Your Tivad
Date issued: October 2024
For review: October 2026
Ref: C-597/SF/Vascular/Your Tivad
PDF: Your Tivad final October 2024.pdf [pdf] 262KB
Introduction
This booklet aims to provide information and support about your Tivad procedure and how to care for it once it has been inserted.
What is a Tivad?
TIVAD stands for Totally Implantable Vascular Access Device.
A Tivad is a long hollow tube that is inserted into one of the large veins in your neck. One end of the tube sits in a vein, usually just above the heart, and the other end is attached to the port that sits underneath your skin on the chest or upper arm.
TIVADs are also known as Ports.
Why do I need a Tivad?
Your medical team will have recommended that you have a Tivad inserted as part of the care you are receiving.
This type of device is recommended for patients who have a prolonged course of intravenous treatment. This makes it possible for you to have treatment without having needles frequently inserted into your veins.
You can go home with a Tivad and carry on your treatment.
What are the benefits of a Tivad?
A Tivad can make treatment more comfortable for you.
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They are suitable for regular, long-term intravenous treatment such as chemotherapy.
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They suitable for patients who have difficulty with other Vascular Devices.
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Allowing you have the medication given directly into your veins.
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Reducing the irritation that certain drugs can cause to smaller veins.
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Preventing the need for multiple needle punctures.
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Preserving the long-term health of your veins.
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When the Port is not in use, they are completely under the skin, with no tubing visible.
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You can do your daily activities without any concerns.
How do I prepare for the procedure?
As a patient you need to do very little to prepare for the insertion of the Tivad. When you arrive your doctor or nurse will discuss the insertion procedure, alternatives and potential problems with you. You will be offered an opportunity to discuss any issues and ask any questions with the clinician performing the procedure. You will normally be asked to provide consent for this procedure. Please inform your doctor or nurse of any allergies that you may have. It is important to tell the doctor or nurse before you attend for your procedure if you are taking any medication that thins your blood, you may need to stop taking this prior to your Tivad procedure. Your team will advise you if it is necessary and when to stop.
Screening for MRSA and MSSA will be required for all patients prior to line insertion. This will be arranged by your medical team in the days leading up to your procedure. You may be asked to use a special body wash prior to your procedure depending upon the results of these tests.
You can eat and drink as normal.
What happens when I have the Tivad inserted?
An outpatient appointment at the hospital will be offered to you for the Tivad insertion. Your port will be inserted in a procedure room. It is not an operation but the clinician inserting your Tivad will treat it as a sterile procedure. They will use an ultrasound scanner to be able to find the best vein for the insertion. They will wear a gown and sterile gloves and will use sterile equipment. Your skin will be cleaned with an antiseptic, after sterile drapes will be placed over your neck and chest or arm. Local anaesthetic is used to numb a small area of your neck and chest/arm skin before the Tivad is inserted.
The catheter can be placed in different veins, the most common being the jugular vein which is located at the base of your neck.
A pocket will be created under the skin of your chest/arm into which will place the port. It will be secured with stitches. The catheter is attached to the port and tunnelled under the skin and inserted into your vein.
You will be wired up to an ECG, using a device called Pilot, to make sure the tip of the line sits in the right place, this way you don't require an x-ray to confirm this.
The procedure usually takes about an hour.
You can go home after your outpatient appointment and your Tivad is ready to be used.
If you have any concerns or questions, please ask the Vascular Access Team. They will help you to clarify your concerns or questions.
Caring for your Tivad
A Tivad requires very little maintenance once the skin is healed. Needs to be flushed every two months if not in use and will be flushed pre and post infusions.
Potential risks
Insertion:
It can sometimes be difficult to find a suitable vein or to get the Tivad into the correct position. If this is the case, we may have to insert the Tivad into a different vein or discuss alternative options with you.
Infection through the skin:
It is possible for an infection to develop inside or around the place where the Tivad goes into the vein (this is the insertion site). Contact your healthcare team immediately if you experience any of the following symptoms: pain, redness or swelling at the insertion site, discolored fluid coming out from the insertion site, a fever or chills.
Local bruising or bleeding in the insertion site:
It is common to experience some bruising or bleeding at the insertion site. Please inform us of any blood thinning medication you are taking before we insert the Tivad, as this can increase your risk of bleeding.
Stenosis:
If you need the catheter for a long period of time there is a risk that the vein becomes narrowed or stenosis. If this happens then you will need the catheter into a different vein.
Lung puncture:
This happens when the lung is accidentally punctured during the procedure. It is very rare to happen, and if so, we will keep you in hospital until the lung is healed.
Extravasation:
This is damage caused by leakage of the medication from the vein to the surrounding tissue during intravenous administration. Extravasation of some chemotherapy drugs from ports can cause tissue necrosis (tissue damage) and may need surgical removal of the port and the affected tissue.
Break or split line:
A break in the catheter or port may lead to extravasation.
Blood clots (thrombosis):
It is possible for a blood clot to develop around the Tivad. If this occurs you may be given medication to dissolve the clot. If a clot does form you may be given medication to break down the clot and your line may need to be removed. Contact your healthcare team immediately if you experience any of the following symptoms: pain, swelling, discomfort in the neck or arm or redness on the side of the insertion site.
Port rotation/ movement:
The port may move out of the place or turn round within the chest wall or arm. The port may need to be repositioned or removed.
Scarring:
There will be a small scar in your chest or arm where the port is inserted. A small bump (port) may be visible under the skin.
Can I bathe or shower?
You can bathe or shower with your Tivad in place. We ask that you try not to soak the dressing. The dressing that covers the insertion site should be covered when taking a shower or bath, at least while the stitches are in situ (7- 10 days and they are dissolvable) the neck dressing should be in place for 3 days. If the dressings are loose after your shower, it should be replaced.
Can I do my normal activities, after the Tivad insertion?
You can resume normal activities after the procedure, but you may have some discomfort in your neck, chest or arm. Take pain relief.
If you do swim it is better to wait until the stitches completely dissolve and the skin is healed.
Hand hygiene
You or any person caring for your Tivad, should wash their hands and put gloves on prior to accessing or dressing.
Dressing changes
If you leave the procedure room with a needle in situ, a dressing will be applied over the top of the needle and when you finish your treatment the needle will be removed, and a small dressing will be applied.
A dressing should be in situ until the sutured area has healed and is dry.
When and how will my Tivad be removed?
Tivads are usually removed at the end of treatment. Rarely, they are removed because of problems.
You will be given an outpatient appointment, and the removal of the Tivad is like the insertion. A small cut will be done over your previous scar, the stitches that keep the port in the right position will be removed as well as the port and catheter. The incision will be stitched again.
Any problems?
To report any irregularities or complications such as swelling in your arm, shoulder or neck, redness, leakage or pain around the Tivad insertion site, please contact the team that is caring for you immediately.
Rarely some bleeding can occur from the insertion site. If you notice a lump developing or if you see any bleeding from the skin, apply pressure to the area and contact the team that is caring for you.
If you develop any shortness of breath or have pain in your chest within a few hours of the Tivad being inserted, then you should go to the Emergency Department immediately.
Contact details for advice
Derriford Hospital: 01752 202082
