O cateter é um tubo especial que é inserido numa veia maior e é conectado a um reservatório que fica implantado debaixo da pele e pode ser deixado neste local por muitos meses. A utilização deste cateter facilita o tratamento quimioterápico venoso pois não é necessário fazer punções repetidas para conseguir “acertar” uma veia.
Nem todas as pessoas que vão fazer quimioterapia vão necessitar de ter um cateter implantado, por exemplo, se a sua quimioterapia for somente por um curto espaço de tempo ou envolver só uma injeção ocasional.
No entanto, se o tratamento for continuar por muitos meses e forem necessários medicamentos extras ou outras drogas, os médicos podem decidir que é melhor fazer o implante do cateter1.
Como o cateter é implantado?
O implante de cateter para quimioterapia é uma operação realizada no bloco cirúrgico, sob anestesia local e anestesia venosa (sedação). Usualmente é feita uma incisão na pele, de 3 a 4 cm de extensão, no local onde será implantado o reservatório. Quando implantado no tórax pode ser necessária uma segunda incisão, de 1 a 2 cm, na base do pescoço, logo acima da clavícula. Localiza-se a veia na qual o cateter será inserido.
Após a introdução do cateter é feito o controle do posicionamento da ponta do cateter por radioscopia (raios-X). O reservatório do cateter (peça que é puncionada para aplicar a quimioterapia) é implantado no subcutâneo, quer dizer, logo abaixo da pele.
Isso quer dizer que todo o conjunto fica sob a pele. A seguir, o sistema é testado e aplicada uma solução com heparina para evitar a obstrução por coágulos. Os cortes são fechados com pontos e realizado um curativo sobre a área operada. Usualmente retiram-se os pontos no período de 7 a 15 dias.
É usual apresentar por alguns dias inchaço e equimoses (manchas roxas) na área operada.
Cuidados com o cateter implantado
É necessária injeção de uma pequena quantidade de solução com heparina (anticoagulante) após cada aplicação de quimioterapia para evitar a obstrução do cateter por coágulos. Nos cateteres não valvulados, é imprescindível realizar essa manutenção a cada 30 a 45 dias, mesmo quando o cateter não esteja sendo utilizado para infusão de quimioterapia. Para além disso, não será necessário nenhum outro cuidado especial da sua parte.
Possíveis complicações
Infecção
Por se tratar de uma prótese implantada no corpo, é possível o desenvolvimento de infecção sob a pele onde foi implantado o reservatório ou dentro do cateter mesmo. Contacte seu médico imediatamente no caso seja detectada a presença de algum dos sinais de alerta a seguir:
• Vermelhidão, inchaço persistente ou dor intensa na área onde foi implantado o
reservatório ou o próprio cateter;
• Dor progressivamente mais intensa no local do reservatório (pior do que no dia
anterior);
• Presença de febre acima de 38ºC, prostração, calafrios, mal estar e falta de ar.
Você deverá ser tratado com antibióticos caso seja detectada infecção. O cateter deverá ser retirado caso a infecção afete a área do reservatório ou do próprio cateter. Um novo cateter poderá ser implantado após a resolução do quadro infeccioso.
Obstrução
O cateter pode ser obstruído por coágulos e o cateter fica impossibilitado para uso. Caso isso aconteça pode ser necessária a desobstrução com aplicação de medicação anticoagulante. O cateter deverá ser retirado caso este procedimento não resultar.
A obstrução pode ser evitada com a aplicação de um selo de heparina no reservatório após a utilização do mesmo ou em sessões de manutenção do cateter.
Retirada do cateter
O cateter pode ser retirado quando não for mais necessário para o tratamento. Este procedimento deve ser feito pelo cirurgião com anestesia local, num procedimento mais simples do que o implante do mesmo. A mesma incisão é utilizada para a retirada do cateter. A pele é fechada com pontos ao final do procedimento.
Outras informações
O cateter não deve interferir com sua vida normal, ele é utilizado para facilitar seu tratamento com as sessões de quimioterapia. No entanto é recomendado evitar esfoços físicos na primeira semana após seu implante. No caso de ser implantado no braço, evite levantar peso maior que 5 kg na primeira semana após a cirurgia2.
Somente agulhas do tipo “Huber” podem ser utilizadas para puncionar o reservatório, as agulhas “comuns” são do tipo cortante e podem danificar o cateter implantado.
cirurgia.med.br
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