In the medical world, port is a small medical device installed under the skin. The catheter connects the port to the vein. Under the skin, the port has a septum through which the drug can be injected and blood samples can be taken many times, usually with less discomfort for the patient than the more typical "needle stick".
Ports are used primarily to treat hematologic and oncologic patients. Ports were previously adapted for use in hemodialysis patients, but were found to be associated with increased rates of infection and are no longer available in the US.
This port is usually inserted in the upper chest (known as the "chest port"), just below the clavicle bone or the collarbone, making the patient's hands free.
Video Port (medical)
Terminology
The port is more appropriately known as "a fully implanted vein access device". Brand Name includes Eco Port, Clip-a-Port, SmartPort, Microport, Bardport, PowerPort, Passport, Port-a-Cath, Infuse-a-Port, Medi-Port, and Bioflo.
Maps Port (medical)
How it works
A port consists of a reservoir compartment (portal) that has a silicon bubble to insert a needle (septum), with an inserted plastic tube (catheter). This device is inserted through surgery under the skin on the upper chest or in the arm and looks like a lump under the skin. It does not require special care and is completely internal so swimming and bathing are not a problem. The catheter runs from the portal and is surgically inserted into a blood vessel (usually a jugular vein or subclavian less optimal vein). Ideally, the catheter ends up in the superior vena cava or right atrium. This position allows the infusion agent to spread throughout the body quickly and efficiently.
Septum is made of special silicone sealing; can be stabbed hundreds of times before it weakens significantly. To arrange a treatment or to draw blood, a health care professional will first find the port and disinfect the area, then access the port by piercing the top skin with a Huber point needle. Because of its design, there is a very low risk of infection, because the violation of skin integrity is never greater than the caliber of the needle. This gives an advantage over the inner lines like the Hickman line. Negative pressure is made to draw blood to the vacuum needle, to check the blood again and see if the port is working normally. Next, the port was rinsed with saline solution. Then the treatment will begin.
The implantation procedure itself is considered small, and is usually done with local anesthesia and moderate sedation. Patients often experience post-procedure discomfort at the most frequently managed insertion site with administration of acetaminophen or non-steroidal anti-inflammatory drugs such as ibuprofen.
A port is most often included as an outpatient surgical procedure in a hospital or clinic by a radiologist or intervention surgeon, under the influence of a sedative. Implantation is increasingly being performed by interventional radiologists due to advances in techniques and the use of their seamless imaging technology. When no longer needed, the ports can be moved in the radiology room of the intervention or operating room.
Usage
Port has many uses:
- To give chemotherapy to cancer patients who have to undergo frequent treatment. Chemotherapy is often toxic, and can damage skin and muscle tissue, and therefore should not be transmitted through this tissue. Ports provide solutions, delivering drugs quickly and efficiently through the entire body through the circulatory system.
- To provide coagulation factors in patients with severe hemophilia.
- To draw (and/or return) blood to the body in patients who require repeated blood tests, and in hemodialysis patients.
- To give antibiotics to patients who need them for a long time or often, such as those with cystic fibrosis and bronchiectasis.
- Providing medication to patients with immune disorders.
- To treat alpha 1-antitrypsin deficiency with replacement therapy
- To provide a radiopaque contrast agent, which increases contrast in CT imaging.
- To fill or draw fluid from Lap-Band or Realize the hull used in Bariatric surgery.
- To provide analgesics in patients with chronic pain, such as cancer patients and patients with sickle cell disease
Insertion
Fluoroscopy is useful in guiding port insertion.
A chest x-ray follow-up can immediately detect complications associated with the procedure in the form of pneumothorax, hemothorax and catheter malposition (see Risk below for more details). However, it is recommended that chest radiography is not mandatory as a routine method after insertion of a fluoroscoped guided port primarily by vein cutting.
The portion of the patient's embedded portion of the chest is usually selected to avoid damage to ports and veins by the seat belt in the event of an accident while sitting as the driver. Thus, there is potential for conflict by left and right traffic as road rules.
Model
There are many different port models. The specific model chosen is based on the patient's specific medical condition.
Portal:
- can be made of plastic, stainless steel, or titanium
- can be single space or double space
- varies in height, width, and shape.
Catheter:
- can be made of biocompatible, polyurethane or medical grade silicone
- can vary in length and diameter
Ports can be placed on the upper chest or arms. The exact position itself is variable because it can be inserted to avoid visibility when wearing low-cut T-shirts, and to avoid over contact because of a backpack or bra straps. The most common placement is in the upper right of the chest, with the catheter itself wound through the right jugular vein, and down toward the patient's heart.
For applications such as CT scan, a high-pressure infusion that allows ports is required.
Risk
- Age: If the tool is put into the child, the child's growth means the catheter becomes relatively shorter and will move toward the head. It may be necessary to remove or replace it.
- Artery Injuries: The subclavian arteries may be accidentally impaled while trying to access subclavian veins, leading to subcutaneous hematoma and sometimes pseudoaneurism. Alternate sites may need to be used for port placement. Carotid artery stress is significantly less frequent, as attempts to access the adjacent jugular vein are increasingly performed with ultrasound guidance.
- Infection: Infection may occur in the channel or around the port. This may require antibiotic treatment or removal of the device.
- Mechanical failure is rare. Ports placed through the subclavian vein may suffer "pinch-off syndrome" in which the catheter fractures as it passes through the vein. Ports placed through the jugular vein do not suffer from this problem. The catheter fragments then travel through the venous system and are usually lodged in the right heart or lungs. Many patients are asymptomatic but mechanical failure is found because of the inability to flush or draw fluid from the port. In the example, an intervention radiologist can usually pick up fragments and place new ports.
- Pneumothorax: Efforts to gain access to a subclavian vein or jugular vein may injure the lungs, potentially causing pneumothorax. If the pneumothorax is large enough, the chest tube may need to be placed. In experienced hands, the incidence of these complications is about 1% when accessing the subclavian vein. When accessing the jugular vein the level of pneumothorax is virtually absent.
- Thrombosis: the formation of blood clots in the catheter may prevent the device from being irrevocable. To prevent clotting, the ports are rinsed with saline and heparin, usually by nurses or other medical professionals, or well-trained individuals who are family members or patients, at least once every four weeks, or more frequently in conjunction with drug delivery.
Manufacturer
The major port manufacturers are AngioDynamics, B. Braun Medical, Bard Access Systems, Medical Cook, MedComp, Navilyst Medical, Norfolk Medical Products, and Smiths Medical.
Use
To reduce damage or coring of the septum during use, low or non-coring needles should be used. After each use, the heparin lock is made by injecting a small amount of heparin (anticoagulant) copy into the device, preventing the development of clots inside the port or catheter. In some catheter designs where there is a self-sealing valve at the end, the system is locked with only saline. Ports can be left accessible for as long as necessary. The port is covered with sauce to protect the site from infection and to secure the needle in its position.
If the port is rarely used, it may be necessary to access the port, water it with saline, and inject a new heparin lock to prevent clotting between usages.
Alternative
Sometimes, the patient's physical condition, especially the structure of his blood vessels, makes it impossible to enter the port. The alternative is the PICC path, although there are shortcomings such as external entry points and limited device life.
In popular culture
In 1984 the cyberpunk Novel Neuromancer , minor character, Peter Riviera, had a type of medical port placed on his arm to facilitate his drug use.
See also
- Hickman line
- Centrally mounted central catheter or "PICC" ​​â € <â € <
- Groshong line
References
Further reading
- Mallon, William (March 2001). "Can It Be Paid to Remove a Heroin User with an Intravenous Line to Solve Antibiotic Therapy for Cellulitis at Home under A Nurse's Supervision?". Point-Counterpoint (column). The Western Journal of Medicine . 174 (3): 157. doi: 10.1136/ewjm.174.3.157. PMC 1071292 . PMIDÃ, 11238332 Ã,
External links
- www.breastcancer.org: Ports for Chemo
- Photo essay on what it's like to have a port
Source of the article : Wikipedia
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