Transcription
A chest port, also known as a port-a-cath, is a small medical device implanted beneath the skin to provide long-term venous access for chemotherapy, blood draws, and IV medications. This animation will guide you through the key steps of the placement procedure using Interventional Radiology.
The patient is positioned supine on the procedural table with the head turned away from the access site. The skin is cleaned, sterilized, and draped in a sterile field to minimize infection risk.
Using real-time ultrasound guidance, the internal jugular or subclavian vein is identified. After finding the access site, local anesthesia is administered to numb the access site. A small incision is made at the chosen access site using a blade. A needle is advanced into the target vein under direct ultrasound visualization. Then, a microwire is advanced through the needle into the vein. The needle is then exchanged for a transitional sheath.
A location approximately two to three finger widths below the clavicle is selected and marked for the port pocket. Local anesthesia is administered to numb the incision site for the port pocket. A small incision is made in the upper chest to provide access for port pocket creation. Repeat local anesthesia is performed to numb the port pocket itself.
Using a clamp, the subcutaneous tissue is gently dissected to create a pocket for the port, ensuring adequate space for secure port placement. Once the port is carefully positioned within the pocket, the catheter is tunneled subcutaneously from the port pocket to the venous access site. The endovascular length of the catheter is measured using the existing microwire as a reference.
The microwire and inner dilator of the transitional sheath are then exchanged for a J-wire. Next, the outer of the transitional sheath is exchanged for a peel-away sheath, which facilitates the catheter placement. The catheter is trimmed to the appropriate endovascular length after removing the dilator of the peel-away sheath and the J-wire.
The catheter is carefully advanced through the peel-away sheath into the vein. The tip of the catheter is guided under fluoroscopic visualization to terminate just above the right atrium, typically within the superior vena cava (SVC). Subsequently, the peel-away sheath is removed, and the catheter is fully secured beneath the skin at the venous access site, ensuring that the catheter is properly aligned.
The port pocket's incision is closed using bioabsorbable sutures based on a simple buried suture technique. Finally, skin glue is applied to both the port pocket incision and the venous access site, followed by a sterile dressing to protect the area and promote healing.
With the procedure complete, the chest port is heparin flushed and now ready for use, providing safe and long-term venous access for patients undergoing ongoing treatments.