Port system

The main components of the port system are: the port consisting of the main body, a silicone membrane and usually a titanium tank that is connected to the catheter using a cannula .

• Long courses of therapy involving multiple infusions (chemotherapy, systemic antibiotic therapy, treatment of HIV). Port system can be used up to 5 years.
• The introduction of drug solutions for a long time (up to 46 hours).
• Infusion therapy in patients with obstructed venous access.
• Frequent blood sampling. Infusion ports allow you to make the procedure faster and more painless.
• Frequent introduction of blood and blood substitutes.
• Parenteral nutrition ^[2] .

Implantation of a port system is contraindicated in cases

• infection or sepsis ,
• allergies to any of the materials that make up the port or catheter,
• incompatibility of drugs with any of the materials that make up the port or catheter,
• impossibility of implantation due to the individual anatomy of the patient,
• previous radiotherapy in the area chosen for implantation,
• previous venous thrombosis .

1. Percutaneous implantation (Seldinger)

• Puncture of the vein with Seldinger's needle.
• A metallic conductor is inserted into the vein through Seldinger's needle, after which it is removed from the vein.
• The introducer with a crushable shell (peel away) and the dilator are installed using a metal conductor.
• Wire guide and dilator are removed. The catheter is inserted into the introducer and advances to the site of the inflow of the superior vena cava into the right atrium. The Introducer is torn. The position of the catheter tip is checked by fluoroscopy.
• The port is washed with a solution of sodium chloride 0.9%.
• A subcutaneous pocket is created for the port. The tip of the catheter is tensioned onto a special instrument, with the help of which a subcutaneous tunnel is formed between the puncture site and the incision.
• A catheter is passed through the tunnel to the incision.
• The catheter is placed on the cannula of the port and securely fastened with a connecting ring.
• The port is immersed in the prepared pocket and fixed. It is important to avoid bending the catheter.
• Catheter and port health monitoring.

2. Implantation surgically

• The skin and tissue are incised. Then a vein is incised with a scalpel.
• The catheter is washed with a solution of sodium chloride (0.9%), after which it is inserted into the vein by means of a venal elevator.
• The catheter moves to the site of the inflow of the superior vena cava in the right atrium. A subcutaneous pocket is prepared. For further steps, see Seldinger's method . ^[3]

• After treating the skin with an antiseptic solution, a Huber needle is inserted. Its edge has a special structure: it does not pierce the silicone membrane, but only pushes its fibers apart, while maintaining integrity. Due to this, it is possible to reuse the port system.
• This is followed by checking the patency of the catheter. The doctor connects the syringe to the needle and pulls on the plunger — blood should appear in the syringe. If this does not occur, 20 ml of saline is injected through a syringe. On the restoration of patency of the catheter indicates the absence of edema and pain, the free introduction of the entire volume of saline.
• The needle of Huber is connected to the infusion system, fixed with a patch or a special sticker. If the port system is installed correctly, the infusion is painless. If pain occurs, the procedure is stopped.
• After completion of the infusion, the port system is washed with saline. The “heparin lock” is installed.
• After removing the Huber needle, the skin is treated with an antiseptic solution, and if necessary, a pressure bandage is applied ^[2] .

• Infections due to lack of sterility . Symptoms - suppuration , redness, swelling , pain. Treatments include antibiotics or removal of the port system.
• Mechanical complications :

• Blocking - the cause may be the wrong diameter of the catheter in relation to the size of the vessel, as well as incompatibility of drugs. Further injections are impossible, there is no reflux of blood, the patient feels pain.

• Leakage of injected drugs may occur due to improper handling of the port system during implantation, for example, incorrect connection of the port to the catheter. The first signs of leakage are swelling and redness of the tissue around the catheter.

• Moving the catheter - may occur due to improper attachment to the port, which may cause arrhythmia, as well as difficulty breathing and pain.

• Thrombosis - improper care, and in particular the lack of flushing of the system, can lead to the formation of thrombosis, due to which further use of the system is impossible.

• Pinching (pinch-off) - may occur if the catheter is implanted in the subclavian vein, is installed too medially, the catheter is pinched between the first rib and the clavicle, the catheter is damaged or ruptured. If the catheter is pinched, it is necessary to change the position of the patient’s body to inject a liquid or obtain a blood sample. In the event of a rupture, complications arise during procedures as well as the risk of moving the severed catheter into the heart, etc. Thorough checking of the position of the catheter during implantation will prevent this kind of complication. ^[3]