Chest wall port

Fig.6.11a,b. Chest wall ports, a Chest X-ray appearance of a chest wall port inserted via the subclavian vein, b Chest X-ray appearance of a chest wall port inserted via the internal jugular vein. (Published with permission of W. B. Saunders Co.)... 

Central venous catheters vary in composition, lumen size, number of injection ports, and other special features that affect ease or convenience of care and maintenance. They may be placed for shorter long-term access. Frequently, short-term central venous access is obtained in critically ill neonates via a catheter placed in the umbilical vein. ° Other sites for central venous access in infants and older children are similar to those in adults. When therapy is expected to last longer than 4 weeks, the catheter usually is tunneled subcutaneously before entering the central vessel, secured initially with retaining sutures, and anchored in place with a felt cuff that promotes the growth of subcutaneous flbrotic tissue around the catheter. The injection port may remain external or be concealed entirely beneath the skin. Implanted central venous catheters have a larger port or reservoir that is surgically placed beneath the skin surface and anchored in the muscle of the chest wall. 

Long-term central venous access devices used for chemotherapy can be categorized into peripherally inserted central catheters (PlCCs), chest wall external catheters (tunneled and non-tunneled), and subcutaneous ports (chest wall and extremity). 

Subcutaneous implantable devices are composed of a reservoir component made of stainless steel, titanium, or plastic connected to a polyurethane or silicone catheter (Fig. 6.3). The reservoirs are implanted into the subcutaneous tissues in the chest wall, upper arm, or forearm (Jaques et al. 1992 Foley 1995 Kaufman et al. 1996). The stainless steel ports produce significant artifacts on computed tomography (CT) and magnetic resonance imaging (MRl), and are not often used in the chest wall location. Titanium ports cause only local MRI degradation and plastic ports result in minimal CT... 

Several factors influence the choice of a specific venous access device length and frequency of therapy patient comfort or activity ability to care for the device personal preference (physician, nurse, home health care and patient). Devices suitable for intermediate lengths of treatment (weeks to months) include PICCs, non-tunneled, and tunneled chest wall catheters. Longer therapies (months to years) favor tunneled external chest wall catheters and subcutaneous ports. Daily access would favor an external... 

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