The permanent central venous catheter systemPort-a-Cathis a complete implantable intravascular catheter system, in which the drum is implanted into a newly created subcutaneous pocket over the pectoralis major muscle, and the tip of the catheter through the subclavian vein ends in the superior vena cava.

Wide application of the device is mostly used in cancer patients that need prolonged access of the central venus system for infusion of:

• drugs
• intravenous fluids
• parenteral nutrition solutions
• blood derivatives
• and for blood sampling.

Η χειρουργική τεχνική τοποθέτησης του port a cath είναι ολιγόλεπτη, διενεργείται υπό τοπική αναισθησία και ήπια καταστολή και για την μέγιστη ασφάλεια του ασθενούς υπό ακτινοσκοπική καθοδήγηση (Echo & C-arm).

Description of technique

Connecting a patient to non-invasive cardiopulmonary monitoring. Intravenous administration of mild sedation. Sterilization of the surgical field with povidone iodide solution and coating of adjacent area with aseptic monitors. Heparinisation of the whole system with heparin solution (1ml - 1000 IU of classical heparin + 99ml N/S). Local perfusion of the venipuncture site with anaesthetic solution and check for anaesthetic adequacy. Venipuncture of internal jugular or subclavian vein under ultrasound imaging guidance and insertion of guide wire (modified Seldinger technique). Check for correct positioning by means of radiography (C-arm). Skin incision widening with N^o11. Expander insertion and expander removal. Placing the sheath on the guide wire. Removing wire guide. Insertion of catheter through the sheath. Removal of the sheath. Re-check for correct positioning by fluoroscopy and check that the catheter is properly threaded. Local infiltration of the subclavian area of subcutaneous placement of the infusion device with anaesthetic d/ma and check for adequacy of anaesthesia. Skin and substrate incision with N blade^ο15. Preparation of a substrate and creation of a space for the infusion device. Thorough hemostasis with electrothermal hemostasis. Sterilization of the case with povidone iodide solution. Creation of an appropriate subcutaneous tunnel connecting the infusion device to the catheter. Securely connect the catheter to the infusion device and place the infusion device in the subcutaneous sheath. Re-check for correct positioning by fluoroscopy and check that the device-carrier is properly seated. Stabilisation of the device in the sheath with two Silk N^o 2-0. Wound closure with individual Prolene N sutures^o 3-0. Sterilization of the surgical field with povidone iodide solution. Re-check for correct positioning with the aid of fluoroscopy, check for proper device-fixing and heparinisation of the system. Coating of the surgical wound with dressing material. Transfer of the patient to his bed and ordering of a chest X-ray.

Instructions after implantation

Imaging assessment

• Directly by chest X-ray (F+P)

Relevant medication and other treatment recommendations

• Broad-spectrum antibiotic treatment (e.g. tb cefuroxime 500mg 1X2 pos for 5 days)
• Analgesic treatment with simple analgesics (e.g. tb paracetamol 1gr 1X3 pos for 2 days)
• Daily wound care (antisepsis and dressing change) for five (5) days
• Wound re-examination and heparinization in two (2) days
• Suture removal in ten (10) days
• The device is rewetting every three (3) weeks with a solution of 5000 IU of classical heparin and 16ml of N/S in a 20ml syringe under the necessary antisepsis conditions.
• Wetting of the device after completion of the infusion of each chemotherapeutic regimen with a solution of 5000 IU of classical heparin and 16 ml of N/S in a 20 ml syringe, observing the necessary antisepsis conditions
• If an unexpected change is observed in the wound area (e.g. bleeding, redness, swelling, burning pain) or swelling of the corresponding upper limb, it is necessary to contact the attending physician.
• The device is immediately available for use after installation
• The type of system is radiopaque and compatible with CT or MRI