Download Port-a-Cath

Port-a-Cath
A Port-a-Cath® is a type of device for intravenous access in patients who require
frequent or continuous administration of intravenous substances. The major users of
Port-a-Caths are oncology patients but recently, they have been adapted for treating
hemodialysis patients as well. The Port-a-Cath® is produced by Smiths Medical MD,
Inc. However, the term is used generically for similar devices by other manufacturers
(usually as portacath). Other synonymous brand names include Bardport, Passport,
Infuse-a-Port, Medi-Port, and Lifesite (for hemodialysis patients). The term totally
implantable venous access system (TIVAS) is also used.
Principles
The name "portacath" is derived from "Portal and Catheter". It consists of a reservoir
compartment (the portal) that has a silicone bubble for needle insertion (the septum),
with an attached plastic tube (the catheter). The device is surgically inserted under the
skin in the upper chest or in the arm and appears as a bump under the skin. It requires
no special maintenance and is completely internal so swimming and bathing are not a
problem. The catheter runs from the portal and is surgically inserted into a vein
(usually the jugular vein, subclavian vein, or superior vena cava.) The surgery itself is
considered minor, and is typically performed under both local anaesthesia and
conscious sedation. Patients can be sent home with Demerol or other narcotic
medication to get them through the first few days of pain. Often they may also be told
to take an anti-inflammatory medication.
The septum is made of a special self-sealing silicone rubber; it can be punctured up to
one thousand times before it needs to be replaced. To administer treatment or to
withdraw blood, a health professional will first locate the portal and sterilize the area.
Then he or she will access the port by puncturing the overlying skin with a Huber
point needle. (Due to its design, there is a very low infection risk, as the breach of
skin integrity is never larger than the caliber of the needle. This gives it an advantage
over indwelling lines such as the Hickman line.) Negative pressure is created to suck
blood into the vacuumized needle, to check for blood return and see if the port is
functioning normally. Next, the portacath will be flushed with a saline solution. Then,
treatment will begin. Also, after each use, a heparin lock is made by injecting a small
amount of heparin (an anticoagulant) into the catheter. This prevents development of
clots in the system.
Uses
Port-a-Caths have many uses:

To deliver total parenteral nutrition in those unable to take (adequate) food
orally for a long period of time.

To deliver chemotherapy to cancer patients who must undergo treatment
frequently. Chemotherapy is often toxic, and can damage skin and muscle tissue, and
therefore should not be delivered through these tissues. Portacaths provide a solution,
delivering drugs quickly and efficiently through the entire body via the circulatory
system.

To deliver coagulation factors in patients with severe hemophilia.

To withdraw (and/or return) blood to the body in patients who require frequent
blood tests, and in hemodialysis patients.

To deliver antibiotics to patients requiring them for a long time or frequently,
such as those with cystic fibrosis and bronchiectasis.

Delivering medications to patients with immune disorders.

For treating alpha 1-antitrypsin deficiency with replacement therapy
Alternatives to portacaths include the Hickman line and the PICC line.
Variability
There are many different types of portacaths. The particular type selected is based on
the patient's specific medical conditions.
Portals:

can be made of plastic, stainless steel, or titanium

can be single chamber or dual chamber

vary in height (although the base is about the size of a quarter)
Catheters:

can be made of polyurethane (grocery bags) or silicone (breast implants)

can vary in length (cm)

can vary in diameter (mm)
Portacaths can be put in the upper chest or arm. The exact positioning itself is
variable as it can be inserted to avoid visibility when wearing low cut shirts, and to
avoid excess contact due to a backpack or bra strap.
Risks
1.
Infection - a severe bacterial infection can compromise the device, require its
surgical removal, and seriously jeopardize the health of the already weak patient.
2.
Thrombosis - formation of a blood clot in the catheter may block the device
irrevocably. To prevent clotting the portacath is flushed with saline and heparin.
3.
Mechanical failure - is extremely unlikely. It is possible in a rare event that part
of the system could break and become lodged in the circulatory system. In such case
it is unlikely to cause any serious harm.
Age - If the device is put into a child, the child's growth means that the catheter
becomes relatively shorter and will move away from the inferior part of the superior
vena cava - it might be necessary to remove or replace it.