Scintigraphic Monitoring of Catheter-Port Systems in Type I Diabetics with Continuous Insulin Therapy

Abstract

Objective

We developed a non-invasive scintigraphic procedure to control the function of percutaneous catheter-port systems for continuous insulin therapy. The aim of the study was to evaluate the scintigraphic results and to compare the absorption kinetics of intraperitoneal and umbilical catheter-ports.

Material and Methods

Seven patients with intraperitoneal and nine patients with umbilical catheter-port systems implanted into the partially redilated umbilical vein were investigated. All these patients had normal functioning catheter-ports. Additionally, three patients with intraperitoneal and three patients with umbilical catheter-port dysfunction confirmed either by radiography or laparoscopy were studied. After the injection of ^{99 m}TcO₄ ^- into the port a region-of-interest was drawn around the activity at the tip of the catheter and the half-life of tracer absorption (Tœ) calculated.

Results

The normal intraperitoneal catheter-port group showed a Tœ value of 6.7 ± 3.2 min and the normal umbilical catheter-port group a Tœ of 6.6 ± 2.0 min. There was no significant difference in Tœ between intraperitoneal and umbilicial systems. The dysfunctional catheter-port group (Tœ 19.3 ± 6.7 min) differed (p = 0.0005) from the normal catheter-port group (Tœ 6.7 ± 3.2 min). On the basis of the normal group an upper threshold value of Tœ was calculated to be 11.8 min.

Conclusions

Imaging with ^{99 m}TcO₄ ^- is an accurate, non-invasive, and quick method to assess the function of insulin catheter-ports. A Tœ value > 11.8 min is indicative of a catheter dysfunction. Umbilical and intraperitoneal catheter-ports show similar absorption rates of ^{99 m}TcO₄ ^-.

Key words

Diabetes mellitus - continuous intraperitoneal insulin infusion (CIPII) - continuous umbilical vein insulin infusion (CUVII) - radionuclide imaging - technetium

References

• 1 Austenat E, Ruthe U, Mann M. Continuous insulin infusion (CIPII) with a new port system (Percuseal® port system), 30 month experience (abstract). Prague: European Association for the Study of Diabetes, 28th annual meeting. 1992: A760
• 2 Boulahdour H, Behar A, Haardt M J, Selam J L. Implantable insulin pumps: diagnosis and management of decreased flow rates using radionuclide investigation.  Int J Artif Organs. 1996;  19 723-729
• 3 Bousquet-Rouaud R, Castex F, Costalat G. et al . Factors involved in catheter obstruction during long-term peritoneal insulin infusion.  Diabetes Care. 1993;  16 801-805
• 4 Hanaire-Broutin H, Broussolle C, Jeandidier N. et al . Feasibility of intraperitoneal insulin therapy with programmable implantable pumps in IDDM. A multicenter study. The EVADIAC Study Group.  Diabetes Care. 1995;  18 388-392
• 5 ICRP Publication 53 .Radiation Dose to Patients from Radiopharmaceuticals. 1st ed. Oxford; Pergamon Press 1988 199 263
• 6 Klein E, Tieben W, Draese K, Petzold R. Die Umbilicalvene als alternativer Zugang zur kontinuierlichen Insulin-Infusions-Therapie.  Diabetes und Stoffwechsel. 1994;  3 177-178
• 7 Klein E, Henrichs H, Liebel A, Petzold R, Renner R, Ziegelasch H. Kontinuierliche Insulin-Infusions-Therapie über die Umbilicalvene (CUVII), bisherige Erfahrungen in klinischer Anwendung.  Diabetes und Stoffwechsel. 1995;  4 168-169
• 8 Lathrop K A, Harper P V. Biologic behaviour of ^{99 m}Tc from ^{99 m}Tc-pertechnetate ion.  Progr Nucl Med. 1972;  1 145-162
• 9 Liebl A. Intraperitoneale Insulintherapie. Hightech zur Behandlung des Typ 1 Diabetes.  MMW-Fortschr Med. 2000;  142 52-54
• 10 Olsen C L, Turner D S, Iravani M, Waxman K, Selam J L, Charles M A. Diagnostic procedures for catheter malfunction in programmable implantable intraperitoneal insulin infusion devices.  Diabetes Care. 1995;  18 70-76
• 11 Oolbekkink M, Heine R J, den Hollander W, Nauta J J, van der Veen E A. Hepatic 123I - insulin binding kinetics in non-insulin-dependent (type 2) diabetic patients after i. v. bolus administration.  Eur J Nucl Med. 1989;  15 292-295
• 12 Renard E, Baldet P, Picot M C. et al . Catheter complications associated with implantable systems for peritoneal insulin delivery. An analysis of frequency, predisposing factors, and obstructing materials.  Diabetes Care. 1995;  18 300-306
• 13 Scavini M, Galli L, Reich S, Eaton R P, Charles M A, Dunn F L. Catheter survival during long-term insulin therapy with an implanted programmable pump. The Implantable Insulin Pump Trial Study Group.  Diabetes Care. 1997;  20 610-613
• 14 Scavini M, Hammarberg B, Dosio F, Torri M, Petrella G, Galimberti G, Vai S, Fazio F, Pozza G. A method for assessing catheter patency in implanted pumps for long-term intraperitoneal insulin delivery.  Artif Organs. 1997;  21 405-408
• 15 Schnell O, Walter H, Gerlach E. et al . Kontinuierliche intraperitoneale Insulintherapie mit Portsystem bei Typ-I-Diabetikern mit subkutaner Insulinaufnahmestörung.  Diab Stoffw. 1994;  3 51-55
• 16 Selam J L, Micossi P, Dunn F L, Nathan D M. Clinical trial of programmable implantable insulin pump for type I diabetes.  Diabetes Care. 1992;  15 877-885
• 18 Shishko P I, Kovalev P A, Goncharov V G, Zajarny I U. Comparison of peripheral and portal (via the umbilical vein) routes of insulin infusion in IDDM patients.  Diabetes. 1992;  41 1042-1049
• 19 Sodoyez J C, Sodoyez-Goffaux F, Guillaume M, Merchie G. [123I]Insulin metabolism in normal rats and humans: external detection by a scintillation camera.  Science. 1983;  219 865-867