CASE STUDY OF RESTURING OF POURTACATH

Patients Information

Patient: A.G.T DATE: 2/11/14
Age: 43 y/o
Surgeon: Dr. Lencio L. Kaw
Anesthesiologist: Dr. Ma. Elena Malong
Type Of Anesthesia: General Anesthesia
Time of Operation: 7:38AM-8:19AM
Scrub Nurse: Karen Poblete RN
Circulating Nurse: Shielo Ann Alvaro RN

Diagnosis: Breast Cancer STP Mastectomy L
SP Pourtacath Insertion

Operation:Resuturing of Pourtacath

Patient had Mastectomy in the Left breast before and advised to have an implanted PourtaCath and place it in the right lower chest. Pourtacath should be place in the upper part of the chest but as for patient request , the doctor put it in the lower part. But after a few months of the operation the patient notice that the Pourtacath is not in place so she consult her doctor and have it checked. The doctor found out that the PourtaCath is really not in place so patient will need to undergo resuturing of Pourta cath.

As I go on with my case study I will discuss what is Pourtacath and what is it use. And what could be the possible reason why it is misplaced.

Why portacath?
A portacath is an implanted venous access device for patients who need frequent or continuous administration of chemotherapy.As for the patient case she need to undergo chemotherapy because she had undergo mastectomy due to breast cancer. Drugs used for chemotherapy are often toxic, and can damage skin, muscle tissue, and sometimes veins. They often need to be delivered into large central vein where the drugs are immediately diluted by blood stream and delivered efficiently to the entire body. Cancer patients also require frequent blood tests to monitor their treatments. For patient with difficult veins, it can be used for withdrawing blood for blood tests.

Using modern technique, the portacaths that have inserted are highly appreciated by patients, oncology nurses and doctors. The procedure is easily performed with minimal risk and pain, a very small price for the convenience and safety months and years ahead.

ANATOMY
This section reviews a few basic parts and functions of the body to help you understand where and how a port is placed. Blood carries nutrients and oxygen to all parts of the body. The heart pumps blood loaded with oxygen through arteries. The cells and tissues of the body use oxygen. When blood doesn’t have much oxygen in it anymore, it returns to the heart. The superior vena cava, also known as the SVC, is the main vein that blood flows through from the arms and head to get to the heart. Blood on its way to the heart from the head goes through two big veins in the neck called the Internal Jugular veins, or IJs. There is a right IJ and a left IJ. Blood on its way to the heart from the arms goes through two big veins under the collar bone called subclavian veins. There are 2 subclavian veins just like there are 2 IJs, one on each side of the body. The IJs and the subclavian veins both flow into the superior vena cava. The inferior vena cava is the main vein that blood flows through on its way to the heart from the abdomen and legs. The heart pumps blood poor in oxygen to the lungs. In the lungs, the blood gets loaded back up with oxygen and proceeds through the body. It then returns to the heart, and the cycle starts again.

What is a portacath?

A portacath consists of a reservoir (the portal) and a tube (the catheter). The portal is implanted under the skin in the upper chest. It may appear as a bump under the skin in thin patients, less visible in patients with thicker subcutaneous fat. The catheter runs in a tunnel under the skin, going over the collar bone and then enters the large vein in the lower neck (the internal jugular vein). Since it is completely internal so swimming and bathing is not a problem. The septum of the portal is made of a special self-sealing silicone rubber. It can be punctured up to one thousand times and therefore can be used for many years.

How is a portacath used?
The oncology nurse can locate the portal between his/her fingers. To administer treatment or to withdraw blood, the skin over the port is sterilized. The port is accessed by puncturing through the overlying skin with a Huber needle. The needle is specially designed so that it will not damage the silicone septum. Blood is sucked back to check if the port is functioning normally. Next, the portacath will be flushed with saline. Then, treatment will begin. After each use, the port is flushed with saline followed by dilute heparin to prevent clotting.

How is a portacath implanted?
The procedure is performed under local anaesthetic, with the aid of imaging guidance (ultrasound and X-ray) in the angiography suite of radiology department. The actual procedure takes less than an hour. An intravenous sedation is given to make the local anaesthetic injection less painful. As for the patient case they use general anesthesia because patient before scream a lot even if she could not feel the operation. There will be a skin incision 3cm long on the chest wall for the port pocket and a 5mm incision in the lower neck to enter the vein. Absorbable sutures are used for the chest wound and are buried under the skin. For the small neck wound, sutures are usually not required and the wound is closed with Steristrips (medical sticky tape).Steristrips is also the one that the doctor use in the operation.

Typically you can go home two hours following the procedure, when you have recovered from the sedation. You should arrange someone to take you home, as you are not allowed to drive or operating machinery for 24 hours.

Why pourtacath is misplaced?
Sometimes pourtcath is misplaced because of two reasons: 1. Patient has massive weight loss and 2. Patient is extremely exercising. As for the patient case the doctor said that the patient had really lose weight since she last saw her. He said that it may be the reason why the pourtacath is been misplaced.