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‘PORTACATH INSERTION’ AND ITS LEARNING CONSTRAINTS FOR THE SURGICAL TRAINEES
Author(s) -
Ashrafi M. W.,
Ashrafy M.,
Lamont P. M.,
Ashrafi A. N.,
Bakshi H.,
Tillekeratne K.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04932_9.x
Subject(s) - medicine , clavicle , surgery , fibrous joint , complication , general surgery
Purpose: 1 To discuss the difficulties encountered in Portacath insertion by the surgeons. 2 To point out that the follow up of a patient with Portacath rarely happens in surgical clinic until there is some complication.Methods: Hospital records of three years were followed to generate the data. Over 169 patients have been done Portacath in a rural hospital. In last four years from January 2005 to December 2008. 157 patients have been for cancer, 2 for IDDM with no available vein to access and one patient for prolonged IV antibiotic therapy. Infection of Portacath happened in 8 improved with oral AB – 6, 2 needed removal and reinsertion later. Last two patients been diabetic. We use assembled Portacaths produced by ‘BARD’. We prefer left infraclavicular area as reservoir site unless contraindicated. Results: In female patients anchorage of the reservoir is must, but in male patients because of thin soft tissue in chest wall, a good primary positioning may avoid suture anchorage. Surgical trainees have very minimum chance to learn how to insert a Portacath. This is not an easy procedure as it is often thought. Learning curve in this procedure towards perfection is very much subjective and diverse. Conclusion: our experience says:– Assembled ones are better. – Left infraclavicular area is better. – Angulations at the lower border of clavicle should not be very close to clavicle – Kinking should be avoided at the time of insertion. – Image intensifier guidance is mandatory. – Patency test should not be with smaller syringe.