PORTACATH/MEDIPORT INSERTION
A portacath, or port-a-cath, is a medical device that's implanted under the skin to allow easy access to the bloodstream, typically used for patients who need frequent or long-term intravenous therapy, like chemotherapy.
The procedure involves two main components:
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Catheter: A thin, soft, flexible tube.
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Port: A small reservoir or chamber that sits under the skin, usually in the upper chest.
Procedure for Insertion:
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Preparation: The patient is typically given a local anesthetic and sometimes sedation. The area where the port will be inserted is cleaned and prepared.
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Making an Incision: A small incision is made on the skin, often on the upper chest.
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Inserting the Catheter: The catheter is threaded into a large vein, often the superior vena cava, near the heart.
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Placing the Port: The other end of the catheter is connected to the port, which is then placed under the skin.
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Securing and Closing: The port is secured in place, and the incision is closed with sutures or surgical glue.
Advantages:
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Reduces the need for repeated needle sticks.
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Can stay in place for long periods, sometimes years.
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Used for various treatments, including chemotherapy, blood transfusions, and antibiotic therapy.
Anesthetic Implications for Portcath/Mediport Insertion
Anesthesia type: General, TIVA, MAC, sedation, local
Airway: ETT, LMA, spontaneous ventilation
Preoperative:
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Used in chronically ill patients
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The implantable access ports are associated with improved patient comfort and reduced infection rates
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Surgeon will be at the head of the bed
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X-ray will be used to check placement
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The surgeon will inject numbing medication in the area of the incision
Intraoperative:
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Position: supine, slight trendelenburg
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Duration: 30-90 minutes
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Slight trendelenburg position improves vein engorgement and prevents air entrapment into the intravascular space
Postoperative:
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Assess for complications
Complications:
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Bleeding/hematoma
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Infection
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Pneumothorax
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Vascular injury
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Arterial puncture
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Venous air embolus
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Thrombus
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Arrhythmias
Sources:
Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.
Vacanti, C., Segal, S., Sikka, P., & Urman, R. (Eds.). (2011). Essential Clinical Anesthesia (1st ed.)