Venous access ports are implanted devices used to provide long-term vascular access for medication, fluids, or blood transfusions. They are safer and have fewer complications than other access methods like tunneled catheters. Ports are placed surgically under ultrasound or fluoroscopy guidance, with the port body implanted just under the skin and the catheter threaded into a large vein leading to the heart. Proper placement and care of ports can provide reliable access for years with minimal risks of infection, thrombosis, or other issues.

1. Venous Access Ports
Dr. Oğuz Kızılkaya
Trakya University Pediatric Surgery Clinic
oguz@fikrikumbara.com

3. 1929, Forssman plastic cannula toward his own heart by peripheral arm vein
1952, Aubaniac catheterization of subclavian vein to access the central venous circulation
1973, Broviac; 1977, Hickman; silicone-based venous access devices (VADS)
For parenteral nutrition
Safe, efficient, and rapid svad insertion ( >200,000 venous port insertion)
Radiologic port placement experience fewer complications
- Venous thrombosis
- Infection,
- Wound dehiscence,
- Catheter occlusion,
- Superficial phlebitis
than surgical patients.

4. Aubaniac catheterization of subclavian vein Broviac-Hickman; silicone-based venous access device

5. Latest ports are
- Lighter,
- Radiolucent,
- MRI compatible,
- Power-injectable for enhanced cross-sectional imaging
Septum tolerates 2000 noncoring punctures
Coring needles,
- Make holes in the septum
- Decrease port life
- Blood reflux
- Thrombosis and infection after only a few punctures
Polyurethane Polysiloxanes
- Greater wall strength - Kink-resistant
- Greater inner lumen - Comfortable
Choice of VAD relies on personal preference

6. Groshong-type catheters
Pressure Activated Safety
Valve
Open end
catheters
Saline flushes
to
maintain
patency
Heparin flushes to
maintain patency
Decreased phlebitis and
infection
Not power-injectable

7. Tunneled VAD
- Chronic but continuous
- Blood stream infections 1.6/1000 catheter days
Port Catheter
- Long-term intermittent
- Blood stream infections 0.1/1000 catheter days

9. Contraindications to ports
- Severe, uncorrectable coagulopathies
- Uncontrolled sepsis or positive blood cultures
- Burns, trauma, or neoplasm on chest Wall / Cystic fibrosis
- Alternate position, arm and abdomen.
- Cachectic and malnourished / fragile skin

10. Ultrasound puncture of the internal jugular vein with
angled transverse puncture along the scan plan of the
transducer.

11. Puncture of the jugular vein greater in the neck leads to
poorer cosmesis and problems with catheter kinking,
thrombosis and withdrawal

12. Ultrasound image of needle (arrows) entering the low righ
internal jugular vein.

13. The port catheter (arrow) is now attached to
saline flush after it was positioned in the
SVC by way of a sheath. An incision for the
port is made >5 cm from the entry site.

14. The stay sutures are positioned and tagged
(arrows) after the pocket is dissected to a
sufficient size and depth and the catheter is
tunneled from the entry site to the pocket.

15. After confirming the catheter tip
position with fluoroscopy, the
catheter is trimmed and connected
to the port, which is then slid into
the pocket.
0.2% port-inversion incidence
(1 case) in >500 chest ports
positioned without fascial suture
fixation
Lock the port with 100 U/cc heparin
after
each use or monthly during times of port
inactivity.

16. Final closure of pocket and entry
site with resorbable subcuticular
sutures

17. Immediate complications
- Bleeding problems,
- Air embolism,
- Pneumothorax,
- Wound dehiscence,
- Catheter migration,
- Catheter tip malposition,
- Cardiac perforation
- And arrhythmias,
- Entry site ecchymoses
- Adhesive dermatitis
- Pocket hematomas
- Abscess formation

18. The catheter tip is suboptimally positioned, causing
arrhythmias or the inability to aspirate (due to endhole
occlusion by the Wall of the superior vena cava)
The optimal position for port catheter tip placement is at
the cavoatrial junction, which decreases later thrombotic
complications while minimizing arrhythmias from atrial tip
position This location is approximately 2 vertebral bodies
below the carina on frontal chest fluoroscopy
If the tip is placed too high in the SVC, it may ‘‘flip’’ into
the internal jugular vein or contralateral brachiocephalic
vein
Method of correction is to inject saline forcefully through
the port using a 1- or 3-cc syringe.

19. Long-Term Complications
Infectious and thrombotic issues in stable patients with suspected
port infection salvage maneuver is augmented by use of the
‘‘antibiotic lock,’’ which consists of high-concentration antibiotic-and
heparin solution infused into the catheter lumen and fibrin sheath
space between uses
Thrombotic sequelae of ports occur in two forms:
(1) stenosis or occlusion of the host vein due to trauma to the
venous wall and
(2) catheter tip thrombus from intravascular protein and cell
deposition.
The latter process begins almost immediately after catheter
placement when albumin, lipoprotein, and fibrinogen create a
protein sleeve around fresh intravascular catheters within 24 h of
placement.
Eventually, coagulation factors and platelets congregate to
completely envelop the catheter, a process known as ‘‘fibrin
sheathing’’

20. Short infusions of thrombolytics generally restore
catheter patency and function with an 88% success
rate.
The Cardiovascular Thrombolytic to Open Occluded Lines
(COOL-2) trial found similarly a cumulative 87% flow-
restoration rate in venous catheters after infusing one to
two doses of 2 mg tPA with a maximum 120-min dwell
time. Most importantly, there was a 0% rate of intracranial
hemorrhage using this approach
Additionally, despite manufacturers’ recommendations that
ports be flushed every 4 weeks, many operators have
adopted the practice of port flushes every 3 months with
no increase in thrombotic or infectious complications and
much improved patient compliance and satisfaction
Stenosis or occlusion of the accessed vein occurs in a
subset of patients receiving ports and results due to
injury
to the venous wall occurring during puncture and
dilation.