From the Guidelines
The recommended method for inserting a port-a-cath involves using ultrasound-guided percutaneous access to the internal jugular or subclavian vein under sterile conditions, followed by fluoroscopic guidance to position the catheter tip at the cavoatrial junction, as this approach minimizes complications and ensures optimal catheter tip positioning.
Key Considerations for Port-a-Cath Insertion
- The internal jugular approach is often preferred over subclavian access due to lower risks of pneumothorax and catheter pinch-off syndrome 1.
- Fluoroscopic guidance ensures optimal catheter tip positioning at the cavoatrial junction to prevent vessel erosion, thrombosis, and maintain proper function 1.
- Correct orientation is confirmed through real-time fluoroscopy and a post-procedure chest X-ray to verify catheter tip placement and rule out complications like pneumothorax.
- The port should be immediately tested by aspirating blood and flushing with heparinized saline (typically 5-10 mL of saline with 100 units/mL of heparin) 1.
Preventing Complications
- Appropriate catheter stabilization plays a major role in reducing the incidence of local complications at the exit site and the risk of dislocations 1.
- The tip of a central venous catheter should be positioned in the lower third of the superior vena cava, or at the atrio-caval junction, or in the upper portion of the right atrium to prevent tip migration and secondary malposition 1.
- Avoiding placement of silicone catheters via the blind infraclavicular venepuncture of the subclavian vein can prevent the 'pinch-off' syndrome 1.
Best Practices
- Insertion of an implantable venous access device should be carried out under strict sterile conditions, in the operating room, and under local anesthesia, with or without sedation 1.
- Chlorhexidine solutions with alcohol should be used for skin preparation 1.
- Antimicrobial prophylaxis to prevent catheter colonization is not recommended 1.
From the Research
Port-A-Cath Insertion Methods
To assure a Port-A-Cath is facing the right way, several methods can be employed during its insertion. These methods aim to confirm the correct orientation and placement of the catheter. The recommended methods include:
- Using ultrasound guidance for the placement of the Port-A-Cath through the right internal jugular vein, as demonstrated in a study by 2.
- Employing percutaneous puncture without guidance, where the catheter length is precalculated for each patient, and postoperative chest radiography is used to check the catheter position, as shown in a study by 3.
- Utilizing a modified method that avoids the use of intraoperative fluoroscopy or other localizing devices, which can offer benefits such as reduced surgical time and avoidance of X-ray exposure, as discussed in a study by 4.
Confirmation of Correct Orientation
Confirmation of the correct orientation of the Port-A-Cath can be achieved through various means, including:
- Postoperative chest radiography to check the catheter position, as mentioned in studies by 3 and 5.
- Use of fluoroscopy during the procedure to guide catheter placement, as described in a study by 6.
- Combined ultrasound and fluoroscopy guidance for port catheter implantation, which has been shown to have a high success rate and low complication rate, as demonstrated in a study by 6.
Key Considerations
When inserting a Port-A-Cath, key considerations include:
- The choice of insertion method, which can impact the risk of complications and the accuracy of catheter placement.
- The use of imaging guidance, such as ultrasound or fluoroscopy, to confirm the correct orientation and placement of the catheter.
- The importance of postoperative monitoring to detect any potential complications, such as pneumothorax or catheter malposition, as discussed in studies by 2, 3, and 5.