Procedure: Right internal jugular double-lumen chest port placement with imaging
Date:
Indication:
Access site: Right internal jugular with ultrasound
Operator: Drs.
Medications: 1 gram IV Ancef, mg IV Versed and mcg IV fentanyl
Fluoro time: minutes
Device: 6.7 French double-lumen Deltec power port
Complications: None immediate
Technique:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained. A timeout was performed.
The patient was assessed for conscious sedation and found to be an acceptable candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure
The right neck and chest wall region was prepped and draped in sterile fashion. Using local anesthetic and ultrasound guidance, the right internal jugular vein was punctured with a 21 gauge needle. A PACS image was stored. A 0.018″ wire was passed centrally and the needle exchanged for a 5 French transitional dilator. The smaller wire was exchanged for a 0.035″ wire. A peel-away sheath was placed at the venotomy.
The soft tissues caudal and lateral to the sheath entry site were anesthetized with lidocaine with epinephrine. A #15 blade was used to incise the skin. Blunt and sharp dissection were used to create a subcutaneous pocket. The pocket was irrigated with 50 cc antibiotic solution.
A tunneling tool was brought from the pocket to the venotomy. The catheter was brought through the tunnel. During suspended respiration, the catheter was advanced through the peel-away and positioned centrally using fluoroscopy. The peel-away sheath was removed and hemostasis achieved with manual compression. The catheter was flushed, cut to length and attached to the port reservoir. The reservoir was aspirated, flushed, and heparinized per protocol. It was sutured/placed into the pocket using a single 3-0 Ethilon suture.
The pocket was closed using absorbable Vicryl suture and Dermabond. The venotomy was closed with Dermabond. Steri-Strips and a sterile dressing were applied. The procedure was well tolerated, and the patient discharged from the angiography suite in satisfactory condition.
Findings:
The right internal jugular vein is ultrasonographically patent and compresses. Needle entry was stored to PACS.
The port catheter has a smooth course with the tip terminating in the right atrium.
additional findings on images.
Impression:
Uneventful image guided placement of right internal jugular low profile chest wall port catheter as described.
Frequently Asked Questions
What is a double-lumen chest port and why is it used?
A double-lumen chest port is a medical device implanted under the skin, typically in the chest area, that provides long-term venous access. It features two separate channels (lumens) allowing for simultaneous administration of different medications or fluids. This is particularly useful for patients undergoing chemotherapy, long-term antibiotic therapy, or frequent blood transfusions.
How is a double-lumen chest port placed?
The procedure involves using ultrasound and fluoroscopy for guidance. After sterilizing the area, the right internal jugular vein is accessed using a needle and guide wires. A subcutaneous pocket is created to house the port. The catheter is tunneled from the pocket to the vein, and its position is confirmed with imaging. The system is flushed, secured, and the incision closed with sutures and sterile dressings.
What are the risks of double-lumen chest port placement?
While generally safe, the procedure carries risks like any medical intervention. Potential complications include infection, bleeding, pneumothorax (collapsed lung), or catheter misplacement. These risks are minimized through sterile techniques and imaging guidance. Patients are monitored closely during and after the procedure to ensure safety.
What preparations are needed before a chest port placement?
Before the procedure, patients are generally advised to avoid eating or drinking for a certain period. A detailed medical history is taken, and informed consent is obtained. Pre-procedure imaging and lab tests may be conducted. Medications like blood thinners may need to be paused, and the procedure plan is discussed with the patient.
How is the chest port cared for after placement?
After placement, the port site should be kept clean and dry. Follow your healthcare provider's instructions for port care, which may include flushing the port regularly to prevent clots. Patients should watch for signs of infection, such as redness, swelling, or fever, and report them immediately. Routine check-ups will ensure the port functions properly.
What does 'fluoroscopy' mean in the context of chest port placement?
Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor. During chest port placement, it helps the doctor visualize the catheter's path and ensure it is accurately positioned within the vein. This real-time imaging enhances precision and reduces the risk of complications during the procedure.
How long does a double-lumen chest port last?
The longevity of a double-lumen chest port can vary but typically lasts several months to a few years. It depends on the patient’s treatment plan, the port's condition, and any complications that may arise. Regular maintenance and monitoring help extend the port's usability and ensure it functions properly.