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How often should a port-a-cath be flushed?
Port-a-cath (PAC) system is one of the most frequently employed venous accesses for administration of chemotherapy and supportive care. To prevent late complications, the latest guidelines recommend flushing/locking procedures every four weeks.
How to Irrigate a Foley Catheter (with Pictures)
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What are the different types of port-a-cath?
- A single lumen port is a port with 1 access point (see Figure 3). Most people will get a single lumen port.
- A double lumen port is a port with 2 access points (see Figure 3). You can put a needle in each access point.
How to Irrigate a Foley Catheter (with Pictures)
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About implanted ports
An implanted port (also known as a “port”) is a flexible tube that is inserted into a vein in your chest. This makes it easier for your healthcare team to:
Give you intravenous (IV, through a vein) medication.
Give you IVs.
Take blood samples.
Give you medication continuously for several days. Sometimes medicines need to be given into a vein larger than the one in your arms. The port allows the drug to enter your bloodstream through a large vein near your heart.
Implanted ports are typically placed about 1 inch below the center of your right collarbone (see Figure 1). When you wear a bra, your implanted port is approximately 1 inch from where your bra strap rests.
Figure 1. Port location
Implanted ports can stay in place for years. Your doctor will remove your port when you no longer need it.
Types of implanted ports
All implanted ports consist of 2 parts: the port with septum and a catheter (see Figure 2).
The port is where fluid flows through the catheter. It sits under your skin and has a raised center called the septum. The septum is made of a self-sealing rubber material. This is the part of the port where the needles will be placed. This is also known as an access point.
The catheter is a small, flexible plastic tube. One end of the catheter is connected to the port and the other end is placed in a large vein near your heart.
Figure 2. Parts of your port
There are 2 types of implanted ports:
A single lumen port is a 1 access point port (see Figure 3). Most people get a port with one lumen.
A dual lumen port is a port with 2 access points (see Figure 3). You can stick a needle into any access point. Dual lumen ports are used for people who regularly need more than one access point.
Figure 3. Single and dual lumen connections
Most implanted ports are the size of a nickel or a quarter. They can be circular, oval or triangular. Your doctor will choose the one that is best for you and your treatments. Your port may be referred to as a BardPort®, Mediport®, PowerPort®, or Port-A-Cath®.
Power-injectable ports
Most implanted ports are intended for use during imaging tests such as computed tomography (CT) scans or magnetic resonance imaging (MRI) to allow for high-speed contrast injections (scans). These implanted ports are called current-injectable ports.
Once you have your implanted port in place, your nurse will let you know if you have a power injectable port. You will also receive a wallet card with information about your implanted port. You should always carry it with you.
Access to your implanted port
If you need IV fluids or medication, your nurse will insert a needle through the access point on your implanted port. This is called accessing your port (see Figure 4). The fluid or medication is passed from your implanted port through the catheter into your bloodstream.
Do not allow anyone who is not trained in port access to access your port.
Figure 4. Accessing your port
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About your implanted port placement
Before your procedure
Your port will be placed either in the interventional radiology department or in the operating room. Port placement is a short procedure. Your doctor or nurse will tell you how to prepare.
Before the procedure, an IV tube will be placed in your arm. You will receive medication through your IV that will make you sleepy. The drug will control pain and anxiety.
Remove devices from your skin
If you have any of the following devices on your skin, the manufacturer recommends removing them before the scan or procedure:
Continuous Glucose Monitor (CGM)
insulin pump
Talk to your healthcare provider to schedule your appointment closer to the date you need to change your device. Make sure you have an extra device to put on after your scan or procedure.
If you are unsure how to manage your glucose while your device is off, speak with the healthcare provider who manages your diabetes care before your appointment.
During your procedure
The area where the implanted port will be placed is cleaned and numbed with a local anesthetic (drug that numbs an area of your body). You will be given a local anesthetic in 2 places, your neck and your chest.
A small incision (surgical incision) is made at the base of your neck. A second incision will be made on your chest, below your collarbone. The catheter is placed through the second incision, tunneled under your skin to the first incision, and threaded into your vein.
Your incisions will be closed with either sutures (sutures) or a surgical glue called Dermabond®. If you have stitches, they will be absorbed and do not need to be removed.
After your procedure
You may experience discomfort at the interfaces and where the catheter was tunneled under your skin. This pain should get better within 24 to 48 hours. You can take over-the-counter (OTC) pain relievers (medications you get without a prescription) if you need them. Most people don’t need a prescription pain reliever.
If your port will be used on the day of its placement, your doctor will insert an access needle into the septum during your port placement. The needle and port are covered with a bandage (bandage). There will also be a small bandage over the upper incision.
Caring for your incision site
If your incisions have been closed with sutures:
You have 2 small bandages covering your incision.
Leave your bandage in place for 48 hours, or for as long as your doctor tells you.
Don’t get your bandages wet. You can shower once your bandages have been removed.
Wearing a seat belt can put pressure on your incisions. You can place a small pillow or folded towel between the strap and your body to help.
Do not lift anything heavier than 4.5 kg for 3 to 5 days after placing your implanted port.
If your incisions have been closed with Dermabond:
You may have small pieces of tape or bandages covering the incisions.
Do not apply lotion or place glue on the tape or bandage.
Do not pick or scratch the Dermabond. It will resolve itself.
Wearing a seat belt can put pressure on your incisions. You can place a small pillow or folded towel between the strap and your body to help.
Do not lift anything heavier than 4.5 kg for 3 to 5 days after placing your implanted port.
After your incision has healed
Once your incision has healed, you can return to your normal daily activities, such as walking. B. Household chores, work commitments and sports. You can swim with your implanted port as long as there is no needle. Do not play contact sports such as soccer or rugby.
Your implanted port may lift your skin about 1/2 inch. You might be able to feel it through your skin, but you probably won’t be able to see it if you’re wearing a V-neck shirt. Most people won’t know you have it.
The skin over your implanted port does not require any special care. You can wash it as usual.
If your implanted port is used, you will have a clear bandage over the needle. The dressing must be kept dry and in place while the needle is in the port. You do not need a bandage over the implanted port when not in use.
Your implanted port will not set off metal detectors.
Flushing your implanted port
Your implanted port will need to be flushed by a nurse every 4 weeks when not in use. This is done to ensure the catheter does not become blocked. If it gets blocked, it may stop working and may need to be removed.
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Call your interventional radiologist if you:
Do you have new or increased pain at the site of your port
Have a swelling or growing bruise at the site of your port
Do you have pus or fluid from your cuts?
Be aware that your cuts may be hot, tender, red, or irritated
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Call your doctor if you have:
A fever of 100.4°F (38°C) or higher
chills
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What is a port-a-cath used for?
A port-a-cath is used to give intravenous fluids, blood transfusions, chemotherapy, and other drugs. It is also used for taking blood samples. A port-a-cath may stay in place for a long time and helps reduce the need for repeated needle sticks.
How to Irrigate a Foley Catheter (with Pictures)
How long can a port go without being flushed?
It is routine practice to flush ports every four to six weeks, according to the manufacturer’s recommendations, using salt solution followed heparin if needed. This study examines the effectiveness of port flushes at an alternative interval of 3 months, reducing the number of visits to the health-care provider.
How to Irrigate a Foley Catheter (with Pictures)
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What happens if a port is not flushed?
Regular flushing might lead to a decreased risk of PORT-A-CATH® thrombosis, but may also lead to an increased infection or thrombosis rate and patients discomfort. Therefore, this study investigates the safety of not flushing the PORT-A-CATH® for 6 or 12 months.
How to Irrigate a Foley Catheter (with Pictures)
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Is a port-a-cath a central line?
A port is a catheter that’s implanted surgically under the skin on the chest. It’s another type of central line.
How to Irrigate a Foley Catheter (with Pictures)
Sometimes chemotherapy is safely given through a standard (or “peripheral”) IV line. In other cases, infusions must be given through a central catheter such as a PICC, CVC, or port.
How are these options different? And which one is right for you? We spoke to Tam Huynh, M.D., Chief of Vascular Surgery at MD Anderson to learn more.
What are the differences between an IV, port and central line?
A peripheral IV line (PIV, or simply “IV”) is a short catheter that is usually placed in the forearm. It begins and ends in the arm itself.
(PIV or simply “IV”) is a short catheter that is usually placed in the forearm. It starts and ends in the arm itself. A PICC lead is a longer catheter that is also placed in the upper arm. Its tip ends in the body’s largest vein, which is why it is considered the midline. PICC stands for “Peripherally Inserted Central Line Catheter”.
Line is a longer catheter that is also placed in the upper arm. Its tip ends in the body’s largest vein, which is why it is considered the midline. PICC stands for “Peripherally Inserted Entral-Line Atheter”. A CVC is identical to a PICC line except that it is placed in the chest or throat. CVC stands for Central Venous Catheter.
is identical to a PICC line except it is placed in the chest or neck. CVC stands for “entral enous atheter”. A port is a catheter surgically implanted under the skin on the chest. It’s a different kind of centerline.
Which one should I take?
This depends on the type of chemotherapy you need and the time it takes for it to be administered.
A PIV can be left in place for up to four days and can only be used with certain types of chemotherapy (those that don’t cause irritation or blistering, which can damage veins).
can be left in place for up to four days and can only be used with certain types of chemotherapy (those that don’t cause irritation or blistering, which can damage veins). A PICC line can stay in place for weeks or months, but must always be kept dry (even when showering). It also requires regular cleaning and maintenance to work well.
Line can stay in place for weeks or months, but must always be kept dry (even when showering). It also requires regular cleaning and maintenance to work well. A CVC can persist for weeks, months, or until treatment is completed. It also needs to be kept dry and maintained regularly.
can remain in place for weeks, months, or until treatment is complete. It also needs to be kept dry and maintained regularly. A port can exist for years. It requires only limited maintenance performed by MD Anderson staff. And patients can shower with a port – or even swim.
All central lines (PICC, CVC and Port) can be used for any type of chemotherapy.
Which Patients Should Consider Port or Central Access?
If you’ve had trouble placing normal IVs, consider installing a port or other central line. Most patients have experience with PIVs and can report if they are difficult to insert. And as treatment progresses, it can become increasingly difficult to place a PIV. It is therefore important that you discuss this with your doctor before starting treatment.
You should also consider getting a port or other central access if you’ve had reactions to chemotherapy infused through a PIV — such as pain, redness, or swelling at the infusion site and/or banding (redness/discoloration along the vein ). .
Under what special circumstances can a doctor recommend a connection or a central line?
If you need continuous infusion of chemotherapy at home via a portable pump, you need centralized access. These types of IVs cannot be given through a PIV because of the high risk of the chemotherapy spilling into surrounding tissues and accidentally dislodging.
Your doctors may also recommend one based on the condition or accessibility of your veins. If you already have small, weak, or difficult-to-find veins, or if MD Anderson staff regularly have difficulty placing PIVs or drawing blood for lab work, a central line or port may be placed prior to beginning treatment.
What is the most common objection patients have to central access? what do you tell them
Most patients have concerns about care and maintenance. PICC lines and CVCs must be changed weekly and daily lavage is recommended.
At MD Anderson, we have resources to help patients and caregivers learn this. We offer centerline maintenance courses. Patients can also visit one of two walk-in infusion therapy clinics (Main Building, Floor 8, Elevator C and Mays Clinic, Floor 8, Elevator U) for routine care and maintenance. Finally, home health care can be an option. Check with your case manager at MD Anderson to see if your insurance policy covers this.
Because port placements require sedation and/or anesthesia in an operating room, some patients are concerned about undergoing surgery. But other central lines can also be placed in the clinic under local anesthesia. So if you want to avoid general anesthesia we usually recommend a PICC line.
How long do patients typically need to use a port or central line?
Most patients keep their PICC, CVC, or port until they’re done with treatment, but it’s different for each person. Ports are often requested because they allow patients more normality in their daily lives and require less maintenance. But ports are not always the best choice. If you only need a central line for a few days to a few weeks, a PICC line may be recommended as it is the easiest to place and remove.
How long does it take for a patient to get centralized access?
PICC lines and CVCs can usually be placed at MD Anderson’s infusion therapy clinic within 24 to 48 hours of receiving a physician’s order. The placement of an implanted port takes up to a week as it is a surgical procedure. These are planned only after a consultation with an oncologist.
What do patients cite as the most difficult aspect of having a port or central line? What advice do you give them?
Caring for PICCs and CVCs can sometimes be a challenge. You must keep the bandage clean, dry, and intact at all times, so you must cover it with plastic wrap and tape when you shower, and you cannot bathe or swim.
Patients also complain about limitations in their activities. Exercising can be difficult because external catheters sometimes get caught on things.
We remind patients that they can still practice some activities, such as B. walking or cycling. We also note that ports allow patients more freedom, so talk to your oncologist if you’re interested in one to see if you’d be a good candidate.
How should patients care for their ports and central lines?
CVCs and PICCs require weekly dressing changes and daily rinsing to maintain. The ports are flushed after each use and only need flushing once a month if not used regularly. No dressing changes are required for a port.
What myths or misconceptions about ports and central lines do you hear often?
Actually there are two:
Patients sometimes mention that they do not want a port or central access because the infection rate or risk is high. While it is true that there is a risk of infection with any catheter, this risk can be reduced with proper care and maintenance. Careful observation of the site helps identify complications early and achieve better outcomes.
Ports and central lines do not end with the tip of the catheter inside the heart. The tip of the catheter is either in the superior vena cava (SVC) or at the atriacaval junction (ACJ) where this large central vein meets the heart.
What is the one thing patients should know about ports and central lines?
Ports and central lines are there to help you and are very safe ways to administer chemotherapy.
Request an appointment with MD Anderson online or by calling 1-877-632-6789.
Can you get an MRI with a port-a-cath?
The MRI technologist will ask whether you have a prosthetic device, implanted port, infusion catheter (brand names Port-A-Cath, Infusaport, Lifeport), or any other implanted devices. Surgical staples, plates, pins and screws pose no risk during MRI.
How to Irrigate a Foley Catheter (with Pictures)
To learn more about your MRI options, call the radiology and imaging specialists today at (863) 688-2334. We have multiple locations in the Polk County area.
MRI is an alternative to traditional X-ray-based and ultrasound imaging modalities. Breast MRI and MRI-guided breast biopsy have been shown to be beneficial for the early detection of breast cancer and are often used in addition to mammography. MRI is the best diagnostic examination of the male and female reproductive system, pelvis and hips, and bladder because it does not expose it to X-rays.
MRI is an emerging tool for early detection of prostate cancer. The benefit of this new technology to patients is that the MR images acquired may be able to identify specific areas within the gland that are suspicious and require additional investigation. These images provide comprehensive summary reports, which in turn highlight all critical aspects of the study. With this information, physicians can communicate study results to patients more effectively and in a timely manner.
MRI scans take 15 to 60 minutes depending on how many images are needed. Very detailed studies may take longer. The technician leaves the room while the individual MRI sequences are performed. The technologist observes the patient during the procedure. The patient can communicate during the examination via an intercom system in the scanner. Our scanners are equipped with special headphones to enjoy music; this is to help the exam time go by quickly.
MRI is a painless way to get a diagnosis. MRI requires special equipment and trained doctors to interpret the scan.
Preparation and special instructions
MRI prostate with and without contrast medium preparation:
The patient should not eat or drink anything 4 hours before the scheduled appointment.
The patient is only allowed to eat a light meal the night before.
The patient should give himself an enema 2 hours before the scheduled appointment.
No sexual intercourse 5 days before the examination.
Patients who have worked with metal must be placed in orbit for a foreign body X-ray. X-rays must be completed before 5 p.m.
Questionnaire is to be filled out by the planner.
Usually, no preliminary tests, diet or medication are required for an MRI.
Some patients undergoing an MRI in a conventional department may feel cramped or claustrophobic. If you are not easily calmed down, a sedative may be given. About 1 in 20 patients will need medication to reduce the anxiety associated with claustrophobia. The open design of recent MRI systems has done much to reduce this response.
The strong magnetic field used for MRI will exert force on any iron-based or ferromagnetic object. The MRI technician will ask if you have a prosthesis, an implanted port, an infusion catheter (brand names Port-A-Cath, Infusaport, Lifeport), or other implanted devices. Surgical staples, plates, pins, and screws pose no risk during MRI. Tattoos, permanent eyeliner, metal zippers, and similar metal objects can distort images but will not cause harm.
An x-ray may be done if you’ve ever had a bullet or shrapnel injury, or have ever worked with metal.
Objects that need to be removed prior to the MRI procedure include:
jewelry
watches
hairpins
Clothing with metal zippers, belts or buttons
Removable dental work (non-removable dental work is fine but may distort images if the face or head area is scanned)
glasses
hearing aids
Neurostimulator (Tens unit)
MRI should not be done in most people with:
Inner ear (cochlear) implants
Brain aneurysm clips
Some artificial heart valves
pacemaker
If you could be pregnant, this should be reported to the technologist or radiologist.
What to expect
The patient must remain still during the imaging process. When the exam is finished, the patient is asked to wait until the images have been examined to determine if more images are needed.
Loud knocking or knocking noises can be heard at certain stages of imaging, so earplugs are given. Some MRI machines are louder than others.
During the exam you may notice a warm feeling in the area being examined; this is normal, but if it bothers you, you should notify the radiologist or technician.
Depending on the exam, a contrast agent may be used to improve the visibility of specific tissues or blood vessels. A small needle is placed intravenously in the arm or hand. Contrast medium is injected about two-thirds of the way through the examination. The most common intravenous MR contrast agent, gadolinium, is very safe. Sequences performed with intravenous contrast media can provide additional data for diagnosis.
After an MRI scan, you can resume your normal diet, activity, and medication. An MRI-skilled radiologist analyzes the images and sends a report with his interpretation to the patient’s GP within 24 hours or less.
Schedule your MRI today
To learn more about our MRI services, please call (863) 688-2334. Radiology and Imaging Specialists proudly serves Lakeland, Kissimmee, Plant City and the surrounding areas of central Florida.
Can you draw blood from a port-a-cath?
Having a special vascular access device (VAD) called a port-a-cath (port) allows chemotherapy to be administered safely. The port can also be used for blood draws, other IV medications, and special imaging tests like CT (computed tomography) scans or PET (positron-emission tomography) scans.
How to Irrigate a Foley Catheter (with Pictures)
Unfortunately, some chemotherapy drugs are too dangerous to put into the small veins of the hands and arms that are normally used for IV fluids. If this medication accidentally leaks out of a vein, it can cause tissue and skin damage in the surrounding areas.
The presence of a special vascular access device (VAD) called a port-a-cath (port) allows chemotherapy to be administered safely. The port can also be used for blood draws, other IV medications, and special imaging tests such as CT (computed tomography) scans or PET (positron emission tomography) scans.
This article explains what ports are, how to use them, and their potential benefits.
Willowpix/Getty Images
What is a port?
A port is a device surgically placed under the skin on either side of the chest just below the collarbone. The port can also be placed in a different part of the body depending on the type of cancer and the person’s medical condition. The procedure is performed in the hospital and most people go home the same day.
The port consists of two parts: the portal and the catheter. The portal is a small, heart-shaped drum. The top of the drum is made of self-sealing silicone, allowing a Huber needle to pierce it. The rest of the drum is plastic.
Some people may have a port with two portals or drums. Although completely under the skin, the portal appears as a small bump on the chest.
The catheter is a thin plastic tube that attaches to the bottom of the portal. It’s a few inches long and is surgically threaded into a large vein in the chest. Commonly used veins are the jugular vein, the subclavian vein, or the superior vena cava.
The port allows for safe and easy administration of medication and blood collection. There are no tubes or catheters outside the body when the port is not in use. Once the surgical site has healed, swimming, bathing, and showering are allowed.
Who Gets Ports?
You and your oncologist (cancer doctor) will decide together whether you need a port. Factors to consider are:
type of cancer
type of chemotherapy
frequency of chemotherapy
Duration of cancer treatment
condition of the veins in your arms
Not everyone receiving cancer treatment needs a port. Some cancer drugs can be safely infused into the veins of the arm. Your oncology nurse will examine the veins in your arms to determine if you need a port.
advantages
The greatest advantage of a port is security. Ensuring that chemotherapy is administered in the safest manner provides peace of mind for you and your oncology team.
Ports are also easy to use. There is no difficulty in finding a vein. If chemotherapy is given daily or frequent blood draws are required, the Huber needle can remain in place, reducing the number of venipunctures required. A clear bandage is placed over the Huber needle to protect it while it stays in place.
In addition, the port device can remain in the body for many years, which facilitates follow-up care for imaging and blood tests. Clinical guidelines must be followed for the management and use of infusion ports.
How is the port used?
Before the port is accessed (punctured), a nurse will clean the skin over and around the port site. Cleaning the skin with an alcohol solution helps reduce infection.
The nurse wears a mask during this procedure and uses sterile materials free of microorganisms. You should not cough or breathe onto your skin during this process. It helps to turn your head to the other side.
Once your skin is dry:
The nurse pricks your skin with a Huber needle and gently pushes it through the silicone port device.
A tube is connected to the Huber needle, which remains outside the body during the infusion. A clear bandage is placed over the needle to keep it clean and to anchor it to the chest wall.
Next, a syringe is attached to the end of the tube to aspirate (remove) blood from the port. This indicates that the port is working. Laboratory tubing can be attached to the tubing for easy blood collection.
The nurse then uses a syringe to flush the tube with normal saline, flushing the blood from the tube and port device. A salty or metallic taste may occur when flushing the port.
When the medication is ready, the nurse connects the chemotherapy tubing to the connector tubing. Most chemotherapy treatments are infused by a pump that is programmed to deliver the right amount of drug for the right amount of time.
Once the chemotherapy has been infused, the nurse flushes the connecting tubing with normal saline. Some ports also require a solution called Heparin Lock. This helps prevent blood clots from forming in the port device.
The nurse then removes the Huber needle and places a bandage or small bandage over the puncture site. You can shower and bathe at any time after the port needle is removed.
Why doesn’t my clinic take my blood through a port?
Although it is convenient to use the port for labs, there may be times when you need a venipuncture (blood drawn from the arm) instead. Here are some reasons why your blood test may not be done through your port:
There are no qualified personnel to access the port.
Certain labs require venipuncture.
It is more expensive to use a port.
There is a suspicion of damage to the port.
The port has no blood return due to a blood clot or an abnormal position.
A nurse or phlebotomist (healthcare professional who draws blood) must be trained in the correct method of cleaning or flushing a port before it can be used to draw a blood sample.
summary
A port is a device implanted under the skin to allow access to a large vein. They are used when a person needs frequent blood draws or IV medications. They are also used to deliver chemotherapy drugs that are too dangerous to be given through small veins. Their main advantage is safety and they can stay in place for a long time.
A word from Verywell
Being diagnosed with cancer and needing chemotherapy can be scary and stressful. While the thought of a port can also be unsettling, it is essential to your safety and well-being during cancer treatment. Once the port site heals, you can resume normal daily activities and may not even know it’s there. In addition, a port can alleviate the worry of getting poked multiple times. After your treatment is complete, you and your oncologist can discuss the best time to have the port removed.
Can you shower with a port-a-cath?
Can I Bathe or Shower? The bandage must be kept dry until the incision is completely healed. This usually takes 5 to 7 days. You can not take a shower during this time.
How to Irrigate a Foley Catheter (with Pictures)
What is an implanted port?
An implanted port has the shape of a disk. It is placed (implanted) under the skin during surgery. The ports can be used for intravenous (intravenous) administration of medication, fluids, food, or for drawing blood samples.
The most common location for a port is on your upper chest just below your collarbone. It can also be inserted in your arm, leg, or abdomen. Ports come in many shapes and sizes. Your doctor will select the port and decide where to place it. He or she will look at your height and what your port is used for.
Your port can remain in place for as long as your doctor deems necessary. It is made of special materials, so it is safe for long-term use. When your port is not in use, a special liquid is fed to it once a month.
How is the port placed?
Your port will be inserted during a brief operation in the operating room. It is usually performed under local anesthesia. Local anesthesia numbs the part of the body being worked on. The surgeon will make a small incision in the area where the port will go. He or she will place the port just under your skin. A small flexible tube called a catheter is attached to the port. The tip of the catheter is inserted into the large vein that leads to your heart.
How does the port work?
Your port will look like a small, raised area under your skin. The center of the disc is raised. This is called the septum. Fluids are introduced into or withdrawn from the port using a special needle that is inserted into the septum. Most patients feel a slight prick as the needle enters their skin above the septum.
The catheter is connected to the septum. The catheter delivers the medication or fluids directly into the blood. Blood can also be taken through the catheter for laboratory tests. When the needle is removed from the septum, no fluid or blood can escape. The port can still be used on the day of installation.
maintenance of your port
If you stay in the hospital, a nurse will attend to your incision and the implanted port. First, strips of tape (i.e., Steri-Strips™) will be placed over your small incision. It is covered with a small bandage. The adhesive strips stay in place until the incision has healed. The incision should heal in about 5 to 7 days. Thereafter, you do not need to wear a bandage unless the port is used for continuous infusion. A bandage is used to keep the needle steady and protected during use.
If you go home after your port is inserted, your caregiver can arrange a home visit. If you do not need a home care nurse, you will receive instructions and specific training for your port. For the first 24 to 48 hours after surgery, the area around your incision will be tender and slightly red. You should call your doctor if this doesn’t improve. You should also call your doctor if you have severe pain, a fever of 100.5 F or more, bleeding, or swelling.
After the surgery, you will receive a medical alert information card from the manufacturer. This map contains information about your port. You should carry it in your wallet in case you require medical treatment from medical personnel who do not know your medical history. You may want to consider purchasing a MedicAlert® bracelet or necklace. It would give information about your port to the health care rescue workers.
How does the port affect my daily activities?
Do not engage in strenuous activities for the first few days after surgery. Make sure you understand and follow any special instructions your doctor or nurse may give you. After your incision has healed, you can return to your normal activities. Check with your doctor or nurse about specific activities, such as jogging, swimming, and tennis.
Can I bathe or shower?
The bandage must be kept dry until the incision has completely healed. This usually takes 5 to 7 days. Showering is not possible during this time. You can usually take a bath when the port is in your chest, but you must keep the bandage dry. You should ask your doctor or nurse for bathing instructions.
Are there some types of clothing I should avoid?
The clothes you can wear and may need to stay away from depend on the location of your port. For example, if your port is in your upper chest, you may need to stay away from some types of bra straps or suspenders. Ask your caregiver if you have a question about an item of clothing.
Who pays for the port?
You should check with your health insurance company. Most insurance policies pay for the port.
Will the port raise security alerts?
The port does not normally raise security alarms. If this is the case, you can show your medical alert information card.
How is the port removed?
The port is removed during the operation. The surgery will be similar to the surgery you had when it was put in place.
When to call your doctor
Once your incision has healed, call your doctor if you have:
redness
swelling
drainage
Fever
Pains
dizziness
You can also call your doctor or nurse if you have other problems with your port.
Revised February 2013
How painful is a chemo port?
3. Does it hurt? Not typically, but when it is accessed for chemo or a blood draw, the initial poke does sting a bit (similar to an IV poke in your arm). Over-the-counter or doctor-prescribed numbing creams can help ease the discomfort.
How to Irrigate a Foley Catheter (with Pictures)
1. What is a port and why should you have one? A port is a plastic disc (about the size of a US quarter or Canadian loonie) that is placed under your skin, usually above your chest or below your collarbone, and is used to deliver medication intravenously directly into a large vein and to lead into the heart . It can also be used to draw blood. When you are being treated, you will need to access your veins frequently. A port is used to avoid having your arm poked multiple times with needles and to protect small veins. It is removed after therapy, leaving a small scar. Although a port can be recommended, it is a decision you must make with your doctor. There are many factors to consider, including cost, type and schedule of treatment, and other existing medical conditions you may have. It can also be inserted in the upper arm, but for that you often have to put in an effort in Canada as that is not the standard position. Make sure you’re doing what you think is right and understand the risks and benefits of porting.
2. How long does it take to insert a port and what is the recovery like? It’s a short procedure and you can expect to stay in the hospital for a few hours. During this time you will be given a local anesthetic in the chest area. For the rest of the day, avoid wearing tight bras or carrying a handbag across your chest. You are encouraged to relax at home for the day (the perfect excuse to watch your favorite series on Netflix). You can eat and drink normally, but expect some pain. After a few days you can shower or bathe, but only after the bandage has been removed. The threads will dissolve over time and the Steri-Strips (white tape under the bandage) will fall off by themselves. Just watch for signs of infection and tell your doctor right away if you notice one: swelling
Pains
redness
fluid around the incision
shortness of breath
chest pain
Fever
dizziness
Swelling of the neck, face, or arm on the side where the port will be inserted. Removing the port is done in a similar way.
3. Does it hurt? Not usually, but when accessed for chemotherapy or a blood draw, the initial stitch will sting a little (much like an IV in your arm). Over-the-counter or doctor-prescribed numbing creams can help relieve discomfort.
4. How does it feel when not used for treatment? It can be uncomfortable. Carrying a seatbelt or handbag directly over the port area can irritate him, but luckily accessories can help – think small cushions between your port and the seatbelt or a seatbelt sleeve. (If you want to add a bit of personality to your pillow, Etsy carries some cute ones.)
How long can a port go without being flushed?
It is routine practice to flush ports every four to six weeks, according to the manufacturer’s recommendations, using salt solution followed heparin if needed. This study examines the effectiveness of port flushes at an alternative interval of 3 months, reducing the number of visits to the health-care provider.
How to Irrigate a Foley Catheter (with Pictures)
Your access to the NCBI website at www.ncbi.nlm.nih.gov has been suspended due to possible misuse/abuse of your website. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a script running away or learning how to make better use of e-utilities http://www.ncbi.nlm.nih.gov/books/NBK25497/ to work more efficiently so that your work this does not affect the ability of other researchers to also use our website. To restore access and understand how you can better interact with our site to avoid this in the future, ask your system administrator to contact [email protected].
Is a port a cath considered a central line?
An implanted port is a type of central line. A central line (also called a central venous catheter) is like an intravenous (IV) line. But it is much longer than a regular IV and goes all the way up to a vein near the heart or just inside the heart.
How to Irrigate a Foley Catheter (with Pictures)
A patient can receive medication, fluids, blood or food through a central line. It can also be used to draw blood.
An implanted port is a type of central access. A central line (also known as a central venous line) is like an intravenous (IV) line. But it’s much longer than a regular IV, reaching up to a vein near the heart or right inside the heart.
Healthcare providers insert a needle into the port to administer treatments or draw blood. This is easier and less painful than a typical needle stick. Applying a numbing cream or spray to the skin can relieve the discomfort.
Types of ports include Port-a-Caths and Medi-Ports.
When are implantable ports used instead of regular IV lines?
Physicians may use an implanted port (or other central line) instead of a regular IV line because:
It can stay in place longer (up to a year or even longer).
It makes blood collection easier.
Patients may receive large amounts of fluids or drugs (such as chemotherapy) that may not go through regular IVs.
Doctors may place an implantable port (or other central line) for someone who:
has a severe infection so they can be given antibiotics intravenously for a few weeks
has had cancer for a few weeks so they can get chemotherapy and blood work through the line
needs IV nutrition
will need many blood transfusions
How is an implanted port placed?
Before the port is placed, your child will be given medication to help them relax and not feel pain.
To place the port, a doctor will:
Clean and numb the skin where the port goes. Make two small incisions in the skin. Insert the catheter into a vein in the chest using ultrasound to determine where the line goes. Thread the line into a large vein near the heart or just into the heart. Check the placement of the line with an x-ray. Place a bandage (a type of bandage) over the area.
Are there risks for an implanted port?
There are some risks for all ports, but most don’t cause any problems. When problems arise, it is usually because the port becomes infected or has stopped working. Very rarely, a port can cause a blood clot. Doctors discuss the risks with families before placing the port.
When should I call the doctor?
Call your doctor if your child:
Redness or swelling where the port is
new or worse pain where the port is
Fluid or pus from the port area
a fever
How can parents help?
After the skin over the port has healed, the area does not need any special care. Children can go to school and engage in most regular activities. You can swim and bathe normally. Check with your healthcare team about:
what physical activities are okay for your child (most children need to avoid rough play and contact sports)
How often does the port need to be flushed by a nurse (usually about every 4 weeks)
Let your child’s teachers, school nurse, counselor and PE teacher know about the port. You can make sure your child avoids any activities that could harm them and support your child during treatment.
Ports: Access and Care
See some more details on the topic irrigation port a cath here:
Recommended irrigation volume for an intravenous port – NCBI
In our study, the eal irrigation volume was found to be 20 times the intra-luminal volume of the implanted port, including the injection …
Source: www.ncbi.nlm.nih.gov
Date Published: 3/11/2022
View: 4525
(PDF) Recommended irrigation volume for an intravenous port
Furthermore, the intraluminal volume differs due to the size of the injection chamber and implanted catheter length. Hence, the eal recommended irrigation …
Source: www.researchgate.net
Date Published: 12/8/2021
View: 2695
Current port maintenance strategies are insufficient: View b…
For this reason the recommendation for central venous catheter irrigation cannot not be applied universally in daily port maintenance.
Source: journals.lww.com
Date Published: 9/22/2021
View: 248
How to Irrigate a Foley Catheter (with Pictures) – wikiHow
First, detach the drainage bag and tubing from the actual catheter. Attach a 60cc catheter-tipped syringe (“Toomey syringe”) to the catheter and pull back to …
Source: www.wikihow.com
Date Published: 6/1/2021
View: 4575
Urinary catheter irrigation – Children’s Minnesota
Irrigation is a procedure to open a plugged urinary catheter. Normal saline (NS) is inserted into the catheter to remove the plug, so that the urine can …
Source: www.childrensmn.org
Date Published: 2/10/2021
View: 7000
Maintenir la perméabilité des cathéters veineux centraux …
Irrigation et héparinisation d’un cathéter AVSC (Port-A-Cath® ou chambre implantable) … Usagers porteurs d’un cathéter veineux central (CVC) visé par cette …
Source: cdn.ciusssnordmtl.ca
Date Published: 6/20/2022
View: 2697
Bladder Irrigation: Management of Haematuria
Prior to performing insertion of urinary catheter and/or bladder irrigation, the health professional … Swab T irrigation and catheter drainage ports with.
Source: aci.health.nsw.gov.au
Date Published: 3/7/2022
View: 9255
Same sized three-way indwelling urinary catheters from …
Results: Different catheter models of the same caliber have different internal irrigation port diameters, internal drainage port diameters and internal cuff …
Source: journals.sagepub.com
Date Published: 6/7/2021
View: 2631
WWW Error Blocked Diagnostic
access denied
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Current port maintenance strategies are insufficient: View b… : Medicine
1 Introduction
A functioning intravenous port is critical for oncology patients. It is not only used for safe vascular access, but also enables better mobility without an external bandage.[1] Three different factors, including structural design, implantation technique, and daily care practices, can affect the functional status of an implanted port. Scientists, clinical practitioners, and manufacturers have for decades sought solutions to keep implanted intravenous ports functional. From a design point of view, there are design differences between central venous catheter and intravenous port. The central venous catheter is an open system that connects the intravascular space with an extracorporeal connecting portion (Figures 1A-G, black circle). The intravenous port can be considered as a closed system as the catheter is attached to the injection chamber (Fig. 1G/H, white circle). This structure means that the flow pattern within the intravenous port is quite different from that of the central venous catheter. Flow within the port is vortex flow in the injection chamber, followed by laminar flow within the attached catheter (Fig. 2A), but flow within the central venous catheter is fully laminar flow (Fig. 2B). For this reason, the recommendation for central venous catheter flushing cannot be universally applied in daily port care.[2] In addition, the vortex flow within the injection chamber depends on the orientation of the non-drilling needle.[3] Optimal irrigation can only be achieved when the non-coring needle is inserted in a 180° orientation into the injection chamber at the mid-section of the silicone diaphragm.[3] To reduce possible residual blood components in an intravenous port, two major modifications have been proposed, including a valved catheter tip and a reorientation of the connecting tubing (Supplement 1, https://links.lww.com/MD/D326). In the former, a one-way valve is added to prevent backflow of blood into the catheter, which could be caused by a vacuum effect when withdrawing the non-coring needle.[4] In the latter, the connecting tube is reoriented to induce a full vortex in the injection chamber to facilitate effective lavage.[5] However, further research has shown that these structural modifications may not be sufficient to eliminate catheter occlusion[6,7] or a higher failure rate during deprivation of function testing.[8]
Figure 1: Difference between central venous catheter and intravenous port. A–C: Central venous catheter. D–F: Hickmen catheter for dialysis. G: Peripherally inserted central venous catheter (PICC). H–I: Intravenous ports. The difference from the catheters shown in Figures 5A-G was the injection chamber. (White circle) in place of the connector (Black circle) on one end of the catheter. Figure 2: Ideal flushing flow pattern of an intravenous port and a central venous catheter. A: Ideal flushing flow pattern of an intravenous port: vortex within the injection chamber followed by laminar flow within the attached catheter. (Black circle: needle shaft of the non-piercing needle. Blue egg: opening of the non-piercing needle. Yellow circle: opening of the injection chamber. Black arrow: flow direction. B: Central venous catheter ideal flushing flow pattern: laminar flow throughout the catheter C: flow pattern of the connector tubing of a non-coring needle D: A vortex was noted at the junction and a residual blood clot remained in the Y-junction.
From the point of view of the implantation technique, the vascular incision technique for intravenous port implantation is recommended by the guidelines due to the low complication rate. [9–11] The angle of the catheter nut should be obtuse to avoid catheter impingement [7] and a reasonable tip position should be 1 cm below the carina, right at the junction between the superior vena cava (SVC) and the right atrium (RA).[12,13] Subclavian puncture should be avoided to prevent iatrogenic pneumohemothorax and pinch-off syndrome.[14,15] Late catheter-related complications such as malfunction, infection, and migration have been reported however, they were found to be reduced after a standard algorithm was proposed.[16,17] The reported mechanical failure rate was 6.81%.[16] However, it has been found that catheter complications, including catheter infections and malfunctions, persist even though all implantations have been performed using a standard surgical procedure.[17] This observation suggests that current port maintenance practices may be inadequate.
From the point of view of daily care practice, 3 factors can influence the effectiveness of port care. First is the alignment of the non-piercing needle, which poses a difficulty for the nursing staff as the opening is invisible during the puncture and accurate alignment cannot be confirmed. (Fig. 3A-D) Second is the purge volume. According to guidelines[18] and manufacturer instructions[19-21], 10 mL of saline is recommended for flushing an implanted port, regardless of port size, catheter caliber, and intraluminal volume of the connecting tube. Our simulation showed that 20 times the intraluminal volume including port and connecting tubing would be required as the minimum flushing volume.[22] Third is the flow pattern within the connecting tube (Fig. 2C). Residual blood components in the Y-connector in the ex vivo simulation[22] have led to microscopic deposits in the ports (Fig. 2D). This indirect clinical evidence again points to an inadequacy of current port maintenance. The aim of this study is to identify the effectiveness of the current maintenance strategy and to analyze the correlation between complications and actual port presentations based on the analysis of intravenous ports deconstructed after patient removal.
Figure 3: Actual puncture of the implanted port. A: Actual puncture status of an implanted intravenous port. The puncture holes were distributed over the entire silicon membrane. The puncture hole with a silicone defect possibly caused by an oblique puncture. (white arrow). B. Oblique puncture in the peripheral area of the silicone membrane. C. Oblique puncture in the central area of the silicone diaphragm. D. Vertical puncture in the central area of the silicone diaphragm.
2. Materials and Methods
2.1 Patient selection
From March 2012 to December 2017, 434 implanted IV lines were removed from patients after completion of therapy or due to complications. We retrospectively reviewed medical records for clinical information on entry vessel type, type of IV line, function of the line, and reason for removal. All patients who had the port removed were included and the data collected were de-identified (anonymized) prior to further analysis. The requirement for informed consent was waived as all ports were removed under appropriate clinical scenarios and they were thoroughly inspected immediately after removal for medical record purposes. All study methods were performed in accordance with accepted guidelines.
2.2 Ethics
This study was approved by the Chang Gung Memorial Hospital Institutional Review Board under number IRB #101-4798A3 and funded by the Chang Gung Medical Foundation under grant numbers CMRPG3F0171 and CMRPG5G0131.
2.3 Intravenous port maintenance
The implanted intravenous ports were maintained by the following routine maintenance protocol: 10 mL normal saline flush once, followed by 10 mL heparin lock (50 U/mL) each time after chemotherapy injection, blood transfusion, drug injection, or blood collection. The lavage method was the pulsed technique commonly used in venous line lavage, which has been shown to provide superior lavage in ex vivo simulation.[23] Patients undergoing chemotherapy were followed up every 2 to 3 weeks to assess port function, and patients not undergoing chemotherapy were followed up every 3 months.
2.4 Definition of Complications
Catheter-related complications in this study included infection, migration, fracture, malfunction, and others. Infection was defined as patients with fever or chills and blood cultures from peripheral vessels and ports positive for bacteria or fungi. Migration was defined as a catheter tip that was no longer at the junction of the superior vena cava and the right atrium. A fracture was defined as a broken catheter integrity identified by smooth chest film or pocket swelling during lavage. Malfunction was defined as catheter occlusion during flushing. Other types of complications included pocket erosion and pocket hematoma.
2.5 Deconstruction of the removed intravenous port
After port removal, port function was checked with a 10 mL syringe of normal saline. Ten different brands of ports were collected and analyzed, with 4 brands dominating. These intravenous ports shared common design concepts, with each 1 being broken down into 3 major components including the catheter, locking nut, and port body (Supplement 1, https://links.lww.com/MD/D326). The port body could be further divided into connecting tube, injection membrane and injection chamber. We first examined the structural integrity of the removed intravenous ports and broken them down into the 3 main components as mentioned above. The actual representation (Figs. 4 and 5) of the removed ports after deconstruction was recorded photographically.
Figure 4: Maintenance related presentations. A. Lace blood clots (Tyco Fr. 6; Tyco Healthcare Group, CT, USA). B. Catheter clot (Bard Fr. 8; Bard Access Systems Inc., Utah, USA). C. Fibrin (Bard Fr. 8; Bard Access Systems Inc., Utah, USA). D. Injection chamber blood clot (White Star; Tyco Fr. 6; Tyco Healthcare Group, CT, USA). E. Injection chamber biofilm (Black Star; Bard Fr. 8; Bard Access Systems Inc., Utah, USA). Figure 5: Structure-related representations. A. Locknut impingement (white arrow): caused by insufficient pocketing (Bard Fr. 8; Bard Access Systems Inc., Utah, USA). B. Catheter fracture: Caused by pinch-off syndrome (Medcomp Fr.7; Medcomp Medical Component Inc., PA USA). C. Protruding pin fracture (Tyco Fr. 6; Tyco Healthcare Group, CT, USA). D. Compression Groove: Caused by shear force generated by protruding bolt of connector tube and lock nut (B’Braun Fr 6.5; B’Braun Medical, Boulogne Billancourt, France). E. Locknut Split: Can be caused by improper assembly or over-assembly of the catheter to the connector tubing, resulting in a flare at the bottom (Bard Fr. 8; Bard Access Systems Inc., Utah, USA). F. Diaphragm rupture (Bard X Port Fr. 6; Bard Access Systems Inc., Utah, USA).
2.6 Definition of current presentations
Apex clots were defined as blood clots identified at the catheter tip (Figure 4A). Catheter clots mean clots identified within the catheter at any location other than the tip opening (Figure 4B). Fibrin was a thin yellow biofilm deposited over the catheter wall with no apparent old blood clot (Figure 4C). A blood clot in the injection chamber was defined as a blood clot within the injection chamber (Figure 4D). Injection chamber biofilm refers to the yellow biofilm deposit inside the injection chamber (Fig. 4E). Locknut impingement was defined as the indentation of the catheter at the rim of the locknut (Fig. 5A). The catheter is compressed by the rigid locking nut as the surrounding soft tissue pushes it up when changing posture. The integrity of the ruptured catheter was defined as the integrity of the ruptured catheter (Figure 5B). Broken catheter at protruding pin was the situation where the catheter was broken at the fitting above the injection chamber connecting tube (Fig. 5C). The compression groove is the indentation caused by the shear force created by the protruding link tube bolt and lock nut (Fig. 5D). The lock nut gap is the gap between the bottom of the lock nut and the injection chamber (Figure 5E). It is caused by incorrect assembly, such as B. an over-assembly of the catheter on the connecting tube, which leads to a flare at the bottom. A membrane rupture meant that the silicone membrane was pushed up and removed from the injection chamber (Fig. 5F).
2.7 Statistics
All collected clinicopathological factors were first analyzed by univariate analysis. Categorical variables were compared using chi-square or Fisher’s exact tests. A P-value less than 0.05 was considered statistically significant. The reported confidence intervals (CI) were assumed with a 95% coverage probability. All analyzes were performed with SAS version 9 (SAS Institute, NC, USA). Based on the reason for removal, a multivariate analysis was performed to identify the correlation between actual presentation and reason for removal.
3. Results
From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or due to complications (Table 1). The mean age was 56.9 ± 11.88 years, with women predominating (298/434, 68.7%). Of the ports removed, 85.5% had an open catheter. The mean implantation time was 43.2 ± 25.68 months and most of the removed ports were implanted via the superior vena cava. All removed ports were subjected to a functional test prior to dismantling, which revealed a failure rate of 16.2%. The main reason for port removal was completion of treatment (346/434, 79.7%). A catheter tip clot was identified in 50.4% of the removed ports, while a residual catheter clot was found in 36.8%. Fibrin deposits within the catheter were found in 36.3% of the removed ports. Blood clots and biofilm in the injection chamber were found in 22.1% and 34.8%, respectively. In the subgroup analysis, more ports were implanted via the inferior vena cava (IVC) in patients where the port was removed due to infection (7.7%) or dysfunction (4.5%). After the implanted ports were removed, an ex vivo functional test was performed using a non-coring needle. Total occlusion rates in patients who underwent port removal for fracture and dysfunction were 71.4% and 63.5%, respectively (Supplement 2, https://links.lww.com/MD/D326).
The remote port presentations have been categorized as maintenance and structural and are listed in Table 2. A high percentage of apical clots were found in ports removed due to treatment completion (53.5%), fracture (50%), or malfunction (54.5%). Similarly, a high rate of catheter clots was noted in ports removed due to fracture (42.8%) and malfunction (50%). A higher rate of blood retention in the injection chamber was noted in patients presenting with fracture (50%), migration (40%), or dysfunction (54.5%). A higher percentage of biofilm in the injection chamber was identified in patients who had completed treatment (35.8%) or presented as a fracture (40%) or dysfunction (40.9%). Regarding structural presentations, a higher rate of locking nut impingement after port removal due to catheter fracture (42.9%) and dysfunction (36.4%) was observed. Catheter integrity was observed in 57.1% of ports removed due to fracture.
Table 2: Comparison of actual presentation and reasons for port removal.
We further analyzed the relationship between port appearance and reason for removal (Supplement 3, https://links.lww.com/MD/D326, Table 3). From the perspective of maintenance-related presentations, blood clot in the injection chamber was highly correlated with completion of chemotherapy (p<0.001) and dysfunction (p=0.005). Blood clot in the tip (P=0.043) was related to completion of chemotherapy, while fibrin in the catheter (P=0.015) was related to malfunction. From the perspective of structural presentations, broken catheter integrity correlated with completion of chemotherapy (p=0.007), fracture (p<0.001), and dysfunction (p=0.008). Compression groove was associated with completion of chemotherapy (p=0.03), while a broken catheter at the protruding pin was associated with fracture (p=0.04). The diaphragmatic hernia correlated with the completion of chemotherapy (P = 0.048) and dysfunction (P < 0.001). A longer implantation time was observed in patients who had the port removed because chemotherapy was completed (46.5 ± 22.62 months) and a fracture (64.9 ± 41.44 months). Patients who underwent port removal due to infection (13.6 ± 12.6 months) and migration (17.1 ± 15.91 months) had shorter implantation times (Supplement 4, https://links.lww.com /MD/D326). Table 3: Multivariate analysis of actual presentation vs. reason for removal. 4. Discussion Intravenous ports have been used for safe vascular access for decades.[24] The primary concern is to keep an implanted port functional throughout the treatment period. From the perspective of implantation technique, a standard algorithm for port implantation [12] has been proposed to avoid catheter-related complications shown in previous studies.[12,14,16,25] No procedure-related complications have been reported since the standardized algorithm was implemented in the clinical practice, but late complications such as malfunctions and infections are still reported.[12] Once intravenous ports are implanted, caregivers play a critical role in maintaining port integrity.[26] Milani et al. found that occlusion was highly correlated with frequency of irrigation, administration of chemotherapy, and blood sampling.[26] All of these factors are related to the maintenance protocol after use. However, the only recommendation in the nursing guidelines is 10 mL of saline to flush the implanted port, regardless of port size, catheter caliper, and intraluminal volume of the connecting tubing. This study was conducted to clarify the relationship between actual presentations and reasons for removal in order to identify potential shortcomings in current maintenance practices. In this study, we found that female patients had more fractures (85.7%) and dysfunction (81.8%) (Supplement 2, https://links.lww.com/MD/D326). This may be related to soft tissues repeatedly pushing the catheter up while lying down, resulting in a nick (Fig. 5A) and may further develop into a fracture. More infection was seen in patients who received their port via the inferior vena cava, consistent with results reported in the literature.[27,28] Patients who had their port removed due to a malfunction (63.6%) or a fracture (71.4%) had a higher risk of full occlusion (Supplement 2, https://links.lww.com/MD/D326). The former may be related to inadequate irrigation and the latter to broken catheter integrity. From the point of view of maintenance-related presentations, differences between the groups were identified for the different reasons for removal, with the exception of fibrin (Table 2). These differences may be related to maintenance irrigation efficiency. A higher rate of blood clot formation in the tip, catheter and injection chamber was noted in fracture and malfunction. This may be due to less flushing solution reaching the catheter because it seeps into the surrounding soft tissue, or because it is difficult to inject into the port. From a structural presentation perspective, greater locking nut impingement was noted in patients undergoing port removal for fracture (42.9%) and malfunction (36.4%). Locknut bounce is caused by insufficient pocketing. The initial presentation was lumen narrowing leading to malfunction and broken catheter integrity as a result of fatigue induced by concentrated loading forces. This finding was similar to our previous studies.[11,14] In addition, greater catheter integrity was also observed in patients with catheter fractures. (57.1%) In multivariate analysis, clot at the tip (p=0.043) and clot in the injection chamber (<0.001) were correlated with ports removed due to completion of chemotherapy. Theoretically, no maintenance-related representation should be found under good port maintenance. This result implies that blood components are not fully flushed under the current maintenance strategy. In addition, catheter fibrin (P=0.015) and injection blood clots (P=0.005) were associated with dysfunction; a finding implying that a larger retained blood component further leads to catheter malfunction. In addition, a longer implantation time was observed in patients in whom the port was removed due to the completion of chemotherapy (46.5 ± 22.62 months) and a fracture (64.9 ± 41.44 months). These results imply that removal of implanted ports can be considered after 5 years if no disease relapse is detected. Broken catheter integrity was noted in ports removed due to completion of chemotherapy, fracture, and malfunction (Table 3 and Appendix 4, https://links.lww.com/MD/D326). Two common fracture sites were identified, one between the locking nut and the proximal catheter and one on the catheter itself. The former was related to catheter impingement related to insufficient pocketing or soft tissue compression, and the latter related to pinch-off Syndrome. Both scenarios relate to point loading forces and are avoidable. The former could be avoided by adequate pocket formation and the latter prevented by avoiding subclavian venipuncture.[17] In addition, a broken catheter at the protruding pin was also noted in patients where the port was removed due to a fracture. This is related to the stress created by the locking nut being focused on the catheter at the point of attachment of the protruding bolt. This finding was identical in laboratory[29] and clinical observations.[14] The diaphragmatic hernia also correlated with the completion of chemotherapy and with dysfunction. The former refers to the number of punctures and material fatigue, the latter to the functional test. According to the literature review and the manufacturer's instructions, a 10 mL syringe is recommended for lavage because the maximum pressure generated is below the pressure for which the ports are designed.[30] Some caregivers may use a smaller syringe that can generate greater pressure that can then overcome an occluded catheter to regain port function, but this can also be the reason poorly functioning ports have been identified as having a diaphragmatic hernia. Based on the findings from deconstructed ports, the current maintenance recommendation is insufficient. In terms of ideal maintenance, several aspects should be considered, including preparation before flushing, flushing orientation, flushing method, flushing volume, catheter locking method, and frequency of maintenance. First, the nursing staff should confirm that there are no blood components in the connecting tube of the non-coring needle (Fig. 2C, D).[22] Second, the coreless needle should be inserted perpendicular to the diaphragm as far as possible while keeping the orifice opposite the outflow point of the injection chamber. The orientation should not be changed for any reason in order to keep the best irrigation as close as possible to the experimental model.[3] Third, the ports should be flushed continuously with normal saline rather than with a pulsatile technique as this creates an intermittent vortex flow that cannot provide effective flushing and leads to residual clots in the injection chamber (Fig. 2D). Fourth, the recommended minimum flush volume is 20 times the total intraluminal volume of the implanted ports [22]. Although there are differences between different manufacturers, the total intraluminal volume can be easily calculated using the following equation: 20 × (implanted catheter length [cm] × intraluminal volume per unit length [ml/cm] + volume of the injection chamber). In most clinical scenarios, the intravascular volume of the SVC port and the IVC port is 0.5 and 0.78 mL, respectively.[22] The recommended flush volume is therefore 10 mL for the SVC port and 20 mL for the IVC port.[22] However, there was no consensus regarding catheter closure method [31-33] and frequency of maintenance [34-37] and further investigation is warranted. There are some limitations to this study. First, it is a retrospective study with a moderate sample size. However, this is the first study to demonstrate and examine the actual presentation of implanted ports and clarify the link to the reason for port removal. Second, although ports manufactured by different manufacturers were included in this study, all ports share common components and are similar in size and can therefore be studied together. Despite these limitations, we not only clarified the actual representation of the implanted ports, but also proposed a definitive port maintenance strategy. 5. Conclusion Current port maintenance is inadequate for ideal port maintenance, with maintenance-related presentations including tip clots, catheter fibrin, and blood clots in the injection chamber identified. Based on our findings, we propose a recommendation for the maintenance strategy. Structural presentations including broken catheter integrity, broken catheter at the protruding pin, and diaphragmatic hernia have been observed in patients with longer implant durations. The implanted ports can be removed after 5 years if no disease recurrence has been detected. author contributions Conceptualization: Jui-Ying Fu, Yen Chu, Chia-Hui Cheng, Ching-Feng Wu, Ching Yang Wu. Data maintenance: Pin-Li Chou, Jui-Ying Fu, Chia-Hui Cheng, Ching-Feng Wu. Formal Analysis: Ching Yang Wu. Funding Acquisition: Po-Jen Ko, Yun-Hen Liu, Ching Yang Wu. Investigation: Yen Chu, Chia-Hui Cheng, Yun-Hen Liu. Methodology: Pin-Li Chou, Jui-Ying Fu, Yen Chu, Ching-Feng Wu, Yun-Hen Liu, Ching Yang Wu. Project leaders: Po-Jen Ko, Yun-Hen Liu, Ching Yang Wu. Sources: Po-Jen Ko, Ching Yang Wu. Software: Po-Jen Ko. Supervision: Yun-Hen Liu, Ching Yang Wu. Confirmation: Ching Yang Wu. Writing - Original draft: Pin-Li Chou. Writing - Review & Editing: Ching Yang Wu. correction The second grant number in the Ethics section was incorrectly displayed as CMRP5G0131 and has been corrected to CMRPG5G0131.
How to Irrigate a Foley Catheter (with Pictures)
This article was co-authored by Robert Dhir, MD. dr Robert Dhir is a board-certified urologist, urological surgeon and founder of HTX Urology in Houston, Texas. With over 10 years of experience, Dr. Dhir minimally invasive treatments for enlarged prostate (UroLift), kidney stone disease, surgical treatment of urological cancers and men’s health (erectile dysfunction, low testosterone and infertility). His practice has been named a center of excellence for the UroLift procedure and is a pioneer in non-surgical procedures for ED with its patented wave therapy. He received his bachelor’s and medical degrees from Georgetown University and received honors in pre-medical studies, urology, orthopedics and ophthalmology. dr Dhir served as an Associate Physician during his urological surgical residency at the University of Texas at Houston / MD Anderson Cancer Center in addition to completing his internship in general surgery. dr Dhir was voted Top Physician in Urology for 2018-2019, one of the top three rated urologists for Houston, Texas in 2019 and 2020, and Texas Monthly included him in their 2019 and 2020 Texas Super Doctors Rising Stars list. This article has been viewed 420,018 times.
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