Port catheter placement is a method used to insert a central venous catheter, which serves as an access point for injecting medications. It provides permanent access under the skin and is designed to allow medications to be administered frequently and over a long period without the need to continually puncture veins at new sites.
This system is implanted under the skin in the central fatty tissue and can be accessed easily by a doctor using a hollow needle. In most cases, the port catheter is connected to a central vein, but in some special cases, it may be linked to arteries near the heart or to body cavities such as the abdominal cavity.
Port catheter placement involves a minor surgical procedure to implant the device.
When is port catheter placement performed?
Port catheter placement is often recommended when constant injection punctures and frequent medication administration begin to strain and damage the veins. This technique provides a more elegant and sustainable solution by allowing medication to be delivered through a subcutaneous device without the need for repeated vein punctures.
Port catheter placement is particularly common in oncology patients, such as those with liver or spleen cancer, who require ongoing chemotherapy. The catheter ensures that chemotherapy drugs can be administered regularly and safely into the bloodstream.
In addition to chemotherapy, port catheter placement is also used for administering other intravenous medications that need to be given frequently to treat specific conditions. It is beneficial for patients requiring parenteral nutrition—where special foods or nutrients are delivered directly into the veins—especially when they are unable to eat normally or sufficiently.
Furthermore, port catheter placement allows for easy and reliable access for blood transfusions, especially when multiple transfusions are anticipated.
How the port catheter placement system works
A catheter is usually implanted for the veins, and this is typically done through port catheter placement connected to a central venous catheter (CVC). It is also possible to use a portal catheter for the arterial system.
In some cases, port catheter placement is performed to access a body cavity such as the abdominal cavity (peritoneal port) or the space containing the cerebrospinal fluid or heart chamber.
To install a portal catheter, port catheter placement requires a minor procedure that takes about half an hour.
Strictly speaking, a pyloric catheter is a chamber with a sheath made of plastic or metal that is implanted under the skin. The sheath has a silicone membrane at the top (towards the skin) through which a needle can be inserted. The other walls of the chamber are thick and cannot be pierced with a needle.
The chamber is connected to a long, thin tube (catheter). The other end of the catheter is located in the heart’s usual venous catheterization system (cardiac catheterization), so the catheter passes medicine from the portal catheter through large veins to reach the heart.
In most cases, port catheter placement is done through the subclavian vein or the internal jugular vein. The pyloric catheter unit is permanently located, usually in the subcutaneous fatty tissue above the pectoralis major muscle.
A special hollow needle (such as a Huber needle) can be used to penetrate the portal catheter through the membrane. Inserting the needle is almost pain-free. The needle can remain in the catheter for some time, sometimes for several days, as it secures access to the catheter.
The needle is connected to a thin tube through which various substances, such as drugs, can be injected. The needle must be inserted conscientiously under sterile conditions by the doctor to avoid damage or, more importantly, infection in the catheter.
A pyloric catheter chamber (catheter bag) is a reservoir through which the agent to be introduced is gradually transported via a catheter to the periphery of the patient’s heart. With chemotherapeutic agents in particular, this has the added advantage that the blood in the large veins and the heart is relatively strong and does not cause damage to the blood vessel walls.
A portal catheter is like an intravenous catheter. The catheter is more stable and made slightly differently. Chemotherapy can be administered to specific parts of the body using port catheter placement when delivered to the arteries of the organs to be treated.
How Port catheter placement is performed for central venous access
Port catheter placement surgery is usually performed under local anesthesia.
In the first step, an incision is usually made on the skin under the collarbone.
There is a vein such as the subclavian vein, and the catheter is inserted into this vein.
The thin tube is pushed towards the heart. This is done under fluoroscopy to get the tip in the right place. The port catheter is then placed.
Another shortcut in the skin, also below the collarbone or in the chest area, usually results in a catheter cavity in the fatty tissue under the skin.
The catheter chamber made of plastic or metal is inserted there. The catheter can then be pulled from the vein at its end through the tissue under the skin to the central port reservoir and connected there. After carefully checking whether the port catheter placement really works as a whole, the skin is then finally sutured.
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Possible complications of portal catheterization
The procedure carries certain risks, but they are usually minor.
Bleeding, infections, and healing disorders can occur after Port catheter placement, leading to a high incidence of scarring.
A few patients cannot tolerate any medicinal substances included in the catheter, or can develop allergic reactions. Blood clots (heart attacks) cannot be ruled out.
Infection can develop in a Port catheter implanted under the skin if germs enter it through the needle puncture.
Bacteria in particular can be especially dangerous. The germs can then also travel into the blood. Infection is a common reason why the catheter has to be removed again and a new catheter created to replace the previous one if necessary.
Similarly, the catheter can become clogged, and it is not possible to inject therapeutic substances or withdraw more fluid.
Damage to the material can also occur. It may also be advisable to remove the Port catheter if such issues occur.
Benefits and chances of success of portal catheterization
Many patients benefit from portal catheters. Establishing a portal catheter system simplifies the administration of medications in the body and prevents damage to the veins, which can develop, for example, in the hand muscle.
However, great care needs to be taken with portal catheters when inserting medications. The catheter can be punctured many times, often as many as 2,000 times. Complications such as infection or blockage of the catheter can lead to the need to remove it again or replace it with a new one.
Instructions for patients
Before central venous catheterization
Your doctor should discuss at an early stage whether you should stop taking anticoagulant medications such as aspirin or Coumadin.
After catheterization
After the catheter is implanted, the patient can usually go home after a short observation period. Doctors at the Main Specialty Research Department also recommend taking antibiotics with caution.
Only nurses trained at a certain level are allowed to insert a needle (puncture) into a catheter to minimize the risk of complications.
Aseptic work is a sine qua non for this purpose.
Once the skin wound has healed, showering or bathing is usually possible with a false outlet. The same goes for exercise and physical activity.
The portal catheter guide is a document that enters the dates on which a doctor’s checkup is required.
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