Implantable port

Absolute:

• clinically in bacteremia or sepsis with and without neutropenia.

Relative:

• abnormal coagulation profile, prolonged bleeding time.
• contrast allergy (can be performed without contrast administration)

Advantages

In comparison to peripherally inserted central catheters (PICC):

• implantable ports can last up to several years. PICC lines last for several weeks or months.
• While PICC lines require daily flushing and dressing, implantable ports require less frequent since their under the skin.
• implantable ports are water proof while PICC cant get wet.

Patient preparation

• Prophylactic antibacterial or antifungal agents maybe administered but not compulsory.

Technique

There are wide variations in technique. The following steps is an example of technique.

• preprocedure ultrasound can be performed to identify an appropriately-sized vessel and ensure it is clot free
  • the most common entry site is the right IJV
  • Other entry sites included the left IJV, subclavian veins and the inferior vena cava.
  • vessel and port pocket should also not be ipsilateral with the breast cancer site or overlap with the proposed radiation therapy field
• entry site is punctured under ultrasound guidance, a guide wire is inserted and the proximal end is secured
  • the distal end of the guide wire is ideally placed in the inferior vena cava
• port pocket is created under local anaesthesia
  • the most common site for the pocket was at the delto-pectoral region, around 2.5 cm from the clavicle
• the catheter is then inserted using a trocar subcutaneously from the pocket to the entry site or vice versa
• catheter tip is measured to reach the cavo–atrial junction
• peel-away sheath is inserted to facilitate the catheter insertion into the venous system.
• catheter insertion is done during breath hold or inspiration and pinching of the peel-away sheath to minimize air embolism
• irrigation of the pocket with normal saline
• distal end of the catheter is attached to the port
• port is sutured in at least two sites to the underlying muscle
• catheter was then checked for kinks and optimal positioning with fluoroscopy
• aspiration of blood was done to check its function
• further contrast injection may be performed to reconfirm the tip position and function
• port must flushed with heparinized saline
• pocket is then sutured in two layers and sterile dressings were applied
• post-procedural chest radiograph is taken