Complications - TIVAD implantation - general and visceral surgery
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Intraoperative complications
- Pneumothorax by malpuncture with aspiration of air indicating lung injury→ radiographic and clinical follow-up, with the surgeon staying at the patient’s side; possibly chest tube insertion (depending on the clinical situation).
- Intraoperative air embolism → attempted aspiration of the air (possibly) via the catheter in situ. Otherwise no specific treatment possible.
- Port tubing cannot be inserted below the clavicle → predilate by inserting a bigger dilation catheter
- Arterial malpuncture → steady local compression for at least 5 minutes
- Port catheter cannot be advanced → fluoroscopic imaging while administering contrast agent via the indwelling needle, followed by advancing the guidewire.
- Unsuccessful puncture → termination of operation. Option: Implantation of a TIVAD via the cephalic vein.
Postoperative complications
- Secondary pneumothorax → chest tube insertion
- TIVAD occlusion→ unblocking attempt with heparin, if unsuccessful flush with urokinase or alteplase
- Dislocated catheter → contrast agent and possibly attempted interventional repositioning by the radiologist via the femoral vein, otherwise revision surgery
- Catheter breakage and leakage (catheter trapped between the clavicle and first rib) → port explantation
- Disconnected port with extravasation→ revision surgery
- Port infection (0.8%-5%) → port explantation (any exposed port must always be regarded as infected)
- Postoperative stroke in arterial malinsertion → removal of catheter
- Subclavian bleeding in arterial malpuncture → local compression dressing, in severe arterial bleeding possibly follow-up by CT-angiography, possibly local revision surgery under anesthesia.
- Subclavian vein thrombosis → port explantation not mandatory