l
The Port-A-Cath and Per-QKath Laura J. Hammond,
MSN,
n
RN
Venous access in acute and chronically ill patients can become problematic when attempting to maintain a reliable system. The need for safe and dependable intravascular systems has become quite evident. This article examines the Port-A-Cath (Pharmacia, Inc., St. Paul, MN) and the Per-Q-Cath (Gesco International, Inc., San Antonio, TX). These systems are preferred by several patient populations who require frequent or prolonged intravenous therapy. J PEDIATR HEALTH CARE. (1991). 5, 31-33.
M
aintaining intravenous accessduring long-term therapy is a challenge in both acute and chronic conditions. Although various percutaneous and totally implantable devices exist, the practitioner is charged with selecting a device that is safe, reliable, and both acceptable to and affordable for the patient. Two intravascular devices, the Port-A-Cath (Pharmacia, Inc., St. Paul, MN) and the Per-Q-Cath (Gesco International Corp., San Antonio, TX), have demonstrated safety, reliability and long-term effectiveness when used in the hospital or at home. The following article focuses on both devices and includes information on pros and cons, cost, reliability, and patient satisfaction. The Port-A-Cath is a totally implantable device consisting of a silicone catheter attached to a 2.5 x 1.3 cm stainless steel chamber with a selfsealing injection port (Fig. 1). The catheter connected to the port is tunneled subcutaneously and inserted into either the external jugular or cephalic vein. At this point, the catheter advances proximally to the lefi subclavian vein and enters the superior vena cava. The optimal position of the catheter tip is the upper right atrium. This device is placed by a surgeon while the patient is under general anesthesia. Access to the Port-A-Cath is then obtained externally with a 90” bent huber needle through the skin to the bottom of the portal chamber (Fig. 2). The criteria for considering use of the Port-A-Cath should include whether patients have poor peripheral
Laura Hammond is a recent graduate of the Master’s Program in Nursing at Vanderbilt University, Nashville, Tennessee. Ms. Hammond currently works as a nurse practitioner in adolescent medicine at Vanderbilt University Hospital. Reprint requests: Laura I. Hammond, 436 Medical Center South, Vanderbilt 3571.
MSN, RN, Adolescent University, Nashville,
25/l/20997
JOURNAL
OF PEDIATRIC
HEALTH
CARE
Medicine, TN 37232-
n FIGURE 1 The Port-A-Cath has a stainless steel selfsealing injection port with a silicone catheter attached.
intravenous (IV) access, whether patients require at least three course of IV therapy per year, and whether the patient will comply in the overall care of the device to ensure its reliability (Cassey, Ford, O’Brien, & Martin, 1988). The Port-A-Cath can be placed in individuals ranging in age from 4 months to adulthood. In females placement of the Port-A-Cath is recommended near the clavicle to avoid the upper breast; in males placement is recommended a few centimeters above the nipple where subcutaneous fat is thin.
T
he Port-A-Cath
individuals adulthood.
ranging
can be placed in in age from
4 months
to
Advantages of using the Port-A-Cath include that it allows freedom of activity for the patient, its ease of care, and that it is less conspicuous. The device is used for parenteral delivery of medications, fluids, nutritional solutions, and for blood sampling. When the Port-A-Cath is not being accessed, no dressing change is necessary; however, heparin flushes to 31
32
n
Hammond
Volume 5, Number 1 January-February 1991
FIGURE 2 A transparent
Port-A-Cath
dressing covers the accessed with a 90” bent huber needle.
maintain the port are required every 4 to 6 weeks. The Port-A-Cath can be punctured up to 2000 times and will remain intact an average of 5 years. Disadvantages of the Port-A-Cath include the initial high cost of placement (approximately $2000 to $3000). Conversely, however, it also has low maintenance fees. Occasional complications include catheter occlusion (4%), infection (3%), and catheter tip migration (2%) (Lambert, Chadwick, McMahon, & Scarfee, 1988). Despite the disadvantages, patients electively choose the Port-A-Cath for its reliability, safety, and comfort (Saucy, 1987). The Per-Q-Cath is a Silastic radiopaque percutaneous venous catheter that is placed with a small introducer needle (Fig. 3). The catheter is inserted into either the basilic or cephalic vein and threaded into the subclavian vein. Catheter tip placement is suggested at the juncture of the superior vena cava and in the right atrium. The Per-Q-Cath is available in various sizes of needles with catheters that come
T
he Per-Q-Cath is available in various sizes of needles with catheters that come with or without a guidewire.
with or without a guidewire. It is appropriate for use in neonates to adults (Fig. 4). A surgeon or trained health care provider can insert the Per-Q-Cam The patient does not need to be anesthetized, which reduces the cost of insertion.
n FIGURE 3 The Per-Q-Cath has an introducer needle and Silastic catheter that is measured and cut to the appropriate length to reach the right atrium.
The Per-Q-Cath is recommended when IV access is necessary for 1 week to 6 months. This catheter is able to deliver medications, fluids, nutritional solutions, and blood. Other advantages include low cost (approximately $50 dollars for placement), ease of insertion, and lack of complications. Maintenance requirements include a transparent dressing that is changed only when sterility or dislodgment of the catheter is threatened. Patients prefer the increased comfort level and decreased number of venipunctrues. Patients using this device are able to return to normal activity without impedance of arm activity (Dietrich & Lobas, 1988). Disadvantages of the Per-Q-Cath include daily heparin flushes, the presence of an external dressing, and the limited use time of 6 months. Complications of the Per-Q-Cath are few but inelude thrombophlebitis (13%), leaking at the insertion site (5%), breakage at the catheter and hub junction, and drug reactions (2%) (Chanthas, 1986). In several studies, no catheter infections or sepsis were found with the Per-Q-Cath (Williams, Smith, Woods, & Weller, 1988; Dietrich & Lobas, 1988). Despite these complications and disadvantages, the Per-Q-Cat& has proven to be an easy and safe device and its use as the single IV accesshas been satisfactory
journal of Pediatric Health Care
w FIGURE 4 A transparent
Port-A-Cath
dressing
covers
the
accessed
Per-Q-Cath
in the
cephalic
vein
33
of
an adult.
B0th the
Port-A-Cath and the Per-Q-Cath have been proved to be safe, dependable, and cost effective for many patient populations.
in 80% of reported cases (Dietrich & Lobas, 1988). These two devices are recommended by the author for use in patients who require repeated or long-term IV therapy. Both the Port-A-Cath and Per-Q-Cath have been proved safe, dependable, and cost effective for many patient populations. The practitioner is encouraged to examine both devices and others to knowledgeably choose the best device for a patient’s hospital or home IV therapy. n
REFERENCES Casey J., Ford, W. D. A., O’Brien, L., & Martin, A. J. (1988). Totally implantable system for venous accessin children with cystic fibrosis. Clinical Pediutrh, 27, 91-94. Chathas, M. K. (1986). Percutaneous central venous catheters in neonates. journal of Obstti, C+ncwl&c and Neonatal Nmin&, 15, 324332. Dietrich, K. A., & Lobas, J. G. (1988). Use of a single Silastic intravenous catheter for cystic fibrosis pulmonary exacerbation. P&ztric Pl4hwtw&, 4, 181-184. Lambert, M. A., Chadwick, G. A., McMahon, A., & Scarke, J. H. (1988). Experience with the Port-a-Cath. Hematoltgv o+ludo@, 6, 57-63. Saucy, P. (1987). Experience with the use of the Port-a-C& in children. Jouwal oj-Pediuhc Surgrry, 22, 767-769. Williams, J., Smith, H. L., Woods, C. G., &Weller, P. H. (1988). silastic catheters for antibiotics in cystic fibrosis. A~chiws of LXreaser in Chilrihood, 63, 658-659.
The Port-A-Cath and Per-QKath Laura J. Hammond,
MSN,
n
RN
Venous access in acute and chronically ill patients can become problematic when attempting to maintain a reliable system. The need for safe and dependable intravascular systems has become quite evident. This article examines the Port-A-Cath (Pharmacia, Inc., St. Paul, MN) and the Per-Q-Cath (Gesco International, Inc., San Antonio, TX). These systems are preferred by several patient populations who require frequent or prolonged intravenous therapy. J PEDIATR HEALTH CARE. (1991). 5, 31-33.
M
aintaining intravenous accessduring long-term therapy is a challenge in both acute and chronic conditions. Although various percutaneous and totally implantable devices exist, the practitioner is charged with selecting a device that is safe, reliable, and both acceptable to and affordable for the patient. Two intravascular devices, the Port-A-Cath (Pharmacia, Inc., St. Paul, MN) and the Per-Q-Cath (Gesco International Corp., San Antonio, TX), have demonstrated safety, reliability and long-term effectiveness when used in the hospital or at home. The following article focuses on both devices and includes information on pros and cons, cost, reliability, and patient satisfaction. The Port-A-Cath is a totally implantable device consisting of a silicone catheter attached to a 2.5 x 1.3 cm stainless steel chamber with a selfsealing injection port (Fig. 1). The catheter connected to the port is tunneled subcutaneously and inserted into either the external jugular or cephalic vein. At this point, the catheter advances proximally to the lefi subclavian vein and enters the superior vena cava. The optimal position of the catheter tip is the upper right atrium. This device is placed by a surgeon while the patient is under general anesthesia. Access to the Port-A-Cath is then obtained externally with a 90” bent huber needle through the skin to the bottom of the portal chamber (Fig. 2). The criteria for considering use of the Port-A-Cath should include whether patients have poor peripheral
Laura Hammond is a recent graduate of the Master’s Program in Nursing at Vanderbilt University, Nashville, Tennessee. Ms. Hammond currently works as a nurse practitioner in adolescent medicine at Vanderbilt University Hospital. Reprint requests: Laura I. Hammond, 436 Medical Center South, Vanderbilt 3571.
MSN, RN, Adolescent University, Nashville,
25/l/20997
JOURNAL
OF PEDIATRIC
HEALTH
CARE
Medicine, TN 37232-
n FIGURE 1 The Port-A-Cath has a stainless steel selfsealing injection port with a silicone catheter attached.
intravenous (IV) access, whether patients require at least three course of IV therapy per year, and whether the patient will comply in the overall care of the device to ensure its reliability (Cassey, Ford, O’Brien, & Martin, 1988). The Port-A-Cath can be placed in individuals ranging in age from 4 months to adulthood. In females placement of the Port-A-Cath is recommended near the clavicle to avoid the upper breast; in males placement is recommended a few centimeters above the nipple where subcutaneous fat is thin.
T
he Port-A-Cath
individuals adulthood.
ranging
can be placed in in age from
4 months
to
Advantages of using the Port-A-Cath include that it allows freedom of activity for the patient, its ease of care, and that it is less conspicuous. The device is used for parenteral delivery of medications, fluids, nutritional solutions, and for blood sampling. When the Port-A-Cath is not being accessed, no dressing change is necessary; however, heparin flushes to 31
32
n
Hammond
Volume 5, Number 1 January-February 1991
FIGURE 2 A transparent
Port-A-Cath
dressing covers the accessed with a 90” bent huber needle.
maintain the port are required every 4 to 6 weeks. The Port-A-Cath can be punctured up to 2000 times and will remain intact an average of 5 years. Disadvantages of the Port-A-Cath include the initial high cost of placement (approximately $2000 to $3000). Conversely, however, it also has low maintenance fees. Occasional complications include catheter occlusion (4%), infection (3%), and catheter tip migration (2%) (Lambert, Chadwick, McMahon, & Scarfee, 1988). Despite the disadvantages, patients electively choose the Port-A-Cath for its reliability, safety, and comfort (Saucy, 1987). The Per-Q-Cath is a Silastic radiopaque percutaneous venous catheter that is placed with a small introducer needle (Fig. 3). The catheter is inserted into either the basilic or cephalic vein and threaded into the subclavian vein. Catheter tip placement is suggested at the juncture of the superior vena cava and in the right atrium. The Per-Q-Cath is available in various sizes of needles with catheters that come
T
he Per-Q-Cath is available in various sizes of needles with catheters that come with or without a guidewire.
with or without a guidewire. It is appropriate for use in neonates to adults (Fig. 4). A surgeon or trained health care provider can insert the Per-Q-Cam The patient does not need to be anesthetized, which reduces the cost of insertion.
n FIGURE 3 The Per-Q-Cath has an introducer needle and Silastic catheter that is measured and cut to the appropriate length to reach the right atrium.
The Per-Q-Cath is recommended when IV access is necessary for 1 week to 6 months. This catheter is able to deliver medications, fluids, nutritional solutions, and blood. Other advantages include low cost (approximately $50 dollars for placement), ease of insertion, and lack of complications. Maintenance requirements include a transparent dressing that is changed only when sterility or dislodgment of the catheter is threatened. Patients prefer the increased comfort level and decreased number of venipunctrues. Patients using this device are able to return to normal activity without impedance of arm activity (Dietrich & Lobas, 1988). Disadvantages of the Per-Q-Cath include daily heparin flushes, the presence of an external dressing, and the limited use time of 6 months. Complications of the Per-Q-Cath are few but inelude thrombophlebitis (13%), leaking at the insertion site (5%), breakage at the catheter and hub junction, and drug reactions (2%) (Chanthas, 1986). In several studies, no catheter infections or sepsis were found with the Per-Q-Cath (Williams, Smith, Woods, & Weller, 1988; Dietrich & Lobas, 1988). Despite these complications and disadvantages, the Per-Q-Cat& has proven to be an easy and safe device and its use as the single IV accesshas been satisfactory
journal of Pediatric Health Care
w FIGURE 4 A transparent
Port-A-Cath
dressing
covers
the
accessed
Per-Q-Cath
in the
cephalic
vein
33
of
an adult.
B0th the
Port-A-Cath and the Per-Q-Cath have been proved to be safe, dependable, and cost effective for many patient populations.
in 80% of reported cases (Dietrich & Lobas, 1988). These two devices are recommended by the author for use in patients who require repeated or long-term IV therapy. Both the Port-A-Cath and Per-Q-Cath have been proved safe, dependable, and cost effective for many patient populations. The practitioner is encouraged to examine both devices and others to knowledgeably choose the best device for a patient’s hospital or home IV therapy. n
REFERENCES Casey J., Ford, W. D. A., O’Brien, L., & Martin, A. J. (1988). Totally implantable system for venous accessin children with cystic fibrosis. Clinical Pediutrh, 27, 91-94. Chathas, M. K. (1986). Percutaneous central venous catheters in neonates. journal of Obstti, C+ncwl&c and Neonatal Nmin&, 15, 324332. Dietrich, K. A., & Lobas, J. G. (1988). Use of a single Silastic intravenous catheter for cystic fibrosis pulmonary exacerbation. P&ztric Pl4hwtw&, 4, 181-184. Lambert, M. A., Chadwick, G. A., McMahon, A., & Scarke, J. H. (1988). Experience with the Port-a-Cath. Hematoltgv o+ludo@, 6, 57-63. Saucy, P. (1987). Experience with the use of the Port-a-C& in children. Jouwal oj-Pediuhc Surgrry, 22, 767-769. Williams, J., Smith, H. L., Woods, C. G., &Weller, P. H. (1988). silastic catheters for antibiotics in cystic fibrosis. A~chiws of LXreaser in Chilrihood, 63, 658-659.
