A port-a-cath, also referred to as a port, is an implanted device which allows easy access to a patient’s veins. A port-a-cath is surgically inserted completely beneath the skin and consists of two parts – the portal and the catheter.

The portal is typically made from a silicone bubble and appears as a small bump under the skin. The portal, made of special self-sealing silicone, can be punctured by a needle repeatedly before the strength of the material is compromised. Its design contributes to a very low risk of infection. The slender, plastic catheter attached to the portal is threaded into a central vein (usually the jugular vein, subclavian vein, or the superior vena cava).

A port has two components:

• Septum: This soft silicone top serves as the vein access point.
• Catheter: This thin, flexible tube connects the port directly to a vein.

What is the Indication for a Port-a-Cath?

Ports are indicated for patients requiring frequent and long-term intravenous therapy, such as the oncology or autoimmune encephalitis population. Having a port allows healthcare professionals easy access to a major vein with low risk of infection.

This benefit is extremely important for the immunocompromised population of  patients. Additionally, it reduces the pain that would otherwise be experienced with countless needle pokes for IVs, since the skin over a port hub becomes thicker and desensitized.

Another consideration is that AE patients may receive chemotherapy often, which can be toxic and erosive to tissues in the body. By infusing chemotherapy through a strong vein via port, the medication has a lower chance of leaking into tissues and causing extravasation or irritation.

The implantation of a port is considered a minor procedure performed under local or general anesthesia by an interventional radiologist or surgeon. With one or two small incisions, the catheter is threaded into the vein and attached to the portal chamber. The procedure is typically completed within one hour. A simple x-ray is used for post-operative imaging to confirm appropriate placement of the port. For a few days after the procedure, the patient may experience discomfort at the insertion site, which can be managed by NSAIDs.

Once a port is cleared for use, a patient may receive intravenous therapy through it for the course of his/her treatment. An adult portal chamber can take about 2,000 punctures on average, which may last a patient several years.

Are There Different Types of Ports?

A port can be single or double lumen. Single lumen ports are most common and typically sufficient for patients requiring scheduled intravenous therapy.

However, having a double lumen port is advantageous for patients who often receive multiple intravenous therapies at once. If two intravenous agents aren’t compatible in the same line, you can infuse both simultaneously in different port lumens without complication. The double lumen port also allows concurrent infusion of medication, chemotherapy, blood products, or parenteral nutrition. It is also beneficial for drawing labs without interruption of an infusion.

What Are Some Important Things to Know About Caring for Ports?

A port provides direct access to a major vein, so if the line becomes infected, it could be detrimental to a patient’s wellbeing. In order to avoid line infections potentially leading to sepsis, healthcare professionals need to take great care when handling ports. Ports should be accessed using sterile procedure. When being handled for treatment, the end of the line outside of the body needs to be cleaned according to hospital policy with each use. Additionally, always wash hands before touching the catheter tip.

Some signs of port-related infection may include,

• Local swelling
• Warmth
• Redness
• Pus formation
• Tenderness

Systemic symptoms may include fever or chills with or without hypotension. If infection is suspected, contact the MD immediately. Blood cultures will likely be drawn BEFORE administering antibiotics, and if the infection cannot be treated with medication, the line may be pulled completely.

If your patient is receiving intravenous therapy through a port, especially chemotherapy, check the site every hour for signs of infiltration or phlebitis. Assessing the port is especially important for patients receiving chemotherapy agents that are vesicants. For these particular chemotherapies, you will often check for blood return every couple of hours during infusion to confirm appropriate placement.

Port catheters do have the potential to crack or rupture with excessive injection pressure. It is important to pay attention to syringe size to avoid creating too much intraluminal pressure. The smaller the syringe, the greater the force on injection. For this reason, many hospital policies do not allow you to use smaller than 10cc syringes to inject and aspirate from the port line.

The catheter tip in the vein may “swim” or float to another area in the body. The tip may also be pushing against the wall of the vein. If you are unable to flush or get return, DO NOT use force to flush the tubing. Have the patient try to change position, lift his/her arms above the head, or breathe deeply and cough.

If the port still does not function appropriately, the patient may need to get an x-ray to confirm placement of the catheter. If a thrombosis is suspected, gently pulse a flush of normal saline to dislodge the clot. If the clot does not flush, the MD may order tPA (tissue plasminogen activator) to help break up the clot. To prevent clotting, a port must be flushed with normal saline daily and locked with heparin when not in use.

What Are the Overall Benefits for a Patient With a Port?

• Easy and quick access with less pain than typical needle sticks
• Longevity of device use
• Reduction of infection risk
• Low maintenance care at home
• Body image (not noticeable under the skin)
• Able to give multiple treatments at the same time (i.e. blood and antibiotics)
• The convenience of medication and chemotherapy administration

What Are Some Cons to Having a Port?

• Risk of infection
• Damage to the port
• Dislodgement of the port
• Irritation with certain clothes
• Occlusion or blockage
• Hematoma formation

FAQs:

• What is port-a-cath used for?

  • A port-a-cath is used to draw blood products, administer medications, intravenous (IV) fluids, and chemotherapy as well as draw blood. 

• Is a port-a-cath the same as a PICC?

  • No, they are not the same thing. Ports are surgically implanted devices that are used for long-term use. Generally, they are kept in place for several months for medication, chemotherapy, and IV fluid use. PICC lines are used for short-term use (usually several weeks). 

• Is a port-a-cath considered a central line?

  • Yes, a port-a-cath is considered a central line. It is surgically implanted. 

• What is a port-a-cath removal?

  • A surgeon will inject numbing medication (typically lidocaine) around the port site. A small incision is made over the port, exposing the tissue, and the entire port is removed. The exposure site is then closed with either sutures or surgical glue. 

• How long does it take to take a port out?

  • The procedure itself does not take long; however, typically the numbing medication will need to sit for 5-10 minutes to take full effect. Then the removal and closure process takes about 15-30 minutes. 

Reference: Nurse.org