PROCEDURE:Â
The patient was placed supine on the angiography table and a scout radiograph of the chest was obtained. The right chest/neck was prepped and draped in sterile fashion. The right groin was also prepped and draped in sterile fashion.
The patient’s right sided chest wall port was accessed and aspiration attempted. Contrast was injected, DSA imaged obtained. A fibrin sheath noted.
The right common femoral vein was identified with ultrasound. The overlying skin and subcutaneous tissues were infiltrated with 2% Lidocaine without epinephrine. Under ultrasound guidance, the right common femoral vein was successfully cannulated using a micropuncture needle. An 0.018″ wire was advanced through the needle into the vein. The needle was exchanged for a 5-F sheath. The inner obturator removed and a 0.035″ Bentson wire advanced into the IVC. The sheath removed and an 8 French long sheath advanced over the wire. The wire and inner obturator removed and an En Snare tulip snare advanced to the port catheter tip. The catheter was stripped and contrast was again injected into the port demonstrated resolution of the fibrin sheath. Blood was able to be easily aspirated from the port. At this time, the right groin sheath and catheter were removed and hemostasis achieved with pressure. Sterile dressing was applied. The port access was removed and sterile dressing applied.
The procedure was well tolerated, and the patient was discharged from the angiography suite in satisfactory condition.
FINDINGS:Â
- Scout radiograph demonstrates []
- Mediport evaluation demonstrated a fibrin sheath on the catheter tip. Uneventful catheter stripping with good port function after procedure.
IMPRESSION:
1.Successful port catheter stripping with good functioning of port after procedure. Ready for use now.
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 in the chest, that provides easy access to veins. It's commonly used for patients who require frequent intravenous treatments, such as chemotherapy or nutrition. The port reduces the need for repeated needle sticks and provides a convenient entry point for IV medications or blood draws.
What does a port stripping technique involve?
Port stripping is a procedure used to clear obstructions in a portacath. During the process, the patient is positioned on an angiography table, and the port is accessed under sterile conditions. A fibrin sheath, a protein build-up that can block the catheter, is removed using a snare device. This restores the port's functionality, allowing for effective medication delivery and blood withdrawal.
How is a fibrin sheath detected in a portacath?
A fibrin sheath around a portacath is typically detected through imaging techniques, such as digital subtraction angiography (DSA). Contrast dye is injected into the port, and images are taken to visualize any blockages. The presence of a fibrin sheath can impede the port's operation, necessitating a stripping procedure to restore normal function.
What are the risks associated with port stripping?
Port stripping is generally a safe procedure, but like any medical intervention, it carries some risks. These may include infection, bleeding, or damage to the portacath or surrounding vessels. However, with proper sterile techniques and skilled practitioners, complications are rare. The benefits often outweigh the risks when restoring the port's functionality.
How should a patient prepare for a port stripping procedure?
Preparation for a port stripping procedure typically involves fasting for a few hours prior, as instructed by the healthcare provider. Patients should inform their doctor about any medications they are taking and any allergies, especially to contrast dye. The procedure is usually done on an outpatient basis, meaning patients can go home the same day.
What is the recovery process like after a port stripping procedure?
Recovery from a port stripping procedure is usually quick. Patients may experience some discomfort or bruising at the access sites, which can be managed with over-the-counter pain medication. It's important to keep the dressing clean and dry and to follow any specific aftercare instructions provided by the healthcare team. Patients can typically resume normal activities shortly after the procedure.
Why might a portacath need to be stripped?
A portacath may need to be stripped if it becomes blocked by a fibrin sheath. This sheath can form when proteins accumulate around the catheter tip, hindering fluid flow. Stripping the port removes the obstruction, ensuring that medications and nutrients can be delivered effectively and blood samples can be drawn without complications.
What imaging techniques are used during a port stripping procedure?
During a port stripping procedure, imaging techniques like digital subtraction angiography (DSA) are commonly used. This involves injecting contrast dye into the port to visualize the catheter and detect any obstructions like a fibrin sheath. Ultrasound may also be used to guide the cannulation of veins, ensuring accuracy and minimizing risks.