Dialysis Access Port in the Upper Right Chest Wall
The access port placed in the upper right chest wall for dialysis is called a "port catheter system" or "dialysis port catheter system." 1
What is a Port Catheter System?
A port catheter system is a subcutaneous device for hemodialysis access that is cannulated with needles 1. The device contains a ball-valve system that is connected to one or more central venous catheters (CVCs) 1.
Key Characteristics:
- Location: The catheter tubing is connected to a subcutaneously placed device in the chest wall 1
- Access method: The catheter lumen is accessed percutaneously using a buttonhole technique 1
- Mechanism: Contains a pinch valve mechanism that requires special cannulation needles to open the valves accessing the circulation 1
- Preferred insertion site: Right internal jugular vein, with the catheter tip positioned at the caval-atrial junction or right atrium 1, 2
Clinical Use
Port catheter systems may be used as:
- A bridge access while an arteriovenous fistula matures 1
- A permanent access for patients who have exhausted other vascular access options 1
The right internal jugular vein is the preferred insertion site because it offers the most direct route to the right atrium and is associated with lower complication rates compared to other sites 1, 2.
Important Distinction from Other Catheters:
Port catheter systems are distinct from tunneled cuffed catheters (TCCs), which have external components. Port systems are totally subcutaneous, eliminating the external appliance that characterizes standard dialysis catheters 2.