Patient Name:   ,          Â
DOB:Â Â Â Â SEX:Â Â Â Â
Ordering Physician:   ,   Â
PROCEDURE:Â Â Â Arm port / Portacath placement with image guidanceÂ
INDICATION:Â Â Â Â
DATE:Â Â Â Â
ACCESS SITE:Â ______Â Â vein with ultrasound
OPERATORS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: Ancef 1 gram IV, Versed   mg IV, Fentanyl   mcg IV
CONTRAST:Â Â Â Â
FLUORO TIME: Â Â minutesÂ
CATHETER: Single lumen arm port
COMPLICATIONS: None immediate
PROCEDURE:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. Informed consent was obtained.
The Right/Left arm was prepped and draped in sterile fashion. Ultrasonographic evaluation was carried out. An appropriate vein was identified. Under local anesthetic, the   vein was punctured with 21-gauge needle. Vein patency and needle entry were documented and stored to PACS. A 0.018″ wire was advanced centrally. A 6 French sidearm sheath was placed at the venotomy.
The soft tissues adjacent to the sheath entry site were anesthetized with lidocaine with epinephrine. A #15 blade was used to incise the skin. Blunt dissection was used to create a subcutaneous pocket. The pocket was irrigated with antibiotic solution.
The port catheter was preloaded with a Glidewire, advanced through the sheath and positioned centrally using fluoroscopy. The sheath and wire were removed and the catheter flushed. The port catheter was cut to length and attached to the port reservoir. The reservoir was aspirated, flushed and heparinized to assess for leak. The reservoir was sutured into the pocket with Ethilon.
The pocket was closed in 2 layers using 3-0 and 4-0 absorbable Vicryl suture. Dermabond and Steri-strips were applied. A sterile dressing was applied.
The procedure was well-tolerated, and patient was discharged in satisfactory condition.
FINDINGS:Â
- Â (Basillic/Brachial) vein is ultrasonographically patent and compresses. Needle entry was stored to PACS.
- The port catheter has its tip in the proximal right atrium.
IMPRESSION: Uneventful image guided placement of a Right/Left arm port as described above.
Frequently Asked Questions
What is a Portacath and why is it used?
A Portacath, or port, is a small medical device implanted under the skin, typically used for patients who require frequent or long-term intravenous therapy. It facilitates easy access to veins for treatments like chemotherapy, antibiotics, or nutrient infusions. The device consists of a reservoir connected to a catheter that leads to a large vein, making it easier and less painful for patients to receive treatments without repeated needle sticks.
How is a Portacath placed in the arm?
Portacath placement in the arm involves several steps performed under sterile conditions. An appropriate vein is chosen using ultrasound guidance. After local anesthetic is administered, a needle is used to puncture the vein, and a catheter is inserted. A subcutaneous pocket is created to house the port reservoir, which is connected to the catheter. The setup is secured, flushed, and sutured in place, and the incision is closed with sutures and a dressing.
What are the risks of Portacath placement?
While Portacath placement is generally safe, there are potential risks, including infection, bleeding, and damage to nearby structures or veins. Rarely, complications such as catheter malfunction or port dislodgement can occur. Patients are informed of these risks before the procedure, and preventative measures are taken to minimize them, such as performing the procedure under sterile conditions and using imaging guidance.
How long does a Portacath last once implanted?
A Portacath can last for several years if properly maintained and cared for. Regular flushing and monitoring by healthcare professionals are essential to prevent blockages or infections. The port remains in place as long as it is needed for treatment and can be removed when no longer required.
What should patients expect after Portacath placement?
After Portacath placement, patients may experience mild pain or discomfort at the incision site, which typically resolves within a few days. The area should be kept clean and dry. Patients will receive instructions on how to care for the port and signs of potential complications to watch for, such as redness, swelling, or fever. Follow-up appointments will ensure the port's function and address any concerns.
What role does ultrasound play in Portacath placement?
Ultrasound is crucial in Portacath placement as it helps identify the best vein for catheter insertion. It provides real-time images, allowing the physician to accurately puncture the vein and place the catheter with minimal risk of complications. Ultrasound guidance improves the safety and success rate of the procedure by ensuring proper placement.
Can a Portacath be used for blood draws?
Yes, a Portacath can be used for drawing blood in addition to administering medications. This reduces the need for frequent needle sticks in the arm, making it more comfortable for patients who require regular blood tests. However, it should only be accessed by trained healthcare professionals to prevent complications.