Central Venous Port Placement: Clinical Protocol and Best Practices

Pre-Procedure Requirements

Patient Assessment

• Complete blood count (CBC)
• Coagulation profile (PT, PTT, INR)
• Recent chest X-ray
• Documented informed consent
• NPO status for 6 hours prior

Equipment Preparation

• Port-a-cath kit
• Sterile surgical instruments
• Ultrasound machine
• Fluoroscopy equipment
• Emergency cart availability

Procedure Steps

1. Patient Positioning and Preparation

• Position patient supine with arms tucked
• Trendelenburg position (15-20 degrees)
• Prep neck and chest with chlorhexidine
• Establish sterile field

2. Venous Access

• Identify internal jugular vein via ultrasound
• Local anesthetic administration
• Ultrasound-guided venipuncture
• Confirm position with guidewire under fluoroscopy

3. Port Pocket Creation

• Mark incision site below clavicle
• Create subcutaneous pocket
• Tunnel catheter from neck to pocket
• Secure port to fascia

4. Catheter Placement

• Trim catheter to appropriate length
• Connect to port
• Verify position with fluoroscopy
• Flush with heparinized saline

Post-Procedure Care

Immediate Care

• Chest X-ray confirmation
• Vital signs monitoring
• Dressing application
• Patient education

Follow-up

• 24-hour assessment
• Weekly dressing changes
• Monthly maintenance flush

Documentation Requirements

• Procedure notes
• Port specifications
• Confirmation imaging
• Patient instructions provided