 (14.7)
Catheter kinking	8 (34.8)	17 (10.0)
X-ray exposure
X-ray exposure time (seconds), mean ± SD	5.3 ± 2.1	18.7 ± 4.5	t = 26.419	< 0.001
Number of fluoroscopies (times), mean ± SD	1.1 ± 0.3	3.5 ± 0.8	t = 29.783	< 0.001
Patients requiring only 1 fluoroscopy	93 (90.3)	0 (0)	χ2 = 168.297	< 0.001
Patients requiring ≥ 3 fluoroscopies	0 (0)	59 (52.2)	χ2 = 73.641	< 0.001
Radiation dose
Average radiation dose (μGy·m2), mean ± SD	14.8 ± 5.6	52.4 ± 12.3	t = 28.937	< 0.001
Operator scattered radiation dose (μSv/procedure), mean ± SD	1.2 ± 0.5	4.3 ± 1.2	t = 24.106	< 0.001
Subgroup analysis (radiation-sensitive population)	n = 15	n = 17	-	-
X-ray exposure time (seconds), mean ± SD	4.7 ± 1.8	19.5 ± 5.2	t = 10.342	< 0.001
Radiation dose (μGy·m2), mean ± SD	12.3 ± 4.7	54.8 ± 13.6	t = 11.579	< 0.001
Multivariate analysis	OR	95%CI	-	P value
Risk factors for multiple adjustments
Female sex	2.13	1.25-3.64	-	0.005
BMI ≥ 25 kg/m2	2.86	1.67-4.91	-	< 0.001
Traditional anatomical landmark technique	6.52	3.78-11.25	-	< 0.001
Protective factor for reduced X-ray exposure
Application of IC-ECG technique	0.12	0.05-0.28	-	< 0.001

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; IC-ECG: Intracavitary electrocardiogram.

Table 4 Comparative analysis of catheter displacement and occlusion complications

Parameter	Experimental group (n = 103)	Control group (n = 113)	Statistics	P value
Incidence rate
Catheter displacement	1.6% (2/103)	5.7% (6/113)	χ2 = 2.417	0.03a
Catheter occlusion	1.6% (2/103)	4.1% (5/113)	χ2 = 1.037	0.309
Displacement characteristics
Time of occurrence (months)	2.7 ± 0.3	1.3 ± 0.5	t = 6.32	< 0.001b
Minor displacement (< 2 cm)	100% (2/2)	66.7% (4/6)	χ2 = 1.143	0.285
Major displacement (> 3 cm)	0% (0/2)	33.3% (2/6)	χ2 = 1.143	0.285
Adjusted under X-ray	100% (2/2)	66.7% (4/6)	χ2 = 1.143	0.285
Required surgical replacement	0% (0/2)	33.3% (2/6)	χ2 = 1.143	0.285
Occlusion characteristics
Chemotherapy-related	100% (2/2)	40% (2/5)	χ2 = 2.500	0.114
Related to inadequate flushing	0% (0/2)	60% (3/5)	χ2 = 3.333	0.068
Recovered with urokinase	100% (2/2)	80% (4/5)	χ2 = 0.556	0.456
Required catheter replacement	0% (0/2)	20% (1/5)	χ2 = 0.556	0.456

^aP < 0.05, Fisher’s exact test.

^bP < 0.01, Fisher’s exact test.