Infusaport

1. Position patient in Trendelenberg, on head ring and sandbag between shoulder blades.
2. Infiltrate LA at marked sites of port and subclavian access.
3. With arm pulled down cannulate (pink needle?12G) subclavian vein at junction of lateral third and medial two third of clavicle. Once vein is entered advance guide-wire which is kept at the ready.
4. Use Image Intensifier to confirm satisfactory placement of guide-wire.
5. Make a transverse incision at site of port placement on anterior pectoral wall. Dissect down to allow an appropriate thickness of skin flap, as well as incising the guide-wire insertion site.
6. Create a pocket in the subcutaneous plane large enough to accommodate the port by dissecting inferiorly.
7. Place stay sutures of 3/0 prolene on either side of the catheter attachment and hold these in artery forceps.
8. Thread the sutures into the port at the pre-formed holes and tie them to secure the port in place (ensure port is primed with heparinized saline).
9. Tunnel an artery forcep of appropriate length into the created pocket via the guide-wire insertion site and hold the catheter to bring it out via the guide-wire site.
10. Adjust the length of the catheter by measuring to the sternal angle and excise redundant length.
11. Use dilator and sheath provided to widen channel for catheter in subcutaneous plane and in the vein itself.
12. Remove guide-wire and dilator only, leaving sheath in place and feed catheter into sheath.
13. Once catheter is completely inserted gradually remove sheath.
14. Use II to confirm satisfactory placement, as well as aspirating the port with the special provided needle (bent at tip) and then priming with heparinized saline.
15. Close both incisions in two layers using vicryl and monocryl.