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INTRAPERITONEAL CATHETER AND PORT PLACEMENT

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Procedure Overview

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The placement of an intraperitoneal (IP) catheter and access port should ideally occur at the time of resection and staging for advanced-stage ovarian cancer confined to the peritoneal cavity. This requires the preoperative expectation that cancer will be found and subsequent consent for planned chemotherapy on a clinical trial or using chemotherapy delivered to the peritoneal cavity. The ease of removal of the device makes it a better choice to place an IP port at initial surgery rather than to have to schedule a second surgery to implant the device.

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Alternatively, the device can be placed at an interval procedure using interventional radiologic techniques, laparoscopy, or a 2- to 4-cm laparotomy incision in the right or left lower quadrant. It is preferred to avoid the previous midline incision, when trying to introduce the catheter into the peritoneal cavity.

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Preoperative Preparation

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The location of the planned device port should not interfere with the patient's undergarments or her sleeping position. The size of the port relative to the size of the patient may cause discomfort and require altering the choice of devices. The nursing staff must be able to palpate the port, and it must be secured to a platform, such as the fascia overlying the ribs, to prevent complications during insertion of the Huber needle.

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The operating room staff must have the device available, as well as 2-0 prolene sutures, Huber needles, and heparin 100 units/mL for flushing. The patient must be sterile and draped from the nipples to the middle thighs and laterally to the posterior axillary line.

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The preferred device is a subcutaneously implanted port attached to a silicone catheter. Do not use products with Dacron cuffs. A Bardport silicone peritoneal catheter 14.3 French is the preferred device, and it has been Food and Drug Administration approved for use in IP therapy. The 9.6-French, single-lumen intravenous (IV) access device, also made of silicone, can be substituted if the peritoneal catheter is not available. The firmness of the catheter prevents kinking, and the silicone prevents adherence to peritoneal structures so the catheter can be withdrawn without difficulty.1,2

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Operative Procedure

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Laparotomy
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The port pocket is created by making a 5- to 6-cm incision 3 finger-breadths above the lower costal margin, at the midclavicular or anterior axillary line, and 4 prolene sutures are placed in the fascia overlying the ribs and through the port to stabilize the device to this platform (Figure 33-1). A long tonsil clamp is tunneled subcutaneously (just above the rectus fascia) to approximately the level of the umbilicus and then through the fascia, muscle, and peritoneum to grasp the nonfenestrated end of the catheter, which pulled it into the port pocket (Figure 33-2). The 2 ends ...

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