Description

Cancer is a rapidly growing, invasive, and metastatic disease caused by an accumulation of genetic mutations that lead to the formation of malignant cells. These genetic changes can result from exposure to chemical carcinogens, chronic inflammation, radiation, or a genetic predisposition. Globally, cancer is a significant public health challenge and ranks as the second leading cause of death in the United States. In recent years, the global burden of cancer has surged, with millions of new cases and fatalities each year. In Egypt, the numbers reflect a similar pattern, highlighting the widespread impact of this disease.

Chemotherapy remains the most commonly used treatment for cancer, utilizing chemical agents that target and destroy cancer cells, preventing their growth and spread. Often, chemotherapy is combined with other treatment modalities like surgery or radiation. While chemotherapy can be delivered through various routes, intravenous (IV) administration is the most common. Modern chemotherapy management requires consistent and safe access to the venous system for the delivery of drugs, fluids, and blood products. Due to the damaging effects of repeated venipuncture and long-term chemotherapy on peripheral veins, long-term venous access devices (VADs) have become essential. One of the most frequently used VADs is the Port-A-Catheter system.

A Port-A-Catheter is a medical device that provides direct access to large blood vessels. It consists of a reservoir (or portal) and a catheter, implanted in a surgically created pocket on the chest wall or upper arm. The portal is placed subcutaneously and connects to the catheter with a specialized lock. It can be used for chemotherapy 12 to 24 hours after insertion and typically remains in place for two to six years.

This device significantly reduces the pain and anxiety associated with repeated needle sticks or venous procedures, allowing patients greater freedom and safety in their daily activities. The Port-A-Catheter enables the delivery of chemotherapy agents, blood products, parenteral nutrition, and the collection of blood samples for testing, all contributing to an improved quality of life.

The primary benefits of ports include easier venous access, especially for patients with small or compromised veins, a lower risk of chemotherapy extravasation, and the ability to administer irritating substances. However, Port-A-Catheters are not without risks, which are categorized as early or delayed complications. Early complications may involve incorrect catheter positioning, pneumothorax, hemothorax, thoracic duct injury, or cardiac tamponade. Delayed complications include infections, thrombosis, stenosis, catheter fractures, and migration.

Proper nursing care and maintenance of implanted ports are crucial to keeping them functional and preventing complications. This care includes regular flushing, heparin locking, dressing changes, needle replacements, and scrubbing the access port with antiseptic solutions to minimize contamination risks. Nurses play a pivotal role in maintaining the integrity of the port, preventing failure, and reducing complications related to its use. Effective nursing care requires sharp assessment skills and sound clinical judgment to identify and manage central venous access device (CVAD) complications effectively.