Ease of chemotherapy administration by CHEMOPORT
Chemotherapy ports are specialised vascular access devise[VAD]. The VADs are classified into 3 according to the longevity of intendeduse.
1. Short term: IV catheters, Midlines.
2. Acute catheters: central venous lines or PICC i.e.peripherally inserted central catheters.
3. Long term: tunnelled catchers or implantedports.
Why chemoports?
The thrombophlebitis following the irritant and hyperosmolarchemotherapeutic agents leave behind the bad marks and memories. That is seenas a major concern for the new patients for chemotherapy. Extravasation ofchemotherapy from peripheral line poses a big clinical problem for treatingteam if left unnoticed. This issue has been circumvented by chemotherapy ports.
What is it?
Chemoport has two parts. One is chamber which is fixed ininfraclavicular fossa i.e. in area below the collar bone. The chemotherapydrugs can be injected in the chamber. The camber has puncture resistantmembrane.
The second part is the tube that carries the drug into thelargest blood vessel draining to heart. This tube is tunnelled beneath skininto the neck and passed into jugular vein that leads to SVC [main vein toheart] – right atrium [first part of heart receiving blood] junction.
How to put it?
The procedure is carried out preferably in generalanaesthesia with supine position and shoulder extension with arms by side. Theoperative areas are prepared with proper antiseptic solutions. The chamber isinserted 4 finger breadth below clavicle [collar bone] and fixed to underlyingmuscle [pectoralis major]. The jugular vein is punctured by identifying thespecific anatomical landmarks and guidewire is inserted. C arm is used to checkthe entry and position of guidewire. One may get few ECG changes at this point.The tube is then cut at an imaginary mark that correlates with its tip positionat sternal angle with help of C arm. The tube attached to chamber is tunnelledsubcutaneously up to an incision made at entry point of skin puncture atguidewire entry in neck and tube is delivered out from it. A specific tearablesheath is transported over the guidewire via jugular vein into SCV. The tube isinserted fully into the sheath after removing guidewire. The sheath is tearedand removed gently taking care that the tube does not come out the same time.
The C arm is again utilised to see the course of tube,smooth genu of tube turning and entering in jugular vein, position of tube atjunction of SVC-heart. The forward and backward flow are confirmed in table.
Post procedure the chamber and tube remain unexposed andbeneath the skin.
Advantages:
As the medicines are administered into the main blood streamdirectly so there is no thrombophlebitis. The repeated and more difficultvenepunctures are thus avoided. That makes patient at comfort. Also, thechemoport five access to central blood stream for pathological tests.
Special care:
Non-coring needle: the needle used to puncture theport chamber is not cutting needle like the ordinary ones. It has a hole fromside and the needle has a 90-degree angle to it.
Sterile puncturing: since the port communicates tothe central blood stream directly , the puncture of port chamber has to beutmost sterile activity.
The proper cleaningof skin with aseptic solution, puncturing and handling using sterile gloves is essential.The specially trained staff or a doctor has to be there.
Check forward and backward flow always: there couldbe kinks, thrombus acting one way valve that can hinder to free back or forwardflow. At times the tube can pinch between the rib and collar bone especially incase of subclavian vein ports.
Ports are precious: the port materials arecostly and the ease to get chemotherapy is so much that the patients areemotionally attached to the experience with ports. There are few makes thatturn the used ports into the ornament like wearables, just to emphasise.