Venous Access - Mark Fusco MD


Long Term Venous Access (mediport, infusaport, chemotherapy port)
When patients need medications infused directly into the blood (intravenous) they are usually treated with a peripheral intravenous catheter (PIV). PIV's are typically placed in the hands or arms. Infrequently they may be placed in the feet or neck. Some medications are too irritating for the peripheral veins and instead must be given via a larger higher flow vein. Catheters that are placed in these larger veins are called Central venous catheters (CVC). The veins most often used for CVC's are the large veins below the collar bones, in the neck, and in the upper leg. Usual CVC's can only be left in place a limited amount of time. Patients requiring repeated PIV's often “run out” of peripheral vein sites. One option to address inadequate peripheral sites in patients who will require access longer than the life span of a CVC, is the use of a long term venous access catheter. This device is often called a port.
Design of the Port
A port is a completely implanted device that consists of: Reservoir - a hollow titanium disk that has a rubber septum. The reservoir is implanted in a pocket just below the skin on the chest wall. Catheter - a tube that is connected to the reservoir and placed into one of the large veins of the chest.
Prior To Surgery Depending on your age and medical condition you may be required to undergo preoperative testing. Testing may include blood work, x-rays, and an electrocardiogram. The office will arrange this and give you instructions when you schedule your surgery. Patients will also be given a prescription for pain medication. We recommend that you fill this prescription prior to the day of surgery. It is very important that you do not eat or drink anything after midnight the night prior to surgery. This includes coffee, water, mints, gum, and candies. You may ingest only a small sip of water with your morning medications.
Dr. Fusco's office staff will advise you when to arrive at the hospital or surgery center. Since the procedures scheduled prior to yours may be longer or shorter than anticipated, we ask that you remain available prior to your arrival time so that you can be contacted and informed of any changes in your surgery time.
Conduct of the Operation The port is usually placed as an outpatient procedure either at Melbourne Same Day Surgery Center or at the hospital. General anesthesia or a local anesthetic with supplemental intravenous sedation is required. The procedure takes approximately one hour and the port can be used immediately after placement. Dr. Fusco's usual approach involves cannulation of the subclavian vein (vein under the collar bone) using a percutaneous technique. The pocket is placed just below the collar bone, After the procedure, patients will have an incision approximately two inches long and a small protrusion of the skin at the reservoir site.
Recovery Patients can go home after the procedure and resume normal activity. Because of the possibility of the anesthetic agents affecting judgment, patients should not drive, make important decisions, or sign legal documents on the day of the surgery. The postoperative bandage can be removed after 48 hours. Patients can bathe normally after the postoperative dressing is removed. The incision must be checked for infection approximately seven to ten days after the procedure. This check can be done by the infusion nurses if the patient is already scheduled to undergo chemotherapy during this time frame. If not, please schedule an appointment to see Dr. Fusco in the office. Patients are encouraged to contact the office sooner than this if they have any questions or problems, or any of the following: Nausea or vomiting that persists for greater then 24 hours after surgery - nausea shortly after surgery is commonly due to general anesthesia and usually resolves within this time period. Temperature greater than 101.5 degrees - Temperature elevations less than this are very common after surgery and usually have little significance. Pain that is not relieved by the oral pain medication prescribed. Inability to pass urine. Any questions or concerns. Patients experiencing any difficulty breathing, chest pain, change in level of consciousness, or loss of vision or strength should promptly call 911 for transport to the nearest emergency department.
Function and Care After the port is placed, it can be used for both infusion of medication and blood draws. The port is accessed using a special needle called a Huber needle. (See photo on on the right) If the port is accessed with a regular needle this could damage the rubber septum leading to leakage from the port which would require port removal. The port should only be accessed by doctors and nurses specially trained to access these ports. To access the port, using sterile technique, the reservoir is identified by feeling the device under the skin. Once the septum is identified, the Huber needle is passed into the reservoir. Blood is aspirated to confirm appropriate placement and the port is used. After the infusion is complete the port is deaccessed (access needle is removed). Once deaccessed no special care is required. Patients can swim and bathe normally as the device is completely implanted below the skin. Usually, the skin above the port is somewhat numb from the surgery making the process of accessing the port less painful than having a PIV placed. If this is not the case, a topical anesthetic cream can be prescribed to place over the port prior to arrival at the infusion center. This helps to further anesthetize the area.


The infusion center will arrange to have the port “flushed” with a heparin solution once per month. Heparin helps to prevent clotting in the catheter which leads to port malfunction. Your doctor may also prescribe a low dose of blood thinner for the same purpose. The port can remain in place indefinitely, but it usually is removed after the patient and the oncologist feel reasonably certain the port is no longer needed. Removal of the port also involves a minor surgical procedure.
Risks Pneumothorax (collapsed lung) - Happens during insertion approximately 1% of the time. When pneumothorax occurs a tube sometimes needs to be placed near the lung to reinflate the lung. This tube is left in place for a day or two. Usually this complication of the procedure does not have any long term effects. Pocket hematoma (collection of blood in the pocket around the reservoir) - Occurs approximately 5% of the time. Almost always resolves without treatment. Port infection - Variable frequency depends on the use of the catheter and the immunologic condition of the patient. Usually requires removal of the port. Port malfunction - Variable frequency depends on the duration of use. Sometimes a poorly functioning port can be salvaged with medication to break up clots or can be manipulated under x-ray guidance. If this is not successful a new port can be placed. Catheter break, disruption, leak - requires removal (<1%)
Additional information Port info from breastdoctor.com Medithesis - Detailed technical info about venous access for medical professionals Instruction manual for Bard® ports - Detailed technical info for medical professionals

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