Totally Implantable Vascular Access Devices –

A Guide for Patients and Carers

This information is for patients who want or need to have a Totally Implanted Venous Access Device (TIVAD) inserted.

 

Click the link below to download the guide –

Totally Implantable Vascular Access Device Patient Booklet

 

What is a TIVAD?

A port is a long-term catheter system. It consists of a reservoir (or port chamber) which is a small container made of plastic or metal sealed with a stable silicone membrane and a thin tube (port catheter). Ports are usually recommended for patients who need certain types of medications over a long period of time.

The port is placed entirely beneath the skin and can easily be located from outside by touch. The silicone membrane can be penetrated as necessary using a Huber needle, whose tip is specially designed to prevent damage to the membrane. The system makes use of special materials and can therefore remain in the body for a long period of therapy without causing problems

 

Why is a TIVAD necessary?

TIVAD’s are inserted for several reasons –

  • Patients whose veins have become painful and difficult to access over time
  • Patients who may require long term IV therapy e.g. chemotherapy, nutrition, regular antibiotics
  • Patients who would prefer a vascular device hidden under the skin
  • Patients who do not want to attend hospitals to have weekly dressing changes and weekly flushes

 

How a TIVAD is inserted

Before the insertion of the TIVAD

When you are referred for a TIVAD, you will be given an appointment to meet with a nurse or doctor from department who will insert the device. This usually takes place one week prior to the date of the insertion. At this appointment, an assessment will be carried out of your veins and the area of skin where the TIVAD will be inserted.

You will need to give your written or verbal consent (agreement) before the TIVAD will be placed. The Healthcare Professional will discuss the risks and benefits of the procedure with you before insertion. They will answer any questions or concerns that you may have.

Prior to the procedure a Healthcare Professional will ask you some questions and swabs will be taken for MRSA and other forms of bacteria that may increase the risk of an infection. If these swabs are positive, you will be given medication to use prior to the insertion of the TIVAD.

A blood test will also be taken at this appointment to monitor for bleeding risks during the procedure, this may be done the day before if you are currently taking medication.

Please note: It is important to tell your doctor or nurse before attending for your TIVAD insertion if you are on any medication to prevent or treat blood clots, such as warfarin, apixaban, rivaroxaban, heparin and aspirin. If you take anti-coagulant (blood thinning) medication, you must discuss this and you will be advised when to stop taking these medications and when you can restart them after the procedure.

 

The TIVAD insertion

You may eat and drink normally on the day you are having a TIVAD inserted. It is not recommended that you drive on the day of insertion but arrange for someone to take you to and collect you from hospital.

The area of the skin where the TIVAD will be placed in the arm or chest will be cleaned and then numbed with an injection of local anaesthetic. The procedure is carried out under full sterile conditions. You may be expected to wear a surgical gown, hat and mask during the procedure and to lay flat and remain still during the procedure.

It is necessary to use a specialist ultrasound, which will help locate the most suitable vein. A ECG catheter tip navigational system may also be used. The navigational system involves having ECG electrodes stickers on your skin (and sometimes with a magnetic paddle placed on top of your chest). This will not be painful or cause discomfort but will help the Healthcare Professional to track the catheter tip inside your chest. Occasionally, it may be necessary to order a chest x-ray, which will confirm the catheter is in the correct position before the procedure is completed.

To implant the chest or arm Port into position, it is necessary to create a ‘pocket’ under the skin of your arm or your chest. This will require sutures (stitches) and will leave you with a small scar about 3-5 cm in length. A catheter is attached to the TIVAD and tunneled under the skin and inserted into your vein. Once this has been done, you will not have any external parts of the TIVAD visible, but it may be possible to notice a raised area on your body, depending on the location of the device. You will initially have dressings to cover the insertion site where the pocket has been formed.

If the TIVAD is to be used within a couple of days of the insertion, a Huber needle will be inserted at the time of insertion to allow access while the pocket is healing.

Once the sutures have healed, your blood tests can be taken from the TIVAD prior to your treatment or for monitoring purposes.

Occasionally, it may be difficult to thread the TIVAD along the vein of choice or to place the line into the correct position, making the procedure unsuccessful at this attempt; other choices will be discussed, if this occurs.

 

After the procedure

After the procedure, you will be asked to wait in a recovery area where you will spend some time until you are ready to go home. If you are an inpatient, you will be transferred back to the ward. After the procedure, you will be able to eat and drink as soon as you have recovered.

There may be some bleeding around the insertion site (where the port was put in). This is quite normal, the Healthcare Professional looking after you may replace the dressing if necessary before you go home.

It is important to keep yourself warm and drink plenty of fluids to minimise any risk of complications.

The sutures at the insertion site are absorbable, but they should be kept dry for approximately 7-10 days following the procedure to allow for satisfactory healing. Most people who have this type of procedure under local anaesthetic will be able to leave hospital after a couple of hours.

 

 

How to care for your TIVAD

Whilst you have a TIVAD, it is vital that anyone who accesses or uses your port has a good standard of hand hygiene by washing their hands with antibacterial soap/gel first and by using a sterile non-touch technique. Do not hesitate to remind all Healthcare Professionals to do this. The skin around the port area must be cleaned with an appropriate solution thoroughly prior to accessing with an EZ Huber™ Needle.

It is normal to cover the needle when the Port is being used. However, when your Port is not in use, and you are not receiving regular treatment, it will need flushing every 4-12 weeks depending on the hospital policy where you are being cared for. Normal activities can be carried out when the sutures have healed and the TIVAD is not in use. It is possible to swim with a TIVAD, but heavy exercises and some sports may need to be modified.

Please note: Before chemotherapy is administered via the TIVAD, blood must always be withdrawn to ensure it is safe to be used. You will be asked to report any pain or discomfort that you experience during an infusion given via the TIVAD; if this occurs the infusion must be stopped. The nursing staff will assess the position of the Huber needle and TIVAD site immediately.

When your treatment is complete and the TIVAD is no longer required, it may be removed in hospital by a Healthcare Professional. Prior to this, you will need to stop any blood thinning medication. This will be explained to you, and you will require blood tests prior to the removal to check for bleeding risks and complications. You will be given an appointment for the removal, which is carried out as a sterile procedure with local anaesthetic.

 

Complications that can occur

Infections can come from the surrounding skin or bloodstream. Please report any pain, redness or oozing around the port site by contacting your Hospital. Information will be provided on how to care for your TIVAD during the initial few weeks after the insertion whilst the skin is healing. You may be given antibiotics to treat infections and in very rare cases, it may need to be removed.

Blood clots can develop in the vein or along the route where the TIVAD is sitting. Signs include pain, swelling and discomfort in the neck or arm on the side where the TIVAD is placed. If this occurs, it will be treated with daily blood thinning injections, but the TIVAD will remain in place.

Lung puncture this may happen when Ports are placed in the chest, in less than 1 in every 6000 patients, and may require further treatment to avoid breathing complications. You will usually have to stay in hospital until the lung has healed.

Arterial puncture is a puncture of the artery that can cause bleeding, this can only occur during the insertion of the device, but this risk is greatly reduced by using the ultrasound.

 

Care and Maintenance

It is important that TIVADs are cared, maintained and flushed regularly to minimise further complications occurring after the port has been inserted. Occasionally the nursing team may have difficulty obtaining blood or the port becomes blocked. This may require a certain type of intravenous medication to help resolve the problem. Ports should be flushed before and after the administration of any drug.

After your treatment has completed the Port may need to remain in place, this will be decided by your consultant or nursing team. The TIVAD should be flushed every 4-12 weeks (as per your hospital policy) to ensure it does not become blocked.

During the first few days, your arm or chest area may ache after having a TIVAD placed. It is still necessary to move your arm as normal to avoid developing any blood clots. If you are worried, please call the nursing team looking after you on the contact numbers you have been given.