Learning objectives
How to perform a two-incision subcutaneous technique of central venous port system implantation in cancer patients.
An experienced interventional radiologist under the guidance of ultrasound and fluoroscopy can safely perform the procedure.
Background
Central venous access plays a critical role in the management of cancer patients.
Repeated delivery of chemotherapy,
parenteral nutrition,
transfusions,
infusions and frequent blood sampling are indication for port system implantation.
Port system preserves patient’s peripheral veins and improves their quality of life.
(1)Contrast medium should only be injected through the high-pressure port systems.
(2) Ongoing infection (bacteremia or sepsis) is a relative contraindication for the port implantation until blood cultures are negative (3).
Complications are classified by the time at wich they arrise to...
Findings and procedure details
NPO 6 hours before procedure is recommended.
Procedure is performed in aseptic conditions under the i.v.
conscious sedation and local anesthesia.
We use up to 30 ml of 2% lidocain to anesthetize the skin above the jugular vein,
the subclavicular port pocket,
and the tunnel site.
The internal jugular vein is preferable central venous access site,
as it is easy accessible and can be evaluated before the procedure by the US to rule out the anatomy variants and thrombosis.
The first incision is made in...
Conclusion
Port systems for permanent central venous access play an important role in modern oncology.
They greatly improve patient’s quality of life.
Subcutaneous port implantation can be safely performed under the US and fluoroscopy guidance by experienced interventional radiologist in the angiosuite.
The complications should be recognized in time,
and the treating physicians and nurses trained how to use and maintain port systems properlyto ensure long-lasting viability of central venous access for infusion therapy.
Personal information
Sarajlic V.,
Clinic for Radiology,
Clinical Center University Sarajevo,
Bolnička 25,
71000 Sarajevo,
Bosnia Herzegovina.
Vesnic S.,
Clinic for Radiology,
Clinical Center University Sarajevo,
Bolnička 25,
71000 Sarajevo,
Bosnia Herzegovina.
Carovac A.
Clinic for Radiology,
Clinical Center University Sarajevo,
Bolnička 25,
71000 Sarajevo,
Bosnia Herzegovina.
References
1.
Teichgräber UK,
Pfitzmann R,
Hofmann HA: Central venous port systems as an integral part of chemothera- py.
Dtsch Arztebl Int 2011; 108(9): 147–54.
DOI: 10.3238/arztebl.2011.0147
2.
Wieners G,
Redlich U,
Dudeck O,
Schütte K,
Ricke J,
Pech M: [First ex- periences with intravenous port systems authorized for high pressure injection of contrast agent in multiphasic computed tomography].
RoFo 2009;81:664–8.
3.
Mukerjee A.
Peripherally Inserted Central Catheters (PICC Lines) and Arm Ports.
In: Kandarpa K.,
Aruny J.E.
Handbook of Interventional Radiologic Procedures.
Lippincott Williams &...