Central Venous Infusion Catheter with Implantable Port

What is placement of a central venous infusion catheter with an implantable port?

Placement of a central venous infusion catheter with an implantable port is a procedure for passing a catheter into the subclavian vein. The subclavian vein is a large vein in the upper part of the chest under the collarbone. The catheter is a thin, soft plastic tube. One end of the catheter is passed through the wall of the vein and advanced to a place just above the heart. The other end is tunneled under the skin to another site on the chest, where a pocket is created. A reservoir, or port, attached to the catheter is placed in the pocket. The reservoir (port) is a hollow metal or plastic disc with a silicone diaphragm. Drugs can be injected into the port and then go through the catheter and into your vein.

When is it used?

This procedure allows you to get intravenous (IV) drugs without having a needle in your vein.

Examples of alternatives are:

• having the drugs put into a smaller arm vein that is close to the surface of your skin
• having a catheter with the IV line coming out of the skin (an external lumen)
• choosing not to have the procedure.

You should ask your healthcare provider about these choices.

How do I prepare for the procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia or sedation. Find someone to drive you home after the surgery.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You may be given a local anesthetic with or without a sedative, or you may be given a general anesthetic. A local anesthetic prevents pain by numbing the part of your body where you will have the surgery. A sedative helps you relax. A general anesthetic relaxes your muscles, causes a deep sleep, and keeps you from feeling pain.

Your healthcare provider will prepare your upper chest area with a special soap and cover it with sterile drapes. The table you are lying on will be positioned with your feet slightly higher than your head. When the area is numb, your provider will make a small cut (puncture) in your upper chest. He or she will place one end of the catheter into the vein under your collarbone, pushing it to a place just above the heart. The other end is tunneled under the skin to another site on the upper chest, where a pocket is created with another cut. A reservoir, or port, is placed in the pocket. Your provider will attach the catheter to the port and sew the cuts closed.

What happens after the procedure?

You will have a chest X-ray to check the position of the catheter and to check your lungs.

You will be watched for a few hours while you recover from the anesthetic, and then you may go home. You should avoid strenuous activity for a day. You will have a dressing over the cut for a few days.

You will need to have the catheter for as long as you need injections of medicine.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You will avoid the pain and discomfort of having medicine injected into a vein by a needle in your arm. You can also avoid damage to your veins from needles and strong medicines.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• When the catheter is inserted into the vein in your chest, the lining of the lung could be punctured. This could cause the lung to collapse. A collapsed lung would require another procedure under local anesthetic to reexpand the lung.
• The longer you have the catheter, the greater the risk of infection. If you get an infection, the catheter and the port will probably have to be removed.
• A clot may form around the tip of the catheter in the vein and block the catheter or block the vein and make your arm swell.

You should ask your healthcare provider how these risks apply to you.

When should I call the healthcare provider?

Call your provider right away if:

• You have a temperature over 100°F (37.8°C).
• You become short of breath.
• You develop a red, swollen, or tender area around the implanted reservoir.

Call your provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.