Spontaneous catheter tip migration in Totally Implantable Venous Access Port (TIVAP) to right atrium

Introduction and importance: The use of a Totally Implantable Venous Access Port (TIVAP) has been a popular access option in chemotherapy for cancer patients, but complications, both long-term and short-term, may arise in the fixation process. This paper discusses the importance of detection and management of complications that arise as a result of TIVAP insertion. Case presentation: A 51-year-old female patient came to the hospital to undergo a TIVAP implantation for her chemotherapy through the right subclavian vein; however, a false route occurred to the right internal jugular vein instead of the right atrium. No direct revision was conducted for this case. Follow-up was conducted for 3 months. The first month post-chemotherapy, the access flow remained smooth. No complications were found. Clinical discussion: The right subclavian vein is preferred for its low complication and high success rates. Typically, a C-Arm is used to guide TIVAP insertion, allowing immediate corrections to prevent complications. In this patient, the C-Arm was unavailable due to logistical constraints. The TIVAP catheter tip was evaluated and sustained. High-velocity flow at the catheter tip can cause a jet effect, potentially shifting the catheter tip cranially or to the proper position in the right atrium. Conclusion: We conclude that TIVAP attachment does not have to be redone when a false route happens, and routine observation on possible complications as well as gradual drug administration should be done instead.