Procedure: Chest port contrast evaluation with thrombolytic infusion
Indication: pt with nonfunctional surgically placed chest port
Operators: Drs.Â
Port site:Â right chestÂ
Contrast: 10 cc nonionic
Medications: 4 mg TPA in 100 mL normal saline infused over 2 hours
Complications: None immediate
Technique: The risks, benefits, and alternatives to the procedure were explained to the patient. The specific risk of remote bleeding was discussed and accepted. The patient denies contraindications to thrombolytic therapy.
The existing right chest port and surrounding soft tissues were prepped and draped in sterile fashion. Access was achieved with a Huber needle. Fluoroscopy was utilized to confirm appropriate location in 2 orthogonal planes.
Contrast was then injected with imaging over the port reservoir and throughout the course of the catheter. A digital subtraction venogram was performed over the tip centrally.
The catheter was flushed and the patient was transferred to the holding area. There, a 4 mg, 2 hour thrombolytic infusion was carried out.
After after the infusion was complete, catheter function was re-tested. There was prompt return of blood, indicating full restoration of function. The catheter was flushed and heparinized. The port was de-accessed and dressed. The patient was discharged in satisfactory condition.
Findings:
- The port reservoir is intact. Â
- There is no evidence for contrast extravasation or early pinch off.
- [] fibrin sleeve is present at the catheter tip.
- The port could not be aspirated.
- After 4 mg t-PA infusion, the port was easily aspirated.
Impression:Â
[] chest port dysfunction secondary to fibrin sheath.
The port function was fully restored with the thrombolytic infusion.
The attending radiologist,  , was present for the procedure and interpreted the images.
Frequently Asked Questions
What is a chest port and why might it become nonfunctional?
A chest port is a small medical device implanted under the skin in the chest to allow easy access to veins for medication delivery or blood draws. It may become nonfunctional due to blood clots, known as fibrin sheaths, that block the catheter tip, or due to mechanical issues like kinking or dislodgement.
How is a thrombolytic infusion used to restore chest port function?
A thrombolytic infusion involves administering medication, such as tissue plasminogen activator (tPA), that dissolves blood clots. In the procedure, a small dose is infused over a couple of hours through the port to clear any blockages, such as a fibrin sheath, thus restoring proper function.
What are the risks associated with thrombolytic therapy for chest ports?
The main risk of thrombolytic therapy is bleeding, as the medication can reduce the blood's ability to clot. Other potential risks include allergic reactions or complications from the infusion process. Patients are carefully evaluated to ensure they have no contraindications before receiving the therapy.
What is a fibrin sheath and how does it affect chest port function?
A fibrin sheath is a layer of fibrous tissue that can form around the catheter tip of a chest port. It can cause blockages that prevent blood from being drawn back through the port, rendering it nonfunctional. Thrombolytic infusion is often used to dissolve the fibrin sheath and restore function.
Why is fluoroscopy used during a chest port contrast evaluation?
Fluoroscopy is an imaging technique that provides real-time moving X-rays. It's used during a chest port contrast evaluation to ensure the correct placement of the port and catheter, to check for any obstructions or leaks, and to guide the procedure safely and effectively.
What does it mean when a chest port cannot be aspirated?
When a chest port cannot be aspirated, it means that blood cannot be drawn back through the port. This usually indicates a blockage, like a fibrin sheath at the catheter tip, which can prevent the port from functioning properly. Thrombolytic therapy may be used to resolve this issue.
What is the role of digital subtraction venography in this procedure?
Digital subtraction venography is an advanced imaging technique used to visualize veins by subtracting pre-contrast images from post-contrast images. In this procedure, it helps assess the central veins and the catheter tip for any blockages or other issues that might affect port function.
How is patient safety ensured during a thrombolytic infusion for a chest port?
Patient safety is ensured through thorough pre-procedure evaluation, sterile technique, careful monitoring during the infusion, and post-procedure assessment. Risks and benefits are discussed with the patient, and the procedure is performed by skilled professionals with experience in managing potential complications.