Implantable port

Implantable ports, also known as chemoports, totally implantable central venous access ports or Port-A-Caths®, are a type of central venous catheter for patients requiring long-term venous access. They offer the ability to have long-term central venous access with some of the advantages over peripherally inserted central catheters (PICC).

History

Implantable ports insertions were frequently performed by surgeons. The first port implantation performed in an angiography unit using interventional radiology techniques in 1992 ². Today, radiological venous port placement has become a regular interventional procedure.

ProcedureIndications

Similar to peripherally inserted central catheters (PICC), implantable ports are primarily inserted to provide long term central venous access. This is particularly useful for patients who require:

• long-term IV administration of medication (e.g. chemotherapy or antibiotics)

• peripheral access with standard IV cannulae is difficult or impossible

• to withdraw blood from the body in patients who require frequent blood tests

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 they are under the skin

• implantable ports are waterproof while a PICC cannot get wet

Patient preparationAbsolute

• antibiotic prophylaxis is not recommended for routine use ^4,5

  clinically in bacteraemia or sepsis with and without neutropenia

Technique

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

• antibiotic prophylaxis is not recommended for routine use ^4,5

• preprocedure ultrasound can be performed to identify an appropriately-sized vein and ensure it is clot free

  • the most common vein is the right IJVinternal jugular vein

  • other veins include the left IJVinternal jugular vein, subclavian veins and 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

• the vein is punctured under ultrasound guidance, a guide wireguidewire is inserted and the proximal end is secured

  • the distal end of the guide wireguidewire is ideally placed in the inferior vena cava

• the port pocket is created under local anaesthesia

  • the most common site for the pocket wasis at the pectoral region, approximately 2.5 cm from the clavicle

• the catheter is then inserted using a trocar subcutaneously from the pocket to the vein or vice versa

• the 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 minimise air embolism

• the catheter tip is adjusted to the cavo-atrialsuperior cavoatrial junction

• the distal end of the catheter is attached to the port

• the port is anchored to the underlying muscle with sutures

• fluoroscopy is used to check for kinks and optimal positioning

• aspiration of blood is done to check its function

• further contrast injection may be performed to reconfirm the tip position and function

• the port must be flushed with heparinised saline

• the pocket is then sutured in two layers and apply sterile dressings applied

Complications

• infection, e.g.: catheter- or wound-related (most common) ³

• tip migration

• deep vein thrombosis

• periprocedural

  • haemorrhage

  • arrhythmia

  • arterial puncture: less common with image-guidance guidance

• malposition: less common with image-guidance guidance

  • beware of anatomical variants such as a left SVC

• line fracture/embolisation

• allergic reaction

• pinch off syndrome if a subclavian approach is used

• pneumothorax

• haemothorax