Background Information:

What are the other Names for the Procedure?

• Intraperitoneal Port Insertion
• Peritoneal Port Placement
• Peritoneal Port-A-Cath

What is Peritoneal Port Insertion radiology procedure? (General Explanation)

• Peritoneal Port Insertion procedure is a minimally-invasive procedure where a port is inserted under the skin, and a catheter connected from the port is suspended in the peritoneum
• A peritoneal port consist of a small chamber which is surgically implanted under the skin for various purposes, such as supplying pain medications, delivering anti-cancer drugs, or removing excess fluids from cavities

What part of the Body does the Procedure involve?

The Peritoneal Port Insertion procedure involves the peritoneum (in the abdominal cavity).

Why is the Peritoneal Port Insertion radiology procedure Performed?

A Peritoneal Port Insertion procedure is used in the treatment of various medical conditions such as:

• In delivering pain medication in chronic pain patients
• For serial paracentesis, where a catheter connected to the port is used to remove excess fluids from the abdomen
• Intraperitoneal treatment, where anti-cancer drugs are supplied into the peritoneal cavity through the port
• It is also used for the treatment of intractable ascites caused by cancer, heart failure, kidney failure, tuberculosis, or cirrhosis

What is the Equipment used? (Description of Equipment)

A Peritoneal Port Insertion procedure involves the following equipment:

• Peritoneal port: It appears like a round chamber with a silicone rubber top. This silicone rubber top can be penetrated later with a needle to deliver medication or remove fluid through the port. The other side of the port is connected with a catheter
• Catheter: It is a thin, hollow, long tube
• X-ray fluoroscopy: It is used in imaging guidance, for the placement of port and catheter. It includes an X-ray machine. A fluoroscopy procedure basically converts x-ray images into real-time video images

What are the Recent Advances in the Procedure?

There have been no recent advances with respect to the Peritoneal Port Insertion procedure.

What is the Cost of performing the Peritoneal Port Insertion radiology procedure?

The cost of Peritoneal Port Insertion procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Peritoneal Port Insertion procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/22080885 (assessed on 3/3/2015)

http://www.bardaccess.com/port-peritoneal.php (assessed on 3/3/2015)

Prior to Peritoneal Port Insertion radiology procedure:

How does the Peritoneal Port Insertion radiology procedure work?

A Peritoneal Port Insertion procedure works in the following manner:

• The peritoneal port is basically a small chamber that collects the medication delivered or fluid extracted from the body
• The port can be scheduled so that it delivers a specific quantity of medication for pain or cancer, at certain specified time intervals
• The ports have silicone rubber top which can be punctured with a needle through the skin that can be used to refill the medication or remove the fluid

How is the Peritoneal Port Insertion radiology procedure Performed?

The Peritoneal Port Insertion technique is as follows:

• The patient is positioned in a supine position on the examination table and various monitors are attached to his/her body to monitor the vital signs
• An IV line is inserted into the patient’s arm vein to deliver sedative medications for the procedure
• The patient may receive moderate sedation or general anesthesia. In case of general anesthesia, the individual will be completely unconscious throughout the procedure
• The area of port insertion is shaved, sterilized, and covered with surgical drape. The area of port insertion is then numbed using local anesthetic
• A small skin incision is made and a catheter inserted through the incision in the abdominal or peritoneal cavity
• Another skin incision is made close to the first incision and a small pocket is created under the skin for the placement of the port
• A tunnel is created under the skin to connect the catheter to the port
• The created pocket is sutured after port placement. An x-ray is taken to check the correct placement of the port

Where is the Procedure Performed?

The Peritoneal Port Insertion procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist or a general surgeon performs the Peritoneal Port Insertion procedure.

How long will the Procedure take?

The Peritoneal Port Insertion procedure usually takes about two hours. It may take longer depending upon the overall health status of the individual undergoing the procedure.

Who interprets the Result?

After a peritoneal port is inserted, radiological studies are performed to confirm that the port is placed in the correct position. The radiological studies are then interpreted by an interventional radiologist.

What Preparations are needed, prior to the Procedure?

• The following preparations may be needed prior to a Peritoneal Port Insertion procedure:
• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions such as a heart disease, asthma, diabetes, or kidney disease
• Lab studies are done prior to the procedure to check kidney functions
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
• Women should notify the physician if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for Peritoneal Port Insertion procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Peritoneal Port Insertion procedure:

• It is a minimally-invasive procedure
• It is of immense help in cancer treatment for patients in chronic pain, as they do not have to visit the physician often for their medication. They can also avoid repeated needle punctures
• The risk of infection with peritoneal ports is substantially lower than other access devices (or medicine delivery or fluid removal methods)

Following are the risks of the Peritoneal Port Insertion procedure:

• For the port insertion, a skin incision is necessary; thus, there is an increased chance of developing infection at the area of insertion
• The risk of infections at port insertion site or in the body cavity is higher in cancer patients receiving chemotherapy, as they generally have weak immune systems

What are the Limitations of the Peritoneal Port Insertion radiology procedure?

The peritoneal ports can be punctured for about a 1000 times. After this, a new peritoneal port must be put in place, which requires repeating the whole procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Peritoneal Port Insertion procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Peritoneal Port Insertion radiology procedure:

What is to be expected during the Peritoneal Port Insertion radiology procedure?

The following may be expected during the Peritoneal Port Insertion procedure:

• The patient may feel a slight sting, when the IV line is inserted into their arm vein and local anesthetic is injected at the site of skin incision
• If the patient is sedated during the procedure, he/she will feel relaxed and sleepy
• The vital signs are monitored by using various health monitors
• The patient has to remain flat throughout the entire procedure, which may feel a little uncomfortable
• An x-ray may be taken at the end to check the placement of the port
• The patient is taken to the recovery room on waking up and placed in the recovery area, until the healthcare provider decides to discharge them

What kind of Anesthesia is given, during the Procedure?

Moderate sedation or general anesthesia is used during the Peritoneal Port Insertion procedure.

How much Blood will you lose, during the Procedure?

The Peritoneal Port Insertion procedure is a minimally-invasive procedure; thus, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Peritoneal Port Insertion radiology procedure?

A Peritoneal Port Insertion procedure involves skin incisions, and thus there is a chance of developing infection at the area of port insertion.

What Post-Operative Care is needed at the Healthcare Facility after the Peritoneal Port Insertion radiology procedure?

• There is no specific post-operative care needed at healthcare facility after the Peritoneal Port Insertion procedure
• The patient and family members are educated about how to take care of the port, and on how to keep it clean, so as to prevent any kind of infections

After the Peritoneal Port Insertion radiology procedure:

What is to be expected after the Peritoneal Port Insertion radiology procedure?

• The patient may return home or may have to stay overnight at the hospital, according to the physician’s instruction
• The patient may have to be driven home after the procedure
• Patient should avoid any kind of physical activity for a period of time, as instructed by the physician
• They may resume their normal activities after the procedure based on the instructions provided to them. However, heavy lifting or taking a shower must be avoided, until the sutures heal completely around the port insertion point

When do you need to call your Physician?

Do inform your physician or healthcare provider:

• If you develop fever greater than 100 deg. F
• If there is any sign of infection around the port insertion pocket such as redness, warmth, swelling, or tenderness
• If any abdominal pain or swelling develops

What Post-Operative Care is needed at Home after the Peritoneal Port Insertion radiology procedure?

• Any kind of physical activity should be avoided for a period of 24 hours, after the Peritoneal Port Insertion procedure
• Normal activities may be resumed a day after the procedure, but heavy lifting should be avoided
• Do not take a shower until the sutures around the port insertion have healed completely
• Sponge showers may however be taken, until the healing is complete
• Patients are advised to wash their hands thoroughly before handling the port
• They may be recommended to use peroxide and antibiotic ointment around the area of port, to avoid any infection

How long does it normally take to fully recover, from the Procedure?

Patients may resume light exercises and normal shower after the complete healing of the port insertion, which may take a week or two.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Peritoneal Port Insertion procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Peritoneal Port Insertion radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before Peritoneal Port Insertion procedure is performed.