Port Placement and Removal
What is a Port or Port-a-Catheter?
A vascular access procedure involves placing a thin hollow plastic tube, or catheter, into a vein to permit drawing blood tests, and giving medications, fluids and nutrition, or transfusions directly into the bloodstream, over a period of weeks, months or even years.
A port, or subcutaneous implantable catheter, is placed entirely under the skin. There is a small reservoir, a plastic or metal cylinder usually placed just below the collar bone, connected to a catheter that enters the jugular vein in the neck. These may stay in for months to years, or permanently. They are accessed with a needle puncture through the skin into a silicone membrane in the top of the reservoir port. The most common use of a port is to give chemotherapy medications that must be delivered into a very large, or central, vein where there is a large blood flow to dilute the medicine.
How should I prepare?
Before the procedure, you may have blood tested to determine how well your kidneys and your blood clotting are functioning. You should inform your doctor of all medications you are taking, including any herbal supplements. Inform us of any allergies, particularly to local or general anesthetic medications or to contrast materials (sometimes called X-ray dye) or to latex gloves. Always inform your doctor if you are or may be pregnant.
Eat a light meal the evening before. You will be instructed not to eat or drink after midnight before the procedure, and if you are diabetic you should receive instructions from your doctor about adjusting medications and insulin dose on the day of the procedure. You will be asked to remove clothing above the waist and put on a gown. You will need a ride home with a friend or relative.
How is the procedure performed?
Port placement will be done in a special procedure room, on a fluoroscopy table where real-time X-ray imaging can be done to make sure the catheter is correctly placed.
You will be flat on your back. The skin will be cleansed with antiseptic and draped with a sterile drape, and a local anesthetic given. The procedure is usually done under conscious sedation. Ultrasound is used to find the needle puncture site for the appropriate vein, and a wire is placed through the needle into the large central vein.
Insertion of a port catheter is a minor surgery and requires a skin incision about an inch in length. This port incision is made with local anesthetic below the clavicle. The catheter is connected to the port, placed under the skin and then into the neck vein, and the port is placed beneath the skin. The incision is closed with self-absorbing sutures that do not require removal.
Removal of a port catheter is similar, but without the need for a puncture of a vein. A similar incision will be made after antiseptic cleansing of the skin and local anesthesia. The port and the catheter are removed and the incision is closed with self-absorbing sutures. The removal of a port is quicker and usually done without the need for sedation.
What will I experience during and after the procedure and when will I get my results?
Sedation may make you feel relaxed or sleepy. Local anesthetic stings when being applied, and will eliminate pain, however, you will feel pressure. After the procedure you may have bruising, swelling and tenderness for a few days. Over-the-counter pain medications may help.
You may not shower for about one week, and then only with plastic wrap over the wound until it is healed. Do not swim or immerse the wound until it is completely healed. Do not allow anyone to access the port other than designated health care professionals, for example oncology nurses. The catheter must be flushed with a blood thinner after every use, to keep it from becoming clogged.
The interventional radiologist will determine that the position of the catheter is correct and that the catheter is functioning at the time of placement. Your health care profession will determine that the port and catheter are functioning by aspirating blood before injecting any medications.
What are the benefits and risks?
Having a port allows medications that may be toxic to small veins to be injected directly into large central veins where they will be diluted by large amount of blood flow. The port can be accessed directly without the need to search for veins. The port membrane does have a limit on the total number of punctures, and therefore a port is not suitable for daily or frequent repeated access. A port can remain in place for years, however, it must be kept flushed with blood thinner every month even when it is not being used. The decision when to remove a port is made by your oncologist.
Any procedure that involves placing a catheter within blood vessels carries certain risks, such as bleeding and bruising, damage to the blood vessel, or infection. Severe complications occur in about 1 percent of patients, as follows:
- The catheter can become infected if it is not handled properly, or if there is a bloodstream infection. This may become apparent by redness and swelling around the port, or unexplained fevers. This can sometimes be treated successfully with intravenous antibiotics, however, often an infected port must be removed, and the wound allowed to heal before a new port can be replaced.
- The catheter may become blocked by blood clot, which may be apparent when blood cannot be aspirated after the port is accessed. This can sometimes be successfully treated by injection of clot-dissolving medications, however, often a non-functioning port catheter must be removed and replaced.
Radiologyinfo.org for Patients
The radiology information resource for patients. RadiologyInfo.org tells you how various X-ray, CT, MRI, ultrasound, radiation therapy and other procedures are performed. It also addresses what you may experience and how to prepare for the exams. The website contains over 200 procedure, exam and disease descriptions covering diagnostic and interventional radiology, nuclear medicine, radiation therapy and radiation safety and is updated frequently with new information. All material on the RadiologyInfo.org website is reviewed and approved by experts in the field of radiology from the ACR and RSNA, as well as other professional radiology organizations.