Port-a-Cath
Implantable Venous Port Placement

Indications

• Chemotherapy — multi-cycle regimens requiring reliable access
• TPN — long-term parenteral nutrition
• Repeated blood transfusions — poor peripheral access
• IV antibiotics — prolonged courses (endocarditis, osteomyelitis)
• Immunotherapy — regular infusions
• Blood sampling — frequent labs, difficult peripheral access
• Power port — CT contrast injection rated (power-injectable port)
• Pediatric ports — smaller reservoir, smaller catheter profile

Technique

• Right internal jugular — preferred access (straight course to SVC)
• Right subclavian — alternative; avoid left-sided (longer course)
• US guidance — IJ puncture under real-time ultrasound
• Catheter tip — cavoatrial junction (lower third SVC/RA junction)
• Fluoroscopy — tip confirmation before pocket closure
• Subcutaneous pocket — anterior chest wall, infraclavicular
• Port reservoir — anchored to fascia with non-absorbable suture
• Contrast injection — confirm flow, no extravasation

Complications and Troubleshooting

• Catheter tip malposition — reposition with snare or exchange
• Catheter occlusion — thrombotic vs mechanical (pinch-off syndrome)
• tPA (alteplase) — 2 mg for thrombotic occlusion, dwell 30–60 min
• Port infection — localized vs bacteremia; removal often required
• Port-related DVT — SVC, subclavian thrombosis; anticoagulation
• Pinch-off syndrome — catheter compression at clavicle-first rib
• Pneumothorax — subclavian access; post-procedure CXR
• Fibrin sheath — no aspiration; catheter stripping or exchange

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