Portacath

A Port-a-Cath&reg; is a device for intravenous access in patients who require frequent or continuous administration of intravenous substances. It is produced by Smiths Medical MD, Inc. The term is also used generically for similar devices by other manufacturers (usually as portacath). The term totally implantable venous access system (TIVAS) is also used.

Uses
Port-a-Caths have many uses:
 * For total parenteral nutrition in those unable to take (adequate) food orally for a long period of time
 * For chemotherapy when this is administered continuously or frequently
 * For coagulation factors in patients with severe hemophilia

Alternatives include the Hickman line and the PICC line.

Principles
The Port-a-Cath is a combination of a port and an intravascular device. The intravascular device in inserted in a vein (usually the jugular vein or subclavian vein) and tunneled under the skin of the chest wall. There, a small device is inserted and connected to the venous line. The procedure is usually performed under sedation or general anesthetic.

The subcutaneous device has a chamber with a silicone membrane that can be accessed by puncturing the overlying skin with a Huber point needle, and fluids can be injected. As the puncture is very small, this can be repeated many times without compromising either the skin or the device. Due to its design, there is a very low infection risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the Hickman line.

After each use, a heparin lock is made by injecting a small amount of heparin (an anticoagulant) into the catheter. This prevents development of clots in the system.

Side-effects
Infection risk is low but not zero. Hemorrhage during insertion is possible. Conversely, thrombosis of the vein in which the line tip is dwelling may occur.