The installation of a central venous catheter is an access point for injecting drugs. It secures a permanent entrance under the skin. They are designed to allow medication to be inserted without the need to continually puncture the veins.
This catheter is designed to allow medication to be inserted more frequently and over a longer period of time without the need to continually puncture the veins at new sites.
The portal catheter system is placed under the skin in the central fatty tissue there and can be pricked (punctured) relatively easily by a doctor with a hollow needle.
In most cases, a portal catheter is attached to a central venous catheter, and in special cases also to arteries near the heart or body cavities such as the abdominal cavity.
Placement of the catheter requires a short surgical procedure to implant it.
When is a central venous catheter inserted? Port catheter ?
Continuous injection holes and sometimes very annoying factors strain the veins and can even cause them to become damaged. This can be circumvented in an elegant manner when inserting the portal catheter.
A portal catheter is inserted to allow the patient to introduce medication into the body for an extended period of time.
So doctors often implant a device such as a catheter, portal catheter, or pump for people who need to Chemotherapy So that the appropriate medication can be administered into the veins on a regular basis. This mainly includes patients Tumors (such as liver and spleen cancer).
An inlet catheter can also be useful for other medications that must be administered frequently into the veins to treat a specific disease.
A portal catheter is a catheter under the skin so it is also suitable for giving special foods or nutrients into the veins (intravenous feeding).
In this way, patients who cannot eat anything or only insufficiently can be fed in the normal way.
Transfusions may also be performed through a portal catheter if more blood transfusions are expected.
How does the portal catheter system work? Central vein catheters
A catheter is usually implanted into the veins. It is then usually connected to a central venous catheter (CVC).
It is also possible to use a portal catheter for the arterial system.
In some cases, a central venous catheter is placed to access a body cavity such as the abdominal cavity (peritoneal port), the space that contains cerebrospinal fluid, or the heart chamber.
To install the portal catheter requires a small operation that takes about half an hour.
A portal catheter in the strict sense of the word is a chamber with a sleeve made of plastic or metal that is implanted under the skin.
This sleeve has a silicone membrane on top (towards the skin) through which a needle can be inserted.
The other walls of the chamber are thick and cannot be punctured by the needle.
The chamber is connected to a long, thin tube (catheter). The other end of the catheter is located in the heart's usual venous catheter system (Cardiac catheterization), so the catheter passes the drug from the portal catheter through the large veins to the heart.
In most cases, the catheter is inserted through the subclavian vein or through the internal jugular vein. The portal catheter unit is usually permanently located in the subcutaneous fatty tissue over the pectoralis major muscle (the pectoralis major muscle).
A special hollow needle (such as a Hopper needle) may be used to penetrate the portal catheter through the membrane.
Inserting the needle is virtually pain-free. The needle may be left in the catheter for some time, sometimes for several days, as it provides access to the catheter.
The needle is attached to a thin tube through which several substances pass, for example, medicines can be injected.
The needle must be conscientiously inserted under sterile conditions by the doctor in order to avoid damage or, above all, infection in the catheter.
Portal catheter chamber (catheter bag) is a reservoir through which the agent to be inserted is gradually transferred through the catheter route to the vicinity of the patient's heart.
With chemotherapeutic agents in particular, this has another advantage in that the blood in the large veins and the heart is relatively strong and causes no damage to the vessel walls.
The portal catheter acts as an intravenous catheter. The catheter is sturdier and made a little differently.
Chemotherapy can be performed on certain parts of the body by means of a portal catheter when it is delivered to the arteries of the organs that wish to be treated.
How is a central venous catheter installed?
Catheter implantation surgery is usually performed under local anaesthesia.
In the first step, an incision is usually made on the skin under the collar bone.
Where there is a vein such as the subclavian vein and the catheter is inserted into this vein.
The thin tube is pushed toward the heart. This is done under fluoroscopy To get the terminal edge in the right place. Then a portal catheter is placed.
Another short cut in the skin, also below the collarbone or in the chest area, usually causes a catheter to burrow into the fatty tissue under the skin.
A catheter chamber made of plastic or metal is inserted there. The catheter can then be withdrawn from the vein at its end through the subcutaneous tissue into the central port reservoir and threaded there. After carefully checking whether the port is really working as a whole, then finally the skin is sutured.
Possible complications of portal angioplasty
The operation involves certain risks, but they are usually minor.
Bleeding, inflammation, and healing disturbances can occur, resulting in a high incidence of scarring.
A few patients cannot tolerate any of the therapeutic materials inside the catheter or may develop an allergy. Blood clots (thromboembolism) cannot be ruled out.
An infection can develop in a portal catheter implanted under the skin if germs enter it through the needle puncture.
Bacteria in particular can be dangerous. The germs can then also travel into the blood. Infection is a common reason why the catheter needs to be removed again and a new catheter created if necessary.
Likewise, the catheter can become clogged and no more fluid can be injected or more fluid can be withdrawn.
Material damage can also occur. It may also be a good idea to remove the portal catheter if such problems occur.
Benefits and chances of success of portal angioplasty
Many patients benefit from a portal catheter. The creation of a portal catheter system simplifies the administration of drugs in the body and prevents damage to the veins, which develop for example on the muscle of the hand.
However, great care needs to be taken with the portal catheter when drugs are inserted. The catheter can be punctured multiple times, often up to 2,000 times. Complications such as infection or blockage of the catheter can result in it having to be removed again or replaced with a new one.
Instructions for patients
Before the operation of the central venous catheter
The physician should discuss at an early stage whether any anticoagulant medications such as aspirin or Coumadin should be discontinued.
After catheterization operations
After the external catheter is implanted, the patient can usually go home after a short observation period. Physicians of the Senior Specialist Research Department also recommend taking antibiotics with caution.
Only nurses trained at a certain level are allowed to perform the insertion of the needle (puncture) into a catheter to reduce the risk of complications.
Sterile labor is an indispensable condition for this.
Bathing or showering using a false port is usually possible once the skin wound has healed. The same goes for exercise and physical activity.
In a document called the Portal Catheter Guide, the dates when a doctor's examination is needed are entered.
The most important frequently asked questions about the installation of central venous catheters in Turkey
When should the portal catheter be cleaned?
It is routine to clean the catheter every four to six weeks, according to the medical manufacturer's recommendations, washing with heparin saline solution if necessary.
What is the shelf life of a portal catheter?
Most surgeons say that a portal catheter can be used for five years or more.
What is the benefit of installing a central venous catheter?
The benefits of installing a central venous catheter is that it replaces the need for peripheral venous catheters. It relieves the pain on the patient and reduces the number of injections for cancer patients.