Venous Diseases and Venous Access
- Varicose veins
- Vascular access: portacaths, central lines and Hickman lines
- Vascular malformations
- Venous thrombosis
- Venous insufficiency
Vascular Access: Portacaths
A portacath is used to allow easy and safe access to the blood of patients with illnesses requiring frequent and intermittent intravenous treatment. A portacath is composed of two components: a reservoir or port body and a tube which runs from the reservoir to the superior vena cava.
A portacath is typically used for patients requiring chemotherapy. Chemotherapy can irritate small peripheral veins in the arms. The veins quickly become inflamed and scarred making them hard to find and not suitable for injection. By using a portacath, the chemotherapy is placed directly into the superior vena cava, which is a large vein containing a large volume of fast flowing blood. This rapidly dilutes the chemotherapy and eliminates the complications of peripheral access and treatment.
The portacath is inserted as part of a day-only admission and is most comfortably inserted with a combination of local anaesthetic and sedation. Intravenous antibiotics are given to minimise any risk of infection. The portacath is placed under the skin, on the chest wall about five finger breadths below the collar bone.
The port tubing is tunnelled under the skin and into the jugular vein. The position of the portacath will be checked with X-ray and the system flushed with heparinised saline to reduce the risk of the portacath becoming clotted. The wound is closed with an absorbable suture which does not need to be removed. The wound is then covered with water resistant dressings.
The Immediate Recovery
While the local anaesthetic is working (about four hours after the procedure), patients feel very little. After that, the chest may feel sore and tender. Dr Baker recommends taking paracetamol for the first twelve hours after the procedure. (i.e. one or two tablets every four to six hours.) Some patients may experience a little bruising which will take a few days to settle.
The portacath can be used immediately. If treatment needs to start on the same day that the portacath is inserted, an access needle will be left in the portacath. It is important that we are advised when the oncology team plans to commence chemotherapy.
The Short-Term Recovery
In the first week, the wound should be kept as clean and dry as possible. A short shower can be taken, but the dressings should not become waterlogged as this may increase the risk of wound infection. Only oncology nurses, who are trained to access the portacath, should do so.
The nurses will also flush the port on a regular basis (four to six weeks) to ensure it does not fill with blood clot and remains patent. When the treatment is complete and following discussion with your doctor, we can remove the portacath. This is a simpler procedure which can be performed under local anaesthetic alone.
Most portacaths are MRI conditional. This means that they can be used on commercially available 1.5T and 3T MRI units in Australia.
Chronic Pelvic Venous Disorders: Pelvic Congestion Syndrome and Chronic Pelvic Pain
Pelvic Venous Insufficiency, also known as Pelvic Congestion Syndrome, is a complex disorder of the pelvic venous circulation involving the pelvic venous plexus, the ovarian and internal iliac veins.
It is typically produced by the reflux (reverse flow) of blood down the ovarian veins into the pelvis, producing dilatation of the veins in the pelvis. The dilated veins act as reservoirs of blood and produce a painful pressure feeling and discomfort. Pelvic venous drainage is also via the branches of the internal iliac veins and these may also be dilated and incompetent.
Pelvic Venous Insufficiency Clinical Symptoms
- Pelvic pain
- Post coital ache
- Bladder irritability and urinary urgency
- Enlarged vulval veins
- Other pelvic symptoms such as rectal discomfort and hip pain
- Symptoms may occur during pregnancy or become worse after pregnancy
The veins in the pelvis also receive blood from the legs and they form a functional unit. As such, pelvic venous disorders may also result in impaired venous drainage from the legs.
A number of tests including pelvic US and MRI are performed to confirm the diagnosis prior to the procedure. The condition is treated by closing or sealing the dilated and refluxing pelvic veins using embolisation. Embolisation is a minimally invasive, image guided treatment performed in an angiography suite, as a day-only procedure under sedation. A catheter is placed into the femoral vein or jugular vein and passed under X-Ray control into the ovarian veins and dilated refluxing veins deep in the pelvis. The dilated, refluxing veins are embolised or sealed off with a combination of medications, which are administered via the catheter. Blood flow then returns to the heart via the normal, non-enlarged veins, eliminating the pooling of blood in the pelvis. Following the procedure, symptoms will usually resolve over three months.