chemotherapy port for medical students.pptx

chemotherapy port

1. Port for Chemotherapy

2. Objectives At the end of this presentation learners will be able to define: What is port for chemotherapy When it is used Sites of insertion How it is inserted Types of port a cath. Possible benefits Possible risk related to port Nursing care

3. CVCs( central venous catheters) are considered more manageable than a regular intravenous (IV) catheter because they can stay in your body longer. Some CVCs can be left in your body for weeks, months, or years. But a regular IV catheter can only stay in for a few days. This means your oncologist or nurse will have to reinsert multiple IVs into your veins over the course of your treatment. There are different types of CVCs that are used, but the most common are peripherally inserted central catheters (PICC lines) and ports. The type of CVC you’ll need depends on a few of the following factors, including which one your oncologist prefers: How long you’ll need chemotherapy How long it takes to inject your chemotherapy doses How many drugs you’ll receive at once Whether you have any other medical problems like  blood clots  or  swelling

4. What is port? A chemotherapy port (also known as a "port-a- cath ") is a small device that is implanted under your skin to allow easy access to your bloodstream. A port-a- cath , also referred to as a port, is an implanted device which allows easy access to a patient’s veins. A port-a- cath is surgically-inserted completely beneath the skin and consists of two parts – the portal and the catheter. 

5. When Is a Port Used? A port can be used to draw blood and infuse chemotherapy drugs. It can also be used if you need transfusions of  red blood cells  or platelets . Without a port, or a PICC line, a new intravenous needle (IV) will need to be placed each time you have chemotherapy, and separate IV lines will need to be placed if your require IV fluids or a blood transfusion.

6. Sites of insertion Juglar vein Subclavian vein Superior vena cava Ideally it is inserted in SVC just upstream of the right atrium

7. How Is a Port Inserted? A port is most often inserted during a same-day surgical procedure that can be performed with a local anesthetic.  Most physicians prefer that you have your port placed at least one week before beginning chemotherapy (if possible) and studies suggest that having your port placed at least eight days prior to an infusion reduces the risk for complications. If you are having a surgical procedure for your cancer, such as a  lobectomy  for lung cancer or a mastectomy for breast cancer, your surgeon may insert a port at the same time your other surgery is performed. When a port is placed during surgery, you will already have a general anesthetic in place.

8. How-To Access a Port: A Port Access Kit (sterile gloves, CHG( chlorhexidine gluconate) cleanser, central line dressing kit, skin protectant) A Biopatch (or disc impregnated with CHG) Masks for yourself and the patient Needless Connector A 90 degree, Non-Coring Port needle (also called a Huber needle) or PowerLoc needle for PowerPort Sterile Normal Saline flush syringe  Explain the procedure to the patient. Perform hand hygiene and apply clean gloves Locate and palpate the port. Place a mask on the patient and nurse. Perform hand hygiene again. Open the sterile port access kit and create a sterile field. Add your non-coring needle, Biopatch , and sterile 10cc syringe to the field. 

9. Apply sterile gloves. Attach the flush to the non-coring needle and purge the air by priming the line until you see the saline drip from the needle tip. Scrub the site clean with CHG from the kit using a back and forth/up and down motion for the amount of time indicated on the directions, typically 30 seconds to 1 minute in each direction.  Allow the antiseptic to dry on the skin. Stabilize the port with the index finger and thumb of your non-dominant hand.  With the needle at a 90 degree angle from the skin, insert the needle into the center of the portal chamber until you feel the needle hit resistance at the back of the chamber.

10. Aspirate the syringe to assess for blood return and verify placement. Once blood return is verified, flush the tubing and clamp. Connect the needless connector.  Apply the Biopatch around the needle with the blue side up.  Apply skin protectant around the site.  Cover the entire site with a transparent dressing. All sides should be occlusive. If patients have sensitivity to Tegaderm, Opsite may be used. Label the site with date, time, and nurse’s initials.  Re-access the site and change the dressing according to hospital policy. 

11. Once a port is cleared for use, a patient may receive intravenous therapy through it for the course of his/her treatment. An adult portal chamber can take about 2,000 punctures on average, which may last a patient several years.

12. different types of ports A port can be single or double lumen. Single lumen ports are most common and typically sufficient for patients requiring scheduled intravenous therapy.  However, having a double lumen port is advantageous for patients who often receive multiple intravenous therapies at once. If two intravenous agents aren’t compatible in the same line, you can infuse both simultaneously in different port lumens without complication. The double lumen port also allows concurrent infusion of medication, chemotherapy, blood products, or parenteral nutrition. It is also beneficial for drawing labs without interruption of an infusion. 

13. Power port A catheter connects the  port  to a vein. Under the skin, the port  has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical "needle stick".  Ports  are used mostly to treat hematology and oncology patients. Lightweight for patient comfort Easily identifiable Power injectable Comprehensive Patient Discharge Packet Receive contrast-enhanced CT

14. The PowerPort ® device is the first port indicated for power injection (when used with a PowerLoc ® Safety Infusion Set Family †  device). It combines reliable venous access with the unique ability for power-injected Contrast-Enhanced Computed Tomography (CECT) scans. Power-injected CECT scans produce superior images to help better manage patient care. Such scans are often used to track tumor markers or perform pulmonary embolism studies. The palpation bumps and unique triangular shape of PowerPort ® Implantable ports make them easily distinguishable from non-power ports. The PowerPort ® devices offer easy, flexible placement and access.

15. PowerLoc The PowerLoc ® safety infusion set is the ideal device for accesing PowerPort ® devices. This combination of power injectable devices enables contrast agents to be power-injected. As a result, tissues show up more clearly in CECT scans, making it easier to monitor patient condition.

16. Benefits and Advantages  Greater comfort:  A single needle stick through your skin is usually all that is needed to access your port. With IV therapy and traditional blood draws, sometimes many needle sticks are needed to find a good vein, especially if your veins have been damaged from repeated blood draws and infusions. (Chemotherapy can cause changes in your vein that make them very difficult to puncture with a needle.)

17. Avoiding delays:  Not only do you avoid the delay of having your nurse attempt to find a good vein to draw blood or infuse chemotherapy, but having a port can reduce the time needed to prepare your hand or arm for the procedure.

18. Lowering the risk of "extravasation:"  When an IV is used, medications are more likely to leak (extravasate) into the tissues surrounding your hand or arm. Since many chemotherapy medications are caustic to tissue, a port can reduce the risk of inflammation-related to leakage of these medications.

19. Easier bathing and swimming:  Since a port is completely under the skin, you can usually bathe and even swim without being concerned about the risk of infection.

20. Possible Disadvantages of a Chemotherapy Port The risk of the surgical procedure   to install the port:  Any surgical procedure can carry the risk of infection.  Uncommon  complications (those which occur in less than one percent of people) of insertion can include bleeding (such as if the subclavian vein is punctured) and a  pneumothorax  (collapse of the lung) if your lung is accidentally punctured during the procedure. 

21. Infection:  The risk of infection varies in studies but isn’t uncommon. If a port becomes infected, it will often need to be removed and replaced. Research is evaluating methods of reducing this risk, so it is important to talk to your oncologist about how to properly manage your port.

22. Thrombosis:  A clot may form in the port or catheter, causing it to stop working. Between 12 and 64 percent of people who have a port placed for chemotherapy will develop a thrombosis (clot) in the catheter (often causing a need for the port to be replaced.)

23. Mechanical problems   that cause the port to stop working:  In some cases, mechanical problems, such as movement of the catheter or separation of the port from the skin, can cause a port to stop working.

24. Limitations in activity:  Though activities such as bathing and swimming are usually okay, your oncologist may recommend holding off on exercises to strengthen your upper body or arms until your port is removed.

25. Scarring:  Given the gravity of cancer treatment, a scar from the port is a relatively minor drawback. But some people may find a scar on their upper chest disturbing for cosmetic reasons or because it is a symbol that you once went through chemotherapy.

26. How It Differs From a PICC Line PICC stands for "peripherally inserted central catheter." A PICC line is usually placed in a vein for shorter-term treatment (for example, for access that will be needed for one to six weeks only). PICC lines are placed in your arm closer to your skin (subcutaneous) and do not reach as close to your heart as a port catheter.

27. Heparin to be flushed Normal saline is  used to flush  fluids through, a heparinized saline solution is  used to maintain patency while maintaining access or to discontinue access. Usually, a Port -A-Cath is  flushed  with 10mL of normal saline and locked with 2.5mL normal saline mixed with 2.5mL of  heparin  100 units/mL for a 5m total volume.

28. Does port require heparin The catheter may be flushed with normal saline, and it  does  not  require heparin  to maintain patency. The PowerPort * implantable  port  is indicated for patient therapies requiring repeated access to the vascular system. The  port  system can be used for infusion of medications, I.V.

29. Nursing management

30. Pre-Insertion Care Provide and document patient teaching. Include the following: purpose, placement, insertion procedure, and post-insertion care, including what to report to the nurse. The following bloodwork may be considered: CBC, INR, PTT to assess for coagulopathies and thrombocytopenia.

31. Insertion care An implanted vascular access device (IVAD) or infusion port may be inserted in interventional radiology or in the operating room. In interventional radiology, the procedure is preformed under local anaesthesia using fluoroscopy to facilitate correct tip placement. Two small incisions are made. A small incision slightly larger than the diameter of the device is made and a small pocket for the port is created under the skin. Another very small incision is made above this site and the catheter is threaded through the vein until the distal end is situated in the lower 1/3 of the SVC. The port is sutured in place. IVADs are flushed and heparin locked at the time of insertion.

32. Post-insertion care Immediately, and for the first two hours post insertion, assess the insertion site for bleeding, redness or swelling. The patient's level of comfort and any abnormal sensations at the site should be assessed. Any abnormal sensations should be reported to the physician immediately. These symptoms may include pain upon inspiration, burning, or throbbing. Steri -strips may be applied to the site or a skin adhesive may be used to close the incision. Immediately following insertion, the site is covered with a sterile gauze dressing; this should be removed 48 hours following insertion. If steri -strips are applied, remove 5-7 days post-insertion.

33. The patient should be encouraged to keep the incision dry when showering or bathing for the first week by applying saran wrap over the wound. If complications are noted, refer to the nursing actions outlined in the complications section. All patients should be aware of safety precautions and signs and symptoms to report to the health care professionals.

34. flushing the port with 20 mLs normal saline following drug administration or blood sampling and every 4 weeks when not in use.

35. Complications Three major complications of all CVADs: 1. Occlusions - may be mechanical, thrombotic or non-thrombotic. 2. Infection 3. Venous thrombosis

36. REFERENCES Bard, C. R. Inc. (2013). Various medical device images. Bard Access Systems, Inc. Retrieved October 2012 from http://www.bardaccess.com Camp-Sorrell, D. (2010). State of the science of oncology vascular access devices. Seminars in Oncology Nursing, 26(2), 80-87. Camp-Sorrell, D. (2009). Accessing and Deaccessing Ports: Where is the Evidence? Clinical Journal of Oncology Nursing, 13 (5), 587-590. Health Canada (2011). Health Alert: Complications of Catheter Pinch-off Associated with Central Vascular Access Devices. Canada: Author. Infusion Nurses Society. Infusion Nursing Standards of Practice, Journal of Infusion Nursing, 2011. 34,1S January/February