Construction of a Risk Model for the Prevention of Catheter-Related Thrombosis by Positioning the Tip of Implantable Venous Infusion Port at the Superior Vena Cava-Right Atrial Junction under Real-Time Ultrasound Guidance: A Single-Center Retrospective Study in Adult Cancer Patients

Objective This study aimed to investigate the value of positioning the tip of implantable venous infusion ports (IVAPs) at the superior vena cava-right atrial junction (SVC-RAJ) under real-time ultrasound guidance for preventing catheter-related thrombosis (CRT), and to construct a risk prediction model based on multivariate logistic regression to provide evidence for precise clinical prevention and control. Methods Clinical data of adult cancer patients who received IVAP treatment at Zhongshan People's Hospital from June 2022 to June 2023 were retrospectively analyzed. Patients were divided into SVC-RAJ group and non-SVC-RAJ group according to the IVAP tip position, and the incidence of CRT was compared between the two groups. Independent risk factors for CRT were identified through multivariate logistic regression analysis, and a nomogram model was constructed. The model's performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results The overall incidence of CRT was 30.33% (182/600). The CRT incidence in the SVC-RAJ group was 22.42%, significantly lower than the 38.73% in the non-SVC-RAJ group (P < 0.001). Univariate analysis showed that age, BMI, neutrophil-to-lymphocyte ratio (NLR), catheterization duration, tumor stage, D-dimer, prophylactic anticoagulation use, and tip position were associated with CRT occurrence (P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for CRT: age (OR = 1.050, 95% CI: 1.024–1.077, P < 0.05), BMI (OR = 1.187, 95% CI: 1.100–1.280, P < 0.05), tumor stage (OR = 2.096, 95% CI: 1.340–3.195, P < 0.05), NLR (OR = 1.489, 95% CI: 1.282–1.730, P < 0.05), D-dimer (OR = 4.280, 95% CI: 2.569–7.131, P < 0.05), catheterization duration (OR = 1.030, 95% CI: 1.020–1.039, P < 0.05), prophylactic anticoagulation status (OR = 1.884, 95% CI: 1.312–2.707, P < 0.05), and tip position (OR = 0.517, 95% CI: 0.353–0.756, P < 0.05). The area under the ROC curve (AUC) of the combined prediction model was 0.866 (95% CI: 0.837–0.895), with a sensitivity of 70.33%, specificity of 85.89%, and Youden index of 0.562, demonstrating good predictive performance. Conclusion Positioning the IVAP tip at the SVC-RAJ under real-time ultrasound guidance can significantly reduce the risk of CRT. The nomogram model constructed based on multiple factors demonstrates good predictive performance and can provide quantitative reference for individualized clinical prevention strategies.