[Clinical Efficacy of A Novel CT-based Localization Method for Totally Implantable 
Venous Access Port Placement in Lung Cancer via Internal Jugular Vein].

BACKGROUND

Implantable venous ports can substantially reduce venous access-related complications in patients undergoing chemotherapy for lung cancer. However, accurate positioning of the catheter tip at the cavoatrial junction (CAJ), defined as the anatomical junction between the superior vena cava (SVC) and right atrium, remains technically challenging. Although electrocardiography (ECG)-guided positioning is widely used in clinical practice, the technique can be relatively complex and time-consuming. Based on clinical practice, we developed a novel computed tomography (CT)-based positioning technique and aimed to evaluate its clinical efficacy and positioning accuracy.

METHODS

We retrospectively analyzed 40 patients with lung cancer who underwent implantable port placement via the internal jugular vein at the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, between January 2024 and April 2026. The patients were divided into two groups according to the catheter tip positioning technique: the CT-guided positioning group (n=20) and the ECG-guided positioning group (n=20). Postoperative CT imaging was performed to measure the distance between the catheter tip and the CAJ. The accuracy and variability of catheter tip positioning were compared between the two groups. In addition, the surface anatomical landmarks corresponding to the internal jugular vein puncture site and the CAJ were recorded and analyzed.

RESULTS

Compared with the ECG-guided group, the CT-guided group demonstrated significantly greater catheter tip positioning accuracy and lower positional variability (P=0.009). The seventh cervical spinous process (C7) was the most common surface anatomical landmark corresponding to the internal jugular vein puncture site. The surface projection of the CAJ was predominantly located at the level of the 4th costal cartilage and the 4th intercostal space on the anterior chest wall and the 7th-8th costal cartilage level on the posterior thoracic wall.

CONCLUSIONS

The novel CT-based positioning technique demonstrated greater accuracy and consistency in catheter tip placement than ECG-guided positioning in patients undergoing internal jugular vein port implantation.