[Experience with the Groshong port in a home TPN patient--a case report]

We experienced a home TPN patient using Groshong port. A 45-year-old woman, recurrent pancreatic head cancer, was treated with home TPN. The Groshong port was inserted via external jugular vein and stayed at home for 8 months with home TPN. Lipid emulsion was administered twice a week. After administration of lipid emulsion, 20 ml of saline was injected and catheter lock was performed with only saline. Heparin was not used for catheter lock. After 8 months' home TPN, patient died. We could not find any precipitate in the catheter and reservoir. A unique feature of Groshong port is a pressure-sensitive two-way valve at the intravascular end. The valve of this port opens outward during fluid infusion or bolus injection. During blood withdrawal, the valve opens inward and then closed after the procedure. Because the valve is designed to remain closed between -7 and 80 mmHg, it will not open spontaneously under normal central venous pressure conditions. This valve eliminates the need for heparin flusing. Catheter obstruction during prolonged TPN is a serious complication. Compound of heparin, lipid emulsion and electrolytes, especially calcium is now becoming one of the most important causes of catheter obstruction and catheter removal. We used the Groshong port to prevent catheter obstruction. After 8 months' use of this port, no precipitate was found in this port. We conclude that the Groshong port is useful for home TPN catheter because it can prevent catheter obstruction due to heparin-lipid-electrolytes compound.