Insertion[ edit ] Hickman lines are inserted under sedation or a general anesthetic by a radiologist or surgeon. The insertion involves two incisions, one at the jugular vein or another nearby vein or groove, and one on the thoracic wall. At the former incision site, a tunnel is created from there through to the latter incision site, and the catheter is pushed through this tunnel until it "exits" the latter incision. The exit area is where the lumen single, double or multiple comes out of the thoracic wall. The catheter at the entrance is then inserted back through the entrance site and advanced into the superior vena cava , preferably near the junction of it and the right atrium of the heart.
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A portacath is a tube catheter with a small reservoir port attached to it. It can be used to give chemotherapy or medicine into your vein, or to take blood sample for blood tests. Portacaths are also simply called ports and are sometimes called implantable ports or subcutaneous ports. The catheter is a thin, soft, flexible tube made of silicone. It is usually put in tunnelled under the skin of your chest or sometimes in your arm.
One end of the tube goes into a large vein just above your heart. The other end connects to the port. It goes under the skin on your upper chest or arm. You will be able to see and feel a small bump on your skin where the port is. What is a portacath used for? A port can be used to give you treatments such as: chemotherapy antibiotics intravenous IV fluids.
Ports can also be used when you need to have blood tests. You can go home with the port in. It can be left in for weeks, months or sometimes years. A port may also be useful if doctors or nurses find it difficult to get needles into your veins.
How is a portacath inserted? Portacath is usually inserted by a specially trained intervention radiologist in a special X-ray room in a hospital. You will usually have a local anaesthetic to numb the area.
You will usually be able to go home on the same day. Feel free to discuss the position of your port with Dr Goyal before it is put in. A small needle will be put into a vein in your arm or hand and you will have medicine to help you relax.
You will receive a local anaesthetic into your skin to numb a few small areas on your chest and neck. Two small cuts incisions will be made in your skin. The first is made to create a pocket under the skin for the port. It will be about 3—4cm long. If the port is being put into a vein in your chest, the incisions are made on your upper chest.
If the port is being put into a vein in your arm, they will be on the inner side of your arm. There will be a smaller cut in the neck region where the catheter is put into the vein.
This incision is usually less than half a cm long. The port will be inserted under the skin. The tube attached to the port will be tunnelled under your skin to the smaller incision, where it will be put into a vein in your chest.
The incisions are then stitched. The nursing team will teach you how to look after this. You may feel a bit sore and bruised for a few days after the port is put in. Simple painkillers such as paracetamol may help with this. Straight after the port has been put in, and for a few days after, check for any redness, swelling, bleeding, bruising, pain or heat around the wounds.
Let your hospital doctor, your own doctor or Dr Goyal know straight away if you have any of these. You could have an infection, which may need to be treated.
The incisions are closed with dissolvable stitches under the skin which will get dissolved on their own in a few weeks. How do I prepare for the procedure? Portacath is usually inserted as a day case procedure which means that you can come in, get the portacath inserted and go home the same day. Blood tests: Before the procedure, you will need to have a blood test to measure full blood count FBC and clotting. This will usually be arranged by your doctor or clinic nurse specialist.
If you are currently receiving chemotherapy, a blood test is needed within one week of the procedure. If you are not currently on chemotherapy a blood test within 8 weeks of the procedure is fine. If you have had a blood test for any other reason within this time we can use the results. Medications: If you are taking any medicines that thin your blood, such as antiplatelet medicines for example aspirin or clopidogrel or anticoagulant medicines for examples warfarin or rivaroxaban , please Dr Goyal or a team member as you may need to stop them temporarily before your procedure.
If you have coronary stents or metal heart valves in place then you should not stop these drugs. You must not eat or drink for six hours before the procedure. We may need to give you a sedative medicine, which may make you feel sick if you have just eaten. You will also need somebody to stay with you overnight. How is the portacath used? The port can be used soon after it has been put in. About half an hour before it is used, the skin over the port can be numbed with an anaesthetic cream Emla cream.
Just before you have your treatment or blood test, the skin will be cleaned. The nurse will then push a special needle, called a Huber needle, through the skin and into the port. It is very important that the port is only used this special needle as normal needles will damage the port. Treatment can then be given directly into the bloodstream, or blood samples can be taken.
If you are having a short treatment, the needle will then be removed. For longer treatments, you will have a dressing placed over the needle to hold it in place until your treatment is finished. The needle is then removed. The port will need to be flushed every four to six weeks if it is not being used regularly. If you feel able to, the nurses at the hospital will teach you how to do this. They can also teach a partner, relative or friend. A district nurse can also do it for you at home.
Your port will not need any other care. Possible problems with portacath The likelihood of problems with port is low. Most of the problems can be sorted with medication or simple interventions.
However, they may require removal and replacement of the port. Infection: It is possible for an infection to develop inside the catheter or around the port.
You should tell your hospital if you have redness, swelling or pain around the port, develop a high temperature fever , feel faint, shivery, breathless or dizzy. If an infection develops, you will be given antibiotics. Blood clots: It is possible for a blood to clot in the vein where the catheter sits. You should contact your hospital doctor or nurse if you notice any swelling, tenderness or redness in the neck or arm on the same side of the body as the port.
If a clot does form, you will be given medication to dissolve it. Your port may have to be removed. Blocked port: The inside of the catheter can sometimes become partly or completely blocked. If this happens, it can be difficult to give treatment or to take blood tests through it. The catheter may be flushed with a solution to try to clear the blockage, or the port may need to be removed.
How is the portacath removed? This is usually a much simpler procedure than insertion. A local anaesthetic is used to numb the area.
A small incision is made over the site of the port and the port removed. The catheter is gently pulled out of the vein. The wound is then stitched and covered with a small dressing. You may feel a bit sore and bruised after your port is removed. It is best to avoid strenuous exercise for a few weeks after insertion, so your body can heal. Only the Huber needles should be used on your port. You may want to wear a medical ID bracelet saying you have an implanted port.
If you need more information, please feel free to contact Dr Goyal. What is a Hickman line? Hickman line is a long, hollow tube made from silicone rubber. The Hickman line is put in tunnelled under the skin of your chest and into a nearby vein. One end of the line goes into a large vein just above your heart.
The other end comes out from under the skin on your chest. The line is usually sealed with a special cap or bung. This can be attached to a drip or syringe containing your chemotherapy or medication.
Sometimes it divides into two or three lines which allow you to have different treatments and medications at the same time. What is Hickman line used for?
Cuidados de Enfermería a Pacientes con Catéter Hickman