Procedure: Power injectable chest port placement with imaging
Date: 5/16/2022
Indication:Â Â Â Â
Access site:Â Right internal jugular with ultrasound
Operator: Â John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â Â Â Â
Medications: 1 gram IV Ancef,   mg IV Versed and   mcg IV fentanyl
Fluoro time:Â Â Â minutes
Device:Â BARD 6.6F low profile chest 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 procedureÂ
The right neck and chest wall region was prepped and draped in sterile fashion. Using local anesthetic and ultrasound guidance, the   vein was punctured with a 21 gauge needle. A PACS image was stored. A 0.018″ wire was passed centrally. Â
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 flushed, attached to the port reservoir and brought through the tunnel. The needle exchanged for a 5 French transitional dilator. The smaller wire was exchanged for a 0.035″ wire. A 7 French peel-away sheath was placed at the venotomy. The catheter was cut to length to reach mid RA . 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 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 3-0 Vicryl and 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 ____ 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.Â
[Multiple Pacer wires are noted over the chest ]
Â
Impression:Â
Uneventful image guided placement of right internal jugular low profile chest wall port catheter as described.
Frequently Asked Questions
What is a power injectable chest port?
A power injectable chest port is a small medical device implanted under the skin, typically in the chest, to provide easy access to a vein. It is used for delivering medications, fluids, or nutrients directly into the bloodstream. The 'power injectable' feature allows for high-pressure injections, such as contrast dye for imaging tests.
How is a power injectable chest port placed?
The placement involves a minor surgical procedure where the port is implanted under the skin, usually in the chest. A catheter from the port is threaded into a large vein, often the internal jugular vein, guided by imaging. The procedure is performed under local anesthesia and sedation, and the site is closed with sutures and adhesive.
What are the benefits of using a chest port?
Chest ports provide a more comfortable and efficient means for frequent or long-term intravenous therapy. They reduce the need for repeated needle sticks, lower the risk of vein irritation, and allow for faster administration of medications, including high-pressure injections.
Are there any risks associated with chest port placement?
Like any medical procedure, chest port placement carries some risks, including infection, bleeding, or an allergic reaction to medications used during the procedure. However, complications are generally rare, especially when performed by experienced medical professionals.
How should I care for my chest port after placement?
Post-procedure care involves keeping the area clean and dry, monitoring for signs of infection such as redness or swelling, and following your healthcare provider's instructions for routine flushes to maintain patency. Avoid heavy lifting and strenuous activities until the incision site has healed.
What is the role of imaging in chest port placement?
Imaging, such as ultrasound and fluoroscopy, is crucial in chest port placement to ensure accurate and safe insertion of the catheter into the vein. It helps guide the procedure, confirm correct positioning, and avoid complications by providing real-time visual feedback.
Can a chest port be used for CT scans or MRIs?
Yes, power injectable chest ports are specifically designed to withstand the high pressure of contrast injections used in CT scans. However, you should always inform the radiology team about your port before undergoing any imaging tests. For MRIs, ensure the port is MRI-compatible.
How long does a chest port last?
A chest port can remain in place for months to years, depending on the patient's medical needs and the condition of the port. Regular maintenance and monitoring by healthcare professionals are essential to ensure its functionality and prevent complications.
What is the recovery time after chest port placement?
Recovery time is generally short, with most patients resuming normal activities within a few days. However, it's important to follow specific aftercare instructions from your healthcare provider, such as avoiding heavy lifting, to ensure proper healing of the incision site.