Indications
A port is a device that is placed completely under the skin and provides access into a vein so that medications can be administered for treatment. The device itself consists of a quarter-sized reservoir that is attached to catheter tubing that runs under the skin from the reservoir into a large vein. The reservoir can be felt as a small bump under the skin. The port is accessed by passing a needle through the skin, through the septum, and into the reservoir. Once that needle is in place, blood can be withdrawn and medication can be administered. The septum of a port is self-sealing and can remain in place for years.
Angiodynamics Smart Port CT Low-Profile Power-Injectable Port
Ports are often used for patients who will be requiring venous access for a long period of time. The ports that we use are usually CT compatible, which means that the contrast dye used during a CT scan can be injected into the port. This is important because patients receiving ports often require frequent CT scans and the ability to inject dye through the port means that separate needle sticks into different veins are not needed at the time of the CT scan. It is important for patients to hold onto the documentation for the port so that they can demonstrate that they have a CT compatible port.
Procedural Details
The port placement procedure is done under sedation and with local anesthesia to ensure that the patients are comfortable throughout the procedure. The procedure begins with gaining access into a suitable vein in the body. The vein that is used is typically a larger vein either in the neck (internal jugular vein) or the chest (subclavian vein). At times, we may use a vein in the arm or the leg based on a patient's individual circumstances. Once a small needle is placed into that vein, we can begin of placing the catheter tubing for the port into the vein. At that point, our attention is directed towards preparing the site, usually on the upper chest, for the reservoir or port body. A small incision is made and a space (or pocket) is created under the skin that will be large enough to accommodate the port. The catheter tubing is then advanced from pocket to the vein access site. The tubing is then advanced into the vein and positioned right near the heart. We determine the exact position of the catheter tubing using x-rays. Once the tubing is in place, we connect it to the port body within the pocket. The port is then flushed and is ready for immediate use. We then close the pocket with stitches that are usually absorbable and do not require a separate visit for removal. Following the procedure, you will spend 1-2 hours in recovery and then you will be able to go home.
Ports are very effective devices and enable patients with many different conditions to receive their care. As with every procedure, there are risks to port placement. We are always concerned with the possibility of infection, especially because many of the patients receiving ports are immunocompromised or at risk for infection. A port infection can potentially require removal of the device and require treatment with antibiotics. Another potential risk is the formation if a blood clot near the tip of the catheter tubing inside the vein. If that occurs, the device will not work because the clot will block the flow of medication from the port into the vein. In order to prevent this from occurring, we usually recommend that ports be flushed on a regular basis by a health care professional (usually every time they are accessed and monthly). If it does occur, we will likely administer a clot-dissolving medication known as tissue plasminogen activator (tPA). Rarer risks are related to the procedure itself and include injury to an artery next to the vein or to the adjacent lung (pneumothorax); both of these risks are greatly minimized by using ultrasound during the procedure to access the vein.
A port can be used immediately after it is placed. Once the port is in place, the nurses delivering your care will be able to use the port to administer medications and draw blood. In addition, nutrition and blood transfusions can be given to patients through ports. Nurses are able to access a port by feeling the port body, cleaning the skin over the port, and inserting a needle into the reservoir.
Post-Procedure Care
Following the procedure, the area around the port may be tender. When the local anesthesia wears off, you may need some oral pain medication, which will prescribe for you.
It is important to take care of a port after it is placed so that it can continue to work for a long period of time. Following the procedure, the dressing should be left in place for 24 hours. Patients can shower after 48 hours. However, an attempt should be made to the keep the incision area as dry as possible. This can be done by taping plastic wrap over the site. We usually recommend that patients do not completely immerse themselves in water (e.g., taking a bath or going swimming) until the site is completely healed. In addition, we recommend that patients do not perform any strenuous exercises or do any heavy lifting for 2 weeks after the procedure. Once the incision has healed, no additional dressing will be required.
As mentioned above, it is important to flush the port on a regular basis so that clot does not form within the tubing. This will prevent the port from working normally. The port will be flushed each time it is used by the physician practice you are working with. However, if the port is not being used, it should be flushed every 4 weeks by a health care professional. Patients can do this themselves after being educated.
Once the port is no longer required, it will be removed by a member of our team. The removal process is similar to the insertion process in that we work at the site where the port was inserted. Under local anesthesia with sedation as needed, a small incision is made over the port pocket. Once the port is visualized, the reservoir is removed from the pocket and the catheter tubing, which remains attached to the reservoir, is easily removed as well. The incision is then closed with stitches that do not need to be removed.