Implantation of a Port

Checklist:

Implantation of a Port

• Is the vein in question patent?

• Procedure: Giufeng has been assigned to Poznansky's outfit today and she enjoys the work in the team. She may hold the ultrasound probe during the puncture of the right femoral vein. "I normally use the right jugular vein but Mr. Stone has already had a thrombosis there," Poznansky explains to Giufeng. He introduces a guide-wire into the femoral vein and on into the iliac vein over which he advances the filter's introductory sheath. A preliminary contrast series via the sheath shows the situation in the vena cava (Fig. 7.13a). "I normally release the filter just below the inflow of the renal veins," he gestures to Giufeng. "Above the renal veins is risky because these veins may be obstructed—that is reserved for exceptional emergencies." He pushes the filter slowly into its proper position and releases it cautiously (Fig. 7.13b). "Sits in there like it's never been anywhere else," he jokes with Mr. Stone. "We're almost at the end. We'll retrieve the filter in a few weeks when you've recovered a bit." The introductory sheath is removed (Fig. 7.13c) and the puncture site is compressed with care for at least 20 minutes until the bleeding has stopped completely. Giufeng wants to do the compression, but Poznansky declines her help: "Compression is not trivial and a lot of complications arise from improper hemostasis at the end. And above all: He who punctures also compresses—that is an old angiographer's rule! You will get your chance."

How Do We Get That Infusion into This Patient?

Joe-James Fitzpatrick (53) has no more sizable veins after having received several cycles of chemotherapy for his lymphoma. The therapy was quite successful, but there is still residual tumor. The oncologists need a reliable vascular access for the last therapy cycle, which lasts at least six weeks. What they need is a vascular port. Dr. Foxhenry has gotten the hang of these ports lately. Giufeng is joining him for the procedure today.

^ Procedure: Under ultrasound guidance—Giufeng is holding the probe again—Foxhenry punctures the internal jugular vein after local anesthesia and a small skin incision. For that he makes sure Mr. Fitzpatrick's head is reclined below the cardiac level to prevent air embolism. He inserts a guide-wire and advances a sheath over it. Foxhenry introduces the port line through the sheath and advances it to the correct position in the superior vena cava under fluoroscopy. After that he opens a little skin pocket for the port reservoir over the pectoral muscle about 10-15 cm distant from the puncture site. The port reservoir is a little plastic or metal chamber with a membranous lid. It can be perforated without permanent da-

I Insertion of a Vena-Cava Filter

Radiographic Positioning Chart

Fig. 7.13 a Venography of the vena cava verifies the exact po- shows the filter at the correct level. Signs of osteosynthetic sition of the renal vein inflow. b After deployment, the position fusion and repair of a vertebral body fracture and some residual of the caval filter is documented. c The noncontrast radiograph contrast in the renal pelvis after the intervention.

Fig. 7.13 a Venography of the vena cava verifies the exact po- shows the filter at the correct level. Signs of osteosynthetic sition of the renal vein inflow. b After deployment, the position fusion and repair of a vertebral body fracture and some residual of the caval filter is documented. c The noncontrast radiograph contrast in the renal pelvis after the intervention.

I Implantation of a Port

0 0

Post a comment