For patients who consistently require chemotherapy treatments, the portacath is a device that simplifies part of the process. A portacath is a small device placed under the skin that allows for easy, recurring access to blood vessels. At Premier Vein and Vascular Center, this procedure is performed by highly experienced doctors who have performed thousands of such procedures.
The device consists of four major components: the septum, portal, catheter connector, and catheter.
- Septum – the tight silicone mesh separating the skin from the portal
- Portal – allows for anything to be injected (medications) or collected (blood samples) via a needle, which can slip through the septum
- Catheter connector – links the portal to the catheter
- Catheter – runs into a central vein
Portacaths allow doctors to insert needles repeatedly into a single opening on the skin to efficiently administer chemotherapy medications and collect blood samples. This eliminates a need for searching for a blood vessel (vein) any time an injection or sample is needed. Some of the medications used for chemotherapy are highly toxic and can damage smaller blood vessels, possibly causing them to leak and damage surrounding tissue. By sending these medicines into the port and then directly to a larger central vein, the likelihood of this occurring is reduced, as they are diluted more rapidly by the flow of blood.
Portacaths can be placed in one of two locations: in the chest or the arm. Chest placement is the most common, and the catheter links to a vein just above the heart. With an arm placement, the catheter also links to a vessel just above the heart, but depending on where the port is placed, it may require a longer catheter. The procedure to implant a portacath takes about half an hour and is performed by an interventional radiologist.
Before the Procedure
In preparation for the procedure, the patient will be asked not to eat or drink anything after midnight on the start of the procedure day. Water and medications are allowed until the procedure is to take place, but it is best to consult with your doctor beforehand to avoid any mishaps. If the patient takes aspirin, plavix, or warfarin, the doctor must be notified so he or she can tell the patient when to cease taking the medication prior to the procedure. The day after the procedure is done, the patient can resume taking these medicines as directed.
During the Procedure
The procedure site is numbed with a local anesthetic and the patient is also given an IV for sedation. The doctor will make a three (3) cm incision in the chest or arm to place the port and a five (5) mm incision in the neck to enter the vein. The portal itself is placed completely under the skin (subdermal) and the catheter is connected to the portal at one end and inserted into the vein at the other end, near the 5 mm incision. Once inserted properly, the procedure is complete.
After the Procedure
After the portacath placement, there may be some redness and tenderness around the procedure site. This should clear up within two days, but if it persists beyond two to three days, especially if it is continually draining, your doctor’s office should be notified immediately. Strenuous exercise involving the chest and arms should be avoided for at least 10 days after the procedure, as well as physical activity that involves repetitive motion of the chest and arms, including swimming, golfing, and weight lifting; this can cause damage to the catheter. If the port isn’t used within one week of placement, a doctor should be consulted for a wound care checkup and a change of dressing. If the portacath is not being used at all, the doctor will need to flush the port with saline water and heparin every few weeks to prevent clotting.
It is important that the port site be kept clean. When no needle is attached to the port, a person can carry on as usual, making sure the port site is kept clean. They can also shower or bathe as normal. When a needle is attached, it will be covered with a dressing to keep the needle in place and keep the site clean. Infection risks are low, but cancer patients may have catheter related bloodstream infections if the port is not kept clean. If an infection does occur, the port will be removed and the patient will be treated with antibiotics. Blood clots can form in the catheter, but this is usually prevented by flushing the port regularly after drawing blood. During chemotherapy treatments, irritation can occur in the skin around the port.
Portacaths can stay in for as long as a doctor deems necessary, but if it is not in use, it must be flushed every 4-6 weeks. MRIs can be conducted with the port, but the MRI technician should be notified that there is a portacath. Portacaths will not set off most security detectors, but a Port ID card should still be carried in case one does detect it. If you notice any skin changes at the port site, or if fluids are not flowing freely through the port, contact your doctor and do not inject anything into the port without instruction to do so from a doctor or nurse.