venous port

venous port

A surgically implanted indwelling–eg, Port-A-Cath, subcutaneous device, consisting of a reservoir attached to plastic tubing in a large vein used to provide venous access for a period of wks

venous port

, venous access port
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IMPLANTABLE VENOUS ACCESS PORT
Part of a venous access device consisting of a subcutaneously implanted port through which medications are injected. Leading from the port is a catheter that is inserted in the cephalic, jugular, or subclavian vein. The catheter extends into the superior vena cava. The port has a self-sealing septum through which a needle is inserted to have access for administering medications, such as cancer chemotherapy agents, and for drawing blood samples. The septum of the port is made to withstand from 1000 to 2000 punctures depending on the size needle used. Sterile technique is used each time a needle enters the port. The port permits unrestricted patient activity. Each time it is used care must be taken to be certain the line is open and that the catheter in the vein has remained in the proper position. See: illustration

Patient care

Venous access ports are useful for patients requiring intermittent intravenous (IV) therapy such as chemotherapy or antibiotics, parenteral nutrition, blood products, or IV fluids, and/or intermittent blood sampling. The port may be implanted for 3 months to several years. It consists of a self-sealing silicone rubber septum (resembling the head of a stethoscope and measuring 7 to 10 mm in diameter) covering a metal or plastic reservoir and a silicone catheter connecting the reservoir to a central vein. Ports may have one or two lumens. The dual-lumen port has two noncommunicating reservoirs with their own catheters in a single port body. The most common site for port implantation is in the anterior chest below the clavicle, although other sites such as the upper arm are options. Once the site heals (5 to 7 days), the skin covering the device protects the patient from infection. Ports also may be open-ended (requiring flushing with a heparinized saline solution to prevent clotting, or valved (with no flushing needed between uses). The patient should be aware of which type device has been implanted, or should carry a wallet card identifying the device. When a port is not in active use the patient can participate in normal activities.

Sterile technique should be used when accessing a port. A topical anesthetic spray or cream should be applied, if the port has been recently implanted, or if the patient requests analgesia to prevent or reduce discomfort. The patient is positioned, so the site is easily viewed. The septum is palpated (unless newly implanted), and assessed for signs and symptoms of infection, such as redness, swelling, pain, and local warmth. Any infection should be documented, the patient’s primary health care provider notified, and the site not accessed. For access, the port septum should be localized and stabilized using the nondominant hand, stretching the skin taut with the thumb and first two fingers. Patient anxiety about the procedure can be eased by speaking reassuringly to the patient throughout, explaining what is being done and the rationale for each action. The site is then prepared following agency procedure. The primed, noncoring needle (20 gauge is appropriate for most injections and infusions) is then held perpendicular to the septum with the dominant hand and inserted at a point between the thumb and fingers. Minimal resistance should be noted as the skin and port septum are punctured. The needle (which should be just long enough to reach the back of the port) is then advanced until the needle stop hits the back of the septum and the bottom of the reservoir is encountered, and blood is aspirated to verify correct needle placement. If resistance is encountered when inserting the needle, it may not be in the middle of the septum. If this occurs, the needle is carefully withdrawn and discarded, and a new, primed needle used. When accessing the port for an infusion, the wings of the noncoring needle are then secured with sterile wound closure strips or sterile tape. A skin protectant solution may be applied if this is part of local institutional protocol.

During continuous use, a needle can remain in place up to 7 days, although most agencies recommend change every 3 to 5 days. The venous access port is flushed per the institution's protocol, prior to being deaccessed. Following administration of prescribed therapy, the port is deaccessed. Hands are washed and nonsterile gloves are donned. Any dressing and tape are removed, and the skin held taut over the port using thumb and first two fingers. Maintaining light pressure on the port body, the needle is pulled straight out in a smooth movement, avoiding side-to-side movements that could damage the septum. A small amount of capillary bleeding may occur at the needle site, which is then covered with an adhesive bandage as desired. Documentation should include needle size, prescribed infusions or bolus dosings, needle and dressing changes and dates, patient tolerance of therapy(ies), complications, blood draws, and any changes in the patient’s physical assessment.

References in periodicals archive ?
Contract award: MFV Central venous catheters, venous ports and venous port pins.
A venous port was implanted, and 4 courses of rituximab (anti-CD20 monoclonal antibody) plus additional chemotherapy (cyclophosphamide, epirubicin, vicristine and prednisolone) were administered from December 2006 through May 2007.
The bacterium might have been introduced during implantation of the venous port or during minor trauma that went unnoticed.
Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems.
A randomized, prospective trial of central venous ports connected to standard open-ended or Groshong catheters in adult oncology patients.
The subcutaneous central venous port was also changed after 6 weeks of treatment.
This open-label multi-center trial will provide extensive data on EMLA's use in a large number of children's hospitals where invasive dermal procedures are performed, such as venipuncture, central venous port injection, as well as for lumbar puncture and bone marrow aspiration (skin anesthesia only).
The venous port releases blood in the SVC and the arterial port draws blood from the right atrium.
Interventional radiologists --vascular experts who are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body -- adapted conventional venous ports to use in the arterial circulation.
Interventional radiologists -- vascular experts who are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body -- adapted conventional venous ports to use in the arterial circulation.