{"id":22572,"date":"2017-10-14T16:41:01","date_gmt":"2017-10-14T20:41:01","guid":{"rendered":"http:\/\/www.stepwards.com\/?page_id=22572"},"modified":"2025-03-21T23:41:08","modified_gmt":"2025-03-22T03:41:08","slug":"interventional-radiology-procedures-chest-port-placement","status":"publish","type":"page","link":"https:\/\/www.stepwards.com\/?page_id=22572","title":{"rendered":"Interventional Radiology Procedures: Chest Port Placement"},"content":{"rendered":"<div id=\"toc_container\" class=\"no_bullets\"><p class=\"toc_title\">Page Contents<\/p><ul class=\"toc_list\"><li><a href=\"#OVERVIEW\"><span class=\"toc_number toc_depth_1\">1<\/span> OVERVIEW<\/a><\/li><li><a href=\"#IMPORTANT_CONSIDERATIONS_BEFORE_BEGINNING_THE_PROCEDURE\"><span class=\"toc_number toc_depth_1\">2<\/span> IMPORTANT CONSIDERATIONS BEFORE BEGINNING THE PROCEDURE<\/a><\/li><li><a href=\"#SUMMARY_OF_STEPS\"><span class=\"toc_number toc_depth_1\">3<\/span> SUMMARY OF STEPS<\/a><\/li><li><a href=\"#STEP_1_PREPARE_THE_PATIENT\"><span class=\"toc_number toc_depth_1\">4<\/span> STEP 1: PREPARE THE PATIENT<\/a><\/li><li><a href=\"#STEP_2_ESTABLISH_VASCULAR_ACCESS\"><span class=\"toc_number toc_depth_1\">5<\/span> STEP 2: ESTABLISH VASCULAR ACCESS<\/a><\/li><li><a href=\"#STEP_3_MEASURING_CATHETER_LENGTH\"><span class=\"toc_number toc_depth_1\">6<\/span> STEP 3: MEASURING CATHETER LENGTH<\/a><\/li><li><a href=\"#STEP_4_CREATE_CHEST_POCKET\"><span class=\"toc_number toc_depth_1\">7<\/span> STEP 4: CREATE CHEST POCKET<\/a><\/li><li><a href=\"#STEP_5_ASSEMBLE_CHEST_PORT\"><span class=\"toc_number toc_depth_1\">8<\/span> STEP 5: ASSEMBLE CHEST PORT<\/a><\/li><li><a href=\"#STEP_6_INSERT_CHEST_PORT\"><span class=\"toc_number toc_depth_1\">9<\/span> STEP 6: INSERT CHEST PORT<\/a><\/li><li><a href=\"#STEP_7_TAKE_FINAL_IMAGE\"><span class=\"toc_number toc_depth_1\">10<\/span> STEP 7: TAKE FINAL IMAGE<\/a><\/li><li><a href=\"#STEP_8_SUTURINGCLOSING\"><span class=\"toc_number toc_depth_1\">11<\/span> STEP 8: SUTURING\/CLOSING<\/a><\/li><li><a href=\"#STEP_9_APPLY_DRESSINGS\"><span class=\"toc_number toc_depth_1\">12<\/span> STEP 9: APPLY DRESSINGS<\/a><\/li><li><a href=\"#STEP_10_LEAVE_PORT_ACCESSED_OPTIONAL\"><span class=\"toc_number toc_depth_1\">13<\/span> STEP 10: LEAVE PORT ACCESSED (OPTIONAL)<\/a><\/li><\/ul><\/div>\n<h5><span id=\"OVERVIEW\"><span style=\"text-decoration: underline;\">OVERVIEW<\/span><\/span><\/h5>\n<p>This page is dedicated to describing how to conduct an\u00a0<strong>chest port placement.\u00a0<\/strong>This is a procedure that is commonly conducted in the field of interventional radiology in order to give patients a semi-permanent form of venous access (that can be used for intravenous treatments such as chemotherapy).<\/p>\n<p>Make sure to read\u00a0<a href=\"http:\/\/www.stepwards.com\/?page_id=24963\">this page dedicated to chest ports<\/a>\u00a0as well as <a href=\"http:\/\/www.stepwards.com\/?page_id=22577\">this page dedicated to their radiological appearance<\/a> as references.<\/p>\n<h5><span id=\"IMPORTANT_CONSIDERATIONS_BEFORE_BEGINNING_THE_PROCEDURE\"><span style=\"text-decoration: underline;\">IMPORTANT CONSIDERATIONS BEFORE BEGINNING THE PROCEDURE<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>What Type Of Port Will Be Placed:<\/strong><\/span><\/p>\n<p>There are multiple models and types of chest ports. It is important to make sure the specific type of device that will be implanted is decided upon prior to the procedure.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>Patient Risk For Bleeding:<\/strong><\/span><\/p>\n<p>There are a few lab values that are evaluated to evaluate if a patient contains a significant risk for bleeding (and if it is safe to conduct this procedure):<\/p>\n<ul>\n<li><strong>INR:\u00a0<\/strong><\/li>\n<li><strong>Platelet count:\u00a0<\/strong><\/li>\n<li><strong>Hemoglobin:\u00a0<\/strong><\/li>\n<\/ul>\n<p><strong><u>What Side Will\u00a0The Port Be Placed On\/What Venous Access Point Will Be Used?<\/u><\/strong><\/p>\n<p>Typically chest ports placed by interventional radiologists are placed on the right side of the patient, using the <a href=\"http:\/\/www.stepwards.com\/?page_id=22589\">internal jugular\u00a0<\/a><span style=\"color: #0000ee;\"><u>vein<\/u><\/span>\u00a0as an access point. In certain circumstances however (in cases of anatomical complications etc) ports may have to be placed on the opposite side\/with a different access point.<\/p>\n<h5><span id=\"SUMMARY_OF_STEPS\"><span style=\"text-decoration: underline;\">SUMMARY OF STEPS<\/span><\/span><\/h5>\n<p>Here are the major steps of performing a chest port implantation:<\/p>\n<ol>\n<li><strong>Prepare the patient<\/strong><\/li>\n<li><strong>Establishing vascular access\u00a0<\/strong><\/li>\n<li><strong>Measuring catheter\u00a0length\u00a0<\/strong><\/li>\n<li><strong>Create chest\u00a0pocket\u00a0<\/strong><\/li>\n<li><strong>Assemble chest port\u00a0<\/strong><\/li>\n<li><strong>Insert chest port<\/strong><\/li>\n<li><strong>Take final image\u00a0<\/strong><\/li>\n<li><strong>Suture chest port in place<\/strong><\/li>\n<li><strong>Suturing\/closing\u00a0<\/strong><\/li>\n<li><strong>Apply dressings<\/strong><\/li>\n<li><strong>Leave port accessed (optional)<\/strong><\/li>\n<\/ol>\n<h5><span id=\"STEP_1_PREPARE_THE_PATIENT\"><span style=\"text-decoration: underline;\">STEP 1: PREPARE THE PATIENT<\/span><\/span><\/h5>\n<p>The neck and chest on the site of where the port will placed needs to be sterilized and draped. Both the neck and upper chest need to be exposed to allow for vascular access<\/p>\n<h5><span id=\"STEP_2_ESTABLISH_VASCULAR_ACCESS\"><span style=\"text-decoration: underline;\">STEP 2: ESTABLISH VASCULAR ACCESS<\/span><\/span><\/h5>\n<p>In the case of chest port implantation, usually the <a href=\"http:\/\/www.stepwards.com\/?page_id=22589\">internal jugular vein<\/a> on the side the port will be implanted will be accessed. With the guidance of ultrasound the <a href=\"http:\/\/www.stepwards.com\/?page_id=22589\">internal jugular vein<\/a> should be accessed right above the clavicle (right above the level where it joins the <a href=\"http:\/\/www.stepwards.com\/?page_id=22064\">subclavian vein<\/a>).\u00a0For reference, read\u00a0<a href=\"http:\/\/www.stepwards.com\/?page_id=22088\">the page on establishing vascular access<\/a>.<\/p>\n<figure id=\"attachment_22684\" aria-describedby=\"caption-attachment-22684\" style=\"width: 676px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4.png\"><img loading=\"lazy\" class=\" wp-image-22684\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4.png\" alt=\"\" width=\"686\" height=\"531\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4.png 796w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-300x232.png 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-768x594.png 768w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-100x77.png 100w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-150x116.png 150w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-200x155.png 200w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-450x348.png 450w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/4-600x464.png 600w\" sizes=\"(max-width: 686px) 100vw, 686px\" \/><\/a><figcaption id=\"caption-attachment-22684\" class=\"wp-caption-text\">This ultrasound image is from a chest port procedure where a micro puncture needle (NT stands for needle tip) has been inserted into the internal jugular vein (IJ). The carotid artery (CA) is also seen on this image.<\/figcaption><\/figure>\n<p>Once access is established, the micro-wire (in the micro-puncture kit used to gain access) can be exchanged for a larger guide wire. This larger guide wire should be inserted into the jugular vein, all the way into the <a href=\"http:\/\/www.stepwards.com\/?page_id=8442\">inferior vena cava<\/a>. The wire should be inserted until the point that it goes beneath the diaphragm (on the right side of the patient). This confirms proper location of the wire as the <a href=\"http:\/\/www.stepwards.com\/?page_id=8442\">inferior vena cava<\/a> is the only venous structure that can go beneath the diaphragm from that can be reached from the <a href=\"http:\/\/www.stepwards.com\/?page_id=22589\">internal jugular vein<\/a>.<\/p>\n<figure id=\"attachment_22690\" aria-describedby=\"caption-attachment-22690\" style=\"width: 592px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5.png\"><img loading=\"lazy\" class=\" wp-image-22690\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5.png\" alt=\"\" width=\"602\" height=\"636\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5.png 663w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-284x300.png 284w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-100x106.png 100w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-150x158.png 150w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-200x211.png 200w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-300x317.png 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-450x475.png 450w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/5-600x633.png 600w\" sizes=\"(max-width: 602px) 100vw, 602px\" \/><\/a><figcaption id=\"caption-attachment-22690\" class=\"wp-caption-text\">This image was taking under fluoroscopy after access was gained into the right internal jugular vein. It shows the guide wire tip (white arrow) well below the level of the right diaphragm (black arrow). This confirms proper location of the guide wire in the inferior vena cava.<\/figcaption><\/figure>\n<h5><span id=\"STEP_3_MEASURING_CATHETER_LENGTH\"><span style=\"text-decoration: underline;\">STEP 3: MEASURING CATHETER LENGTH<\/span><\/span><\/h5>\n<p>There are multiple ways that one can measure the length of the chest port catheter to ensure that its tip will sit in the correct location in the atrial\/caval junction. After establish vascular access, where the location of the incision (for the placement of the chest port) should be marked. Generally this site should be ~4 finger breadths below the clavicle (on the side of vascular access).<\/p>\n<p>After this site has been marked, the tip of the guide wire present inside the <a href=\"http:\/\/www.stepwards.com\/?page_id=22589\">internal jugular vein<\/a> of the patient should be drawn back to ~2 vertebral bodies below the level of the carina. This is generally the level at which the catheter tip should sit. The external end of the wire should be pressed against the patient&#8217;s body (in the general trajectory that the tunneled catheter will eventually take) and the wire should be clamped at the level of the marked incision. This clamped wire can now be removed and measured from its tip to where it is clamped. This should accurately approximate the length of the catheter that is needed.<\/p>\n<p>The catheter tubing can now be trimmed to the measured length.<\/p>\n<h5><span id=\"STEP_4_CREATE_CHEST_POCKET\"><span style=\"text-decoration: underline;\">STEP 4: CREATE CHEST POCKET<\/span><\/span><\/h5>\n<p>Now that the incision site has been marked (again ~4 finger breadths below the clavicle) the chest pocket can be created where the port<\/p>\n<h5><span id=\"STEP_5_ASSEMBLE_CHEST_PORT\"><span style=\"text-decoration: underline;\">STEP 5: ASSEMBLE CHEST PORT<\/span><\/span><\/h5>\n<p>Each port kit can be slightly unique, however the general principle of assembling the port is the same. The trimmed catheter is connected to the port.<\/p>\n<p>After the port is assembled it can be tested to make sure that it flushes properly.<\/p>\n<h5><span id=\"STEP_6_INSERT_CHEST_PORT\"><span style=\"text-decoration: underline;\">STEP 6: INSERT CHEST PORT<\/span><\/span><\/h5>\n<p>After the port is flushed, the tip of the catheter can be connected to the tunneling device included in the kit.<\/p>\n<p>If the chest port is going to be sutured in place, 2-0 proline can be used to throw 2 sutures on either side of the port (through deep dermal tissues) to keep the port in place. At this time these sutures will not be tied, but they will be clamped.<\/p>\n<h5><span id=\"STEP_7_TAKE_FINAL_IMAGE\"><span style=\"text-decoration: underline;\">STEP 7: TAKE FINAL IMAGE<\/span><\/span><\/h5>\n<p>At the end of most IR cases a final image will be acquired to show that the procedure was a success. In the case of a chest port placement a PA frontal image is taken of the chest that should include the entire implanted chest port, and should demonstrate that the catheter is ~ 2 vertebral bodies lower then the level of the carina.<\/p>\n<figure id=\"attachment_22694\" aria-describedby=\"caption-attachment-22694\" style=\"width: 622px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6.png\"><img loading=\"lazy\" class=\"size-full wp-image-22694\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6.png\" alt=\"\" width=\"632\" height=\"661\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6.png 632w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-287x300.png 287w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-100x105.png 100w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-150x157.png 150w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-200x209.png 200w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-300x314.png 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-450x471.png 450w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2017\/10\/6-600x628.png 600w\" sizes=\"(max-width: 632px) 100vw, 632px\" \/><\/a><figcaption id=\"caption-attachment-22694\" class=\"wp-caption-text\">This final image was taken under fluoroscopy after a chest port was implanted. The catheter tip (white arrow) is rough 2 vertebral bodies below the level of the carina (black arrow).<\/figcaption><\/figure>\n<h5><span id=\"STEP_8_SUTURINGCLOSING\"><span style=\"text-decoration: underline;\">STEP 8: SUTURING\/CLOSING<\/span><\/span><\/h5>\n<p>After the final image is taken, and the port\/catheter is confirmed to be in ideal position, the proline suture that was thrown through the deep dermal issues can be tied to the port to keep it secure in place.<\/p>\n<p>2-0 Vicryl sutures can be used to close the deep dermal layer (interrupted buried sutures).<\/p>\n<p>4-0 Vicryl sutures can be used for closing the subcuticular layer (running subcuticular suturing technique).<\/p>\n<h5><span id=\"STEP_9_APPLY_DRESSINGS\"><span style=\"text-decoration: underline;\">STEP 9: APPLY DRESSINGS<\/span><\/span><\/h5>\n<p>&nbsp;<\/p>\n<h5><span id=\"STEP_10_LEAVE_PORT_ACCESSED_OPTIONAL\"><span style=\"text-decoration: underline;\">STEP 10: LEAVE PORT ACCESSED (OPTIONAL)<\/span><\/span><\/h5>\n<p>&nbsp;<\/p>\n<pre>Page Updated: 10.14.2017<\/pre>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Page Contents1 OVERVIEW2 IMPORTANT CONSIDERATIONS BEFORE BEGINNING THE PROCEDURE3 SUMMARY OF STEPS4 STEP 1: PREPARE THE PATIENT5 STEP 2: ESTABLISH VASCULAR ACCESS6 STEP 3: MEASURING CATHETER LENGTH7 STEP 4: CREATE CHEST POCKET8 STEP 5: ASSEMBLE CHEST PORT9 STEP 6: INSERT CHEST PORT10 STEP 7: TAKE FINAL IMAGE11 STEP 8: SUTURING\/CLOSING12 STEP 9: APPLY DRESSINGS13 STEP &#8230; <a title=\"Interventional Radiology Procedures: Chest Port Placement\" class=\"read-more\" href=\"https:\/\/www.stepwards.com\/?page_id=22572\" aria-label=\"More on Interventional Radiology Procedures: Chest Port Placement\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21302,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false},"jetpack_shortlink":"https:\/\/wp.me\/P71awf-5S4","_links":{"self":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/22572"}],"collection":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22572"}],"version-history":[{"count":3,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/22572\/revisions"}],"predecessor-version":[{"id":28755,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/22572\/revisions\/28755"}],"up":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/21302"}],"wp:attachment":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22572"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}