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.