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

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. 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. 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. 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. •Totally Implantable Venous Access Port (TIVAP) catheter malposition•Management of TIVAP Malposition•Preferred Vein for TIVAP