Portacath

Question

Hello,
my daughter should get a portacath due to her poor veins. Are there any alternatives to the location near the calvicle as she does not want to have the portacath at the viewing area of the cleavage. And are the possible alternatives as secure resp. not more painful?
Many thanks,
M.

Answer

Hello,
your daughter should get a portacath implanted due to her poor venous situation. You reuqest, if there are any other locations for the portacath than "near the clavicle" and if those are as secure and which disadvantages might then occur.
Before the implantation of a portacath, the surgeon should discuss with the patient all advantages and disadvantages of the different positions of the portacath. Hereby aspects like hygiene, uncomplicated usage, that means the unproblematic puncture - also via the patient himself, location free of pressure, but also aspects of aesthetics have to be taken into account. After weighing of all aspects a position of the portacath should be determined together and the location of the portacath should be marked on the skin with a colored pencil at the day before implantation.
In general, the upper lateral quadrant of the choosen half of the thorax is proposed and turned out as the location of choice. The portacath is thereby fixed at the fascia of the pectoralis major muscle in order to aviod a slip or turn. It then lies on the bony thorax and can here be fixed well with two fingers for pucture. In this position, clearly below the clavicle, the portacath is hardly exposed at an increased pressure e.g. via the seatbelt or the straps of the clothes. In case of a not too extended cleavage, the portacath can in general not be seen if it is not in use. Other locations have been desired by the female patiens for reasons of aestehics and have also been carried out by the surgeons. In case the poprtacath is implanted more lateral in direction of the armpit or even in the armpit, the self-puncture done by the patient is not possible anymore. At the same time the location of the puncture needle is not as stable anymore (protected from movements), so that it can come to skin damages at the location of puncture and therefore to local infections more easily. For hygiene reasons, the location in the armpit has to be refused. The same applies for a location below the breast (sweating wrikle). Besides the risk of infection, there is a mechanical burden due to the pressure of the bra. Infections and ulcerations of the skin which have led to a removement of the portacath are known.
Theoretically there are also portacath systems which can be implanted in the arm. In case of a preexisting poor venous situation such a location is often not possbile anymore. At the same time it is in general the case that the patient can only hardly or not at all tap the portacath himself. The resting time of such portacaths is in general lower as with portacaths in the standard location.
From what was said can be concluded that your daughter should get to like the location of the upper lateral quadrant of the choosen half of the thorax. This location has already been used for good reasons from many generations of tumor patiens. As the portacath is used in general only in intervals, herewith an unworried nearly unaffected social life is possible.
We wish your daugher a good decision and a time of usage of the portacath as long as possible.
Yours sincerely,
Dr. H.-G. Posselt

29.01.2013