A Portacath (Port) is an implanted device giving access to veins for patients who need regular long-term administration of antibiotics or chemotherapy drugs.
Chemotherapy drugs can be toxic and often need to be delivered into a large central vein where the drugs are instantly diluted into the bloodstream and distributed efficiently to the entire body.
For patients with difficult veins, ports can also be used for withdrawing blood for blood tests.
How is a Portacath inserted?
The Interventional Radiologist will be assisted by nurses and other highly trained staff.
- The patient will be given sedation to make him feel relaxed and sleepy, but he will still be aware during the procedure. The procedure is done using local anesthesia at the insertion site.
- The skin over the front of the chest and the side of the neck are cleaned well with disinfectant swabs.
- Local anesthesia is administered to the skin over the chest site.
- Ports are usually placed on the chest wall. An incision of approximately 3cm is made in the skin on the front of the chest and a “pocket” is created under the skin for the port.
- Local anesthesia is administered to the side of the neck and using ultrasound guidance, access is gained to the vein in the neck, via a small (5mm) incision.
- The tube (catheter) is then fed through the vein until the tip of the catheter is placed in one of the large veins in your chest.
- A small tunnel is made in the skin for the tube to pass through and the other end is connected to the port.
- Correct positioning of the catheter is confirmed by fluoroscopy (using x-ray).
- The incisions under the collarbone and the side of the neck closed with dissolvable sutures (stitches) and a small sterile dressing is put in place.
What will the patient experience during Insertion of Portacath?
- An intravenous catheter (IV line) for the administration of fluids and medication will be inserted into a vein on the back of the patient’s hand or in his arm.
- The patient will feel a slight pin prick when the needle is inserted into his vein for the intravenous line (IV) and when the local anesthesia is administered to the chest wall and neck.
- Devices to monitor the patient’s heart rate and blood pressure will be attached to the body.
- The patient will be given sedation and pain relief through his IV to make him feel relaxed.
- The patient may feel slight pressure when the device and catheter are inserted, but no significant discomfort.
- As the contrast material passes through the patient’s body, he may get a warm feeling.
While the patient is in the hospital, the pain will be well-controlled with medications infused through his IV line.
How should anyone prepare for Insertion of Portacath?
- Fasting: The patient will likely be instructed not to eat or drink anything after midnight before the procedure. The doctor will tell the patient which medications he may take in the morning.
- Allergies or previous reactions to contrast (x-ray dye): Please inform staff at the time of booking the procedure if he has any known history of allergies, particularly allergies to x-ray contrast and seafood.
- Diabetes: If the patient is diabetic he should inform his doctor at the time of booking. The patient may need to discuss the insulin dose with his Interventional Radiologist.
- Medications: Please inform the doctor about all the medication the patient is taking. The doctor may advise the patient to stop taking some medications temporarily for few days prior to the procedure e.g. blood thinners.
What happens after Insertion of Portacath?
- The area around the port may be swollen and tender following insertion. If the port is to be used the same day it is inserted, the Interventional Radiologist will leave a needle in the port.
- When the anesthesia wears off, the patient may feel some discomfort at the site of the incision and therefore he may require some simple pain relief such as paracetamol.
- The portacath system requires no daily care from the patient.
- The patient will be asked to return to the oncology department for removal or change of dressings.
- If left unused the port needs to be flushed with heparinised saline once a month to prevent it from getting blocked. The oncology nurse will organize this.
- The patient may shower 24 hours after the portacath has been inserted with the waterproof dressing in place, but if the dressing gets damp it will need to be changed for a dry one. He may have a bath after 2 weeks.
- Once the wound is healed no dressing will be required.
- It is recommended that the patient does not perform any strenuous exercises or do any heavy lifting for 10 -14 days following the procedure.
Once the port is no longer required, it will be removed by the doctors. The removal process will be similar to insertion, performed under local anesthesia and sedation.
What are the risks associated with Insertion of Portacath?
- Given the use of modern guidance technology (x-ray and ultrasound), the risks are minimal.
- There is a slight risk of wound infection and / or vessel injury
- There is also the remote chance of allergy to medications used during the procedure.
The patient should contact his doctor or oncology nurse immediately if he has any of the following: