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Central venous access devices

Implantedvascularaccessdevices
Animplantedcentralvenousaccessdevice,oftenreferredtoasanimplantedportorby
thepopularbrandnamePortACath,isadeviceplacedundertheskinwithoutany
portionofitexitingtheskin.Itconsistsofasingleordoubleinjectionportwithaself
sealingsiliconeseptumcoveringametalorplasticreservoircalledthebody.The
catheterconnectstheportandreservoirtoacentralvein,typicallythesuperiorvena
cava.Animplantedportcanbeusedtoadministermedicationincludingchemotherapy,
todeliverfluids,andtodrawbloodsamples.
Thistypeofcentralaccessdeviceis
insertedinthesurgicalsuiteorinthe
radiologydepartment.Themostcommon
siteforimplantedportplacementisthe
anteriorchest,justbelowtheclavicle.
Otherlesscommonsitesforimplanted
portplacementincludetheupperarm,
theabdomen,andtheback.

ImplantedPort
Implantedportsareavailablewithsingle
ordoublelumens.Adoublelumenport
hastwononcommunicatingreservoirs.
Advantagesofimplantedportsarethat
theyarecosmeticallyappealing,they
havethelowestriskofinfectionofall
chestaccessedcentrallines,theyallow
patientstocarryonvirtuallyallactivities
includingbathingandswimmingwhenit
isnotinuse,andtheydonotrequire
exitsitecare.
Adisadvantageforthepatientwhohasanimplantedportisthataccessingitcanbe
painful.Checkforstandingordersforatopicalanesthetictoreducethediscomfort
associatedwithaccessingtheport.
Toaccesstheport,useanoncoring,nonbarbed(Huber)needle.Noncoringneedles
haveadeflectedpointthathelpsavoidseptalinjurybyslicingthroughtheseptum
withoutcoringoutatinypieceofiteachtimetheportisaccessed.Mostfacilities
policiesallowaccesstotheimplantedportwiththesameneedlefor7days.

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Implantedportsmaybeopenendedorvalved.Openendedportsrequireheparin
flushingwhilevalvedportsdonotrequireheparin.Youllfindmoredetailsinthe
acceptedpracticesectiononvalvetipsandopenendedtips.Andbesuretoreviewyour
facilityspoliciesaddressingthefrequencyofflushing.Whenanimplantedportisnot
accessed,monthlyflushingisusuallysufficient.

References
Dougherty,L.(2006).Centralvenousaccessdevices:Careandmanagement.Oxford,UK:Blackwell
Publishing.pp.91,95,97.
Ignatavicius,D.D.,&Workman,M.L.(2006).Medicalsurgicalnursing:Criticalthinkingforcollaborativecare
(5thed.).St.Louis,MO:ElsevierSaunders.p.251.
Rosenthal,K.(2006).Whatyouneedtoknowaboutports.Nursing2006,36(1),2021.
Smith,S.F.,DuellD.J.,&Martin,B.C.(2008).Clinicalnursingskills:Basictoadvancednursingskills(7th
ed.).UpperSaddleRiver,NJ:PearsonPrenticeHall,pp.11671171.

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