40-5124-24C IFU, ProPort.indd - Smiths Medical

A. Percutaneous Puncture – Method A (Interventional Radiologists), a
technique commonly used by interventional radiologists for inserting the
catheter over a guidewire.
B. Percutaneous Puncture – Method B (Surgeons), a technique commonly
used by surgeons for inserting the catheter through the introducer sheath
after removing the guidewire.
C. Surgical Cutdown, a technique utilizing direct exposure of the vein to aid
in catheter insertion.
A. Percutaneous Puncture – Method A
(Interventional Radiologists)
This technique describes the use of a 21 gauge (0.81 mm) introducer needle, 0.018
in. (0.46 mm) guidewire, 4 Fr (1.35 mm) transitional dilating system (coaxial
catheter), and a 0.035 in. (0.89 mm) hydrophilic guidewire which are not supplied
with PORT-A-CATH® and PORT-A-CATH® II systems.
1. Place the patient in a supine position. Select the appropriate site for placement
of the catheter and portal. Verify the vein pathway using fluoroscopy or
ultrasound.
2. Prepare the puncture site by using standard aseptic technique and anesthetize
the vein insertion site.
3. For chest placement, puncture the skin with a 21 gauge (0.81 mm) introducer
needle (not supplied) below the clavicle at the lateral aspect of the junction of
its medial and middle third. To confirm that the needle is in the subclavian
vein, attach a syringe and aspirate gently as the needle is directed toward a
point slightly above and behind the suprasternal notch.
4. Remove the syringe if necessary, leaving the needle in place.
5. Insert a 0.018 in. (0.46 mm) guidewire through the needle.
6. Under fluoroscopic guidance, advance the guidewire tip to the desired location.
7. Remove the needle and discard it, leaving the guidewire in place.
8. Advance a 4 Fr (1.35 mm) transitional dilating system (coaxial catheter) over
the 0.018 in. (0.46 mm) guidewire. Remove the inner section of the transitional
dilating system.
9. Exchange the 0.018 in. (0.46 mm) guidewire with a 0.035 in. (0.89 mm) hydrophilic
guidewire. To reduce the opportunity for air embolism, place a finger over the
opened sheath until the catheter is inserted.
10. Replace the remaining section of the transitional dilating system with the
6 Fr (2.0 mm) dilator/sheath assembly using a twisting motion to advance the
assembly into the vein.
11. Remove the dilator from the introducer sheath, leaving the sheath in place
(Figure 1: A–Squeeze, B–Pull Back, C–Sheath, D–Dilator).
12. Place the end of the catheter (tipped end of polyurethane catheters) over the
hydrophilic guidewire and through the sheath and advance the catheter along
the hydrophilic guidewire to the desired location.
13. Withdraw the hydrophilic guidewire after the catheter tip is positioned.
14. Withdraw the sheath from the vessel gradually and, if using a peel away
sheath, at the same time pull outwards on the two tabs of the sheath peeling it
away from the catheter.
15.
16.
17.
WARNING: Failure to withdraw the sheath prior to peeling it may result in
tearing of the vein.
Using the blunt needle and a 10-ml or larger syringe, flush the catheter with
5 ml of heparin solution (10 to 100 IU/ml) and clamp it closed at the end to be
connected to the portal.
Confirm by fluoroscopy or x-ray that the distal tip of the catheter is positioned
at the desired location.
If appropriate, tunnel the catheter from the insertion site to the location for
the portal pocket.
Proceed to Portal Site Preparation.
B. Percutaneous Puncture – Method B
(Surgeons)
NOTE: When using pre-assembled or preconnected systems, first prepare the
portal pocket and then tunnel the catheter from the portal pocket to the vein
entry site. (See Portal and Site Preparation.) Before inserting the catheter in
the vein, determine the length needed and trim the distal end of the catheter
at a right angle.
This technique describes the use of an 18 gauge (1.3 mm) introducer needle, a
0.035 in. (0.89 mm) J-guidewire, and a 6 Fr (2.0 mm) introducer/sheath assembly
which are supplied with certain ProPort systems.
1. Place the patient in a supine position and select the appropriate vein for
placement of the portal and catheter. Mark the site for venipuncture.
2. Prepare the puncture site by using standard aseptic technique and anesthetize
the vein insertion site.
3. Puncture the skin with an 18 gauge (1.3 mm) introducer needle below the
clavicle at the lateral aspect of the junction of its medial and middle third. To
confirm that the needle is in the subclavian vein, attach a syringe and aspirate
gently as the needle is directed toward a point slightly above and behind the
suprasternal notch.
4. Remove the syringe if necessary, leaving the needle in place.
5. Slide the guidewire straightener over the 0.035 in. (0.89 mm) guidewire. Insert
the guidewire through the needle, far enough into the vein to determine that
the venous pathway is open.
6. Withdraw and discard the needle and guidewire straightener, leaving the
guidewire in place.
7. Make a small incision in the skin at the vein entry site to insert the dilator and
sheath assembly into the vein.
8. Introduce the dilator and sheath assembly over the guidewire with a twisting
motion and advance the assembly just past the soft tissue into the vein.
9. Remove the dilator and guidewire, leaving the sheath in place. (Figure 1:
A–Squeeze, B–Pull Back, C–Sheath, D–Dilator). To reduce the opportunity
for air embolism, place a finger over the opened sheath until the catheter is
inserted.
10. Advance the catheter (tipped end of polyurethane catheters) slowly and in
short increments through the sheath to the desired location.
11. Withdraw the introducer sheath from the vessel gradually and, if using a peel
away sheath, at the same time pull outwards on the two tabs of the sheath
peeling it away from the catheter.
12.
WARNING: Failure to withdraw the sheath prior to peeling it may result in
tearing of the vein.
For unassembled systems, using the blunt needle and a 10-ml or larger
syringe, flush the catheter with 5 ml heparin solution (10 to 100 IU/ml) and
clamp it closed.
For pre-assembled or preconnected systems, penetrate the septum with a
non-coring PORT-A-CATH® access needle and flush the system using a 10 ml
or larger syringe filled with 5 ml of heparin solution (10 to 100 IU/ml). Take
care not to manipulate the catheter/portal connection as system damage or
disconnection of the catheter from the portal could occur.
13. Confirm by fluoroscopy or x-ray that the distal tip of the catheter is positioned
at the desired location.
14.
For unassembled systems, tunnel the catheter from the insertion site to the
location for the portal pocket.
Proceed to Portal and Site Preparation.
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