Installation of ports for chemotherapy

A port system is a small device that is implanted under the skin to provide quick, easy, and painless access to central blood flow. The installation of the subcutaneous port system, instead of regular placement of peripheral venous catheters, has long been the "gold standard" for chemotherapy and has important benefits for patients and their families.

Advantages of the subcutaneous port system:

drugs are administered quickly and painlessly;
during injections the patient does not feel unpleasant sensations and fear of an injection;
lack of discomfort in the daily life of the patient;
vessels remain intact and undamaged, the percentage of possible complications is reduced and the recovery period is reduced;
possibility of repeated administration of drugs, irritating action;
the ability to conduct regular blood draws for laboratory tests;
possibility of long use (from 3 to 5 years) without reinstallation;
invisible under the skin during use, and after removal, there is only a small scar - about 2 cm.

Convenience and ease of use of ports during injections is probably their key advantage, as well as the ability to use these systems during surgery, which is important for the treatment of cancer patients.

What is a port for chemotherapy?

The infusion port consists of two parts. The first part is a subcutaneous titanium tank in the form of a thick coin, about 4 cm in diameter and about 1 cm thick, internally coated with a bioinert polymer. At the top of the tank is a membrane covered with multilayer silicone, through which due to the puncture of a special needle (Huber's needle) is the introduction of drugs. The second is a flexible catheter in the form of a thin tube, one end of which is implanted in the jugular vein (rarely, in an artery), and the other is attached to the reservoir.

How is the port implanted?

The port for chemotherapy is implanted during a small surgical operation, which is completely painless and is performed under intravenous or local anesthesia in aseptic conditions of the operating room under radiological control. The location and method of location of the port are set depending on the general condition of the patient and the proposed type of treatment. Usually, the port is implanted in the subclavian region. To do this, the patient's skin is treated with a disinfectant solution at the site where the port will be implanted, then the surgeon inserts a catheter into the superior vena cava, through the subclavian or internal jugular vein, after which a small incision is made and the port system is installed. The duration of the procedure is about 30-45 minutes.

Feelings after the procedure:

The patient may experience some discomfort at the incisions and in the area where the port passes under the skin. Usually, the pain subsides within 24-48 hours. In most cases, patients do not need to take prescription painkillers.

The process of introducing chemotherapeutics through the port system.

Before the procedure, the nurse examines the skin around the port for inflammation (swelling, redness, rash, pain on palpation) and the exact location of the silicone membrane. Next, the nurse fixes the port between the index and thumbs of the left hand. With the right hand, after treating the skin in the port area with a disinfectant solution, a needle is inserted vertically through the skin into the silicone membrane until it stops in the rear wall of the port chamber. After installing the Huber needle, the patency of the catheter is checked. To do this, the nurse pulls the syringe plunger to check for the backflow of blood. If there is no reverse blood flow, then 20 ml of saline is gradually introduced. In cases where there is no swelling around the catheter, the introduction is painless, and all 20 ml of saline is injected into the catheter, the port patency is established, it can be used as usual. Huber's needle is fixed with a sterile fixation bandage. At long infusions, the bandage is replaced. The drug is administered under the constant supervision of a nurse. With a properly installed port system, the administration of drugs should be painless. Otherwise, you need to tell the nurse, she will definitely stop the procedure and call a doctor. After completion of the drug infusion, the port system is flushed with saline and then heparin solution ("heparin shutter") to avoid thrombosis in the catheter.

Contraindications to the implantation of permanent access systems (ports):

patients with uncontrolled disorders of the blood coagulation system;
acute thrombosis of the main veins;
venous obstruction as a result of the previous thrombosis;
a relative contraindication can be considered an extremely serious condition of the patient, multiple organ failure, in which chemotherapy is impossible;
mediastinal tumors;
known allergic reactions to port material;
inflammatory processes in the area of the proposed implantation.

Can the port cause discomfort and does it need constant care?

Infusion ports are well protected from the environment, being securely hidden under the skin. Externally, the port is almost invisible, except for thin people, felt only on palpation. There are no age criteria for port installation, intravenous injection systems can be installed even in infants.

Home care is not required. After implantation of the port, the patient can continue the same rhythm of life as before the procedure. There are absolutely no contraindications for sports, hygienic procedures, etc. Unlike traditional catheters, the port is installed under the skin, does not cause skin inflammation or discomfort.

Bibliography

Лучевая диагностика, лучевая терапия. Полностью имплантируемые инфузионные системы центрального венозного доступа (порты) / А. Г. Югринов, И. Климнюк, Е. М. Новак [идр.] // Клиническая онкология.- К., 2011.-No 2.
Николаев А. В. Пункция икатетеризация подключичной вены по методике Сельдингера / А. В. Николаев // Топографическая анатомия и оперативная хирургия.- М., 2007.-С. 14-24.
Центральные венозные порты - инфузионная терапия в амбулаторных условиях / М. Ю. Шерстнев [идр.] // СТАЦИОНАРОЗАМЕЩАЮЩИЕ технологии. Амбулаторная хирургия.- 2013-No 1.-С.3-6.
Центральные венозные порты - продолженная инфузионная терапия / М. Ю. Шерстнев [и др.] // Клиническая больница.-2013-No 4.- С.60-63.
RowalskiC. M. Migration of central venous catheters: implicationsforinitial catheter timpositoniry /C.M.Rowalski, 1. А. Кaufman, S. M. Rivitz // I. Vasc. Interv. Radiolology. - 1997. -No 8.-Р. 443-447.
Cancer.Net. Catheters and Ports in Cancer Treatment. Approved by the Cancer.Net Editorial Board, 12/2020.
Tubes, Lines, Ports, and Catheters Used in Cancer Treatment. Published online, March 27, 2020.