Definition
A port system or port is a catheter system that is installed under the skin. It serves as a permanent access to vessels or body cavities, so that a peripheral access (at an arm vein) does not have to be placed continuously. The port system is punctured from the outside through the skin. The port is usually placed as a central venous catheter, i.e. on veins close to the heart, to make infusions or similar easier to administer and ensure safe access. Especially substances that would damage small veins in the long run can be better administered in this way.
Indications
The most common indications are presented below as an overview. There are many different indications for a port system. The most common use of a port system is probably in the treatment of tumor diseases, but other diseases that require frequent access to veins or arteries are also an indication.
Indications for a port system therefore include chemotherapy that must be administered via central infusions, long-term parenteral (not through the gastrointestinal tract) nutrition and the administration of blood or blood components. In addition, there are certain drugs that may only be administered centrally, i.e. close to the heart. Furthermore, in patients with difficult vein conditions in the arms, etc., a port may be considered to ensure safe access.
Patients who are prone to complications if the access is outside the body can also be given a port. Examples would be the formation of blood clots (thromboses) and infection of an access, for example in patients with a weakened immune system. There are also people in whom access via an arm vein, for example, is not possible due to anatomical structures.
- Chemotherapy for tumor diseases
- Special drug administration
- Parenteral nutrition
- Administration of blood or blood components
- Difficult vein conditions
Setting the port
After a detailed explanation of the patient, the port is placed in a small surgical procedure. Only the port catheter, i.e. the tube with the connected chamber, is inserted into the body. The operation can be performed under local or general anesthesia and usually takes 30 to 40 minutes.
First, the skin area around the breast is disinfected. Then an incision is made underneath one of the collarbone with the image of one of the large veins, for example the subclavian or jugular vein. The catheter is then inserted into this vessel and advanced to the heart under image control.
Then, with the help of another incision, a pocket for the port chamber is formed in the fatty tissue of the skin. Various localizations are suitable for this. Most commonly, the chamber is implanted below the collarbone, but occasionally further down the anterior chest or arm.
After repeated irrigation and checking of the location, the incisions are sutured and connected. The port can now be punctured from the outside with a port needle for the application of medication. In principle, a port can be placed in all larger central veins.
The most commonly used is the cephalic vein, which is a larger skin vein on the upper arm. From here the catheter is inserted and the port chamber, which is later punctured, is inserted under the skin in the area of the chest muscle and the first or second rib. Other veins that can serve as access are the great cervical vein (internal jugular vein) or the subclavian vein (subclavian vein).
The port chamber is placed in the same place for all three accesses. This means that the puncture site is always on the 1st or 2nd rib. Other accesses are the hepatic artery, the peritoneum or the epidural space (above the meninges). However, these are used for special problems and not the classic port.
